Absorpt drg >16<=48 in w/bdr at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$2.40
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$4.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$0.36 with Aetna vs $27.43 with UPMC Health Plan — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Aetna | CHIP/Medicaid | $0.36 | ↓ -85% |
| Aetna | Medicare | $0.50 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicare | $1.00 | ↓ -58% |
| Geisinger | Medicaid/CHIP | $1.10 | ↓ -54% |
| Preferred Healthcare System | PPO | $1.30 | ↓ -46% |
| Coventry/First Health | Commercial | $1.40 | ↓ -42% |
| Fidelis | Medicare | $1.50 | ↓ -38% |
| InterGroup | InterGroup Services Corporation | $1.50 | ↓ -38% |
| Multiplan | PPO | $1.60 | ↓ -33% |
| SelectCare | Commercial | $1.60 | ↓ -33% |
| Health Coalition Partners | Intergroup | $1.60 | ↓ -33% |
| Private Health Care Systems | PPO | $1.60 | ↓ -33% |
| InterGroup | Approved National Affiliated PPO Business | $1.70 | ↓ -29% |
| Humana | Commercial | $1.70 | ↓ -29% |
| Health Payors Organization | Commercial | $1.70 | ↓ -29% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $3.28 | ↑ +37% |
| Highmark BCBS of PA | Medicare Advantage | $5.42 | ↑ +126% |
| UPMC Work Partners | Workers Comp | $7.02 | ↑ +193% |
| Multiplan | Worker's Compensation | $8.16 | ↑ +240% |
| Highmark BCBS of PA | Managed Care - Social Mission | $9.01 | ↑ +275% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $9.18 | ↑ +283% |
| Highmark BCBS of PA | Managed Care | $12.07 | ↑ +403% |
| Highmark BCBS of PA | Commercial - Indemnity | $12.29 | ↑ +412% |
| Highmark BCBS of PA | UPMC Emergent | $24.14 | ↑ +906% |
| UPMC Health Plan | Commercial | $27.43 | ↑ +1043% |
Visitor-reported prices
Comments
Absorpt drg >16<=48 in w/bdr at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | $1.80 | $2.86 – $16.97 |
| UPMC Passavant-McCandless | Pittsburgh | $1.80 | $5.42 – $24.62 |
| UPMC Altoona | Altoona | $1.80 | $0.50 – $16.97 |
| UPMC Bedford | Everett | $0.60 | $0.25 – $16.97 |
| UPMC East | Monroeville | $1.80 | $0.25 – $16.97 |
| UPMC Hamot | Erie | $1.80 | $5.37 – $7.02 |
| UPMC Northwest | Seneca | $0.60 | $7.02 – $20.53 |
| UPMC McKeesport | Mckeesport | $1.80 | $2.86 – $16.97 |