CMS Price Transparency Data

Culture, bacterial

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 87070 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87070
Insurance Median: $103
Cash Discount Price: $131
vs. Medicare Baseline: 11.95x Medicare

The contracted insurance negotiated median rate for a Culture, bacterial at UPMC Children's Hospital of Pittsburgh is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $131. Compared to the federal Medicare reimbursement reference rate of $8.62, this hospital’s rate is 11.95x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$131

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$8.62

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $8.62 (100%)

Cash / Self-Pay: $131 (1520%)

Insurance Median: $103 (1195%)

Cash: $131 (1520% of Medicare)

Ins. Median: $103 (1195% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $8.62 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1195% of the Medicare baseline (a markup of 1095%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$8 - $120	93%
Amerihealth Caritas	$9 - $26	104%
Blue Cross Blue Shield	$9 - $71	104%
Cigna	$9 - $120	104%
Health Plan Of Upper Ohio Valley	$9 - $142	104%
Upmc Health Plan	$16 - $49	186%
Health Partners Plans (Jefferson Health Plan)	$27	313%
UnitedHealthcare	$27 - $103	313%
Geisinger	$28 - $98	325%
Highmark Wholecare (Prev Gateway)	$28	325%
Pa Health & Wellness	$28	325%
Intergroup	$142 - $186	1647%
Coventry/First Health	$175	2030%
Saudi Armed Forces	$175	2030%
Health Payors Organization	$186	2158%
Multiplan	$186	2158%
National Provider Network	$197	2285%
Private Health Care Systems	$197	2285%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $131.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87070.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Children's Hospital of Pittsburgh is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 87070.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.