CMS Price Transparency Data

Culture, blood

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 87040 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 87040
Insurance Median: $122
Cash Discount Price: $155
vs. Medicare Baseline: 11.82x Medicare

The contracted insurance negotiated median rate for a Culture, blood at UPMC Children's Hospital of Pittsburgh is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $10.32, this hospital’s rate is 11.82x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$10.32

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $10.32 (100%)

Cash / Self-Pay: $155 (1502%)

Insurance Median: $122 (1182%)

Cash: $155 (1502% of Medicare)

Ins. Median: $122 (1182% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $10.32 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 1182% of the Medicare baseline (a markup of 1082%). 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	$9 - $142	87%
Health Plan Of Upper Ohio Valley	$10 - $168	97%
Amerihealth Caritas	$11 - $52	107%
Blue Cross Blue Shield	$11 - $85	107%
Cigna	$11 - $142	107%
Upmc Health Plan	$32 - $80	310%
Health Partners Plans (Jefferson Health Plan)	$54	523%
Highmark Wholecare (Prev Gateway)	$56	543%
UnitedHealthcare	$56 - $122	543%
Pa Health & Wellness	$57	552%
Geisinger	$58 - $116	562%
Intergroup	$168 - $220	1628%
Coventry/First Health	$207	2006%
Saudi Armed Forces	$207	2006%
Health Payors Organization	$220	2132%
Multiplan	$220	2132%
National Provider Network	$233	2258%
Private Health Care Systems	$233	2258%

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 $155.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 87040.

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 87040.
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.