Absorpt drg <=16 sq in w/bdr at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$1.20
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.
$2.00
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.
$0.18 with Aetna vs $10.96 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 | $0.18 | ↓ -85% |
| Aetna | Medicare | $0.25 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicare | $0.50 | ↓ -58% |
| Geisinger | Medicaid/CHIP | $0.55 | ↓ -54% |
| Preferred Healthcare System | PPO | $0.65 | ↓ -46% |
| Coventry/First Health | Commercial | $0.70 | ↓ -42% |
| Fidelis | Medicare | $0.75 | ↓ -38% |
| InterGroup | InterGroup Services Corporation | $0.75 | ↓ -38% |
| Multiplan | PPO | $0.80 | ↓ -33% |
| SelectCare | Commercial | $0.80 | ↓ -33% |
| Health Coalition Partners | Intergroup | $0.80 | ↓ -33% |
| Private Health Care Systems | PPO | $0.80 | ↓ -33% |
| InterGroup | Approved National Affiliated PPO Business | $0.85 | ↓ -29% |
| Humana | Commercial | $0.85 | ↓ -29% |
| Health Payors Organization | Commercial | $0.85 | ↓ -29% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $1.28 | ↑ +7% |
| Highmark BCBS of PA | Medicare Advantage | $2.18 | ↑ +82% |
| UPMC Work Partners | Workers Comp | $2.80 | ↑ +133% |
| Multiplan | Worker's Compensation | $3.26 | ↑ +172% |
| Highmark BCBS of PA | Managed Care - Social Mission | $3.62 | ↑ +202% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3.68 | ↑ +207% |
| Highmark BCBS of PA | Managed Care | $4.85 | ↑ +304% |
| Highmark BCBS of PA | Commercial - Indemnity | $4.93 | ↑ +311% |
| Highmark BCBS of PA | UPMC Emergent | $9.69 | ↑ +708% |
| UPMC Health Plan | Commercial | $10.96 | ↑ +813% |
Visitor-reported prices
Comments
Absorpt drg <=16 sq in w/bdr at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | $0.60 | $1.12 – $6.78 |
| UPMC Mercy | Pittsburgh | $0.60 | $2.16 – $5.35 |
| UPMC Passavant-McCandless | Pittsburgh | $15.00 | $2.18 – $9.83 |
| UPMC Altoona | Altoona | $0.60 | $0.50 – $6.78 |
| UPMC Bedford | Everett | $13.80 | $2.80 – $20.70 |
| UPMC East | Monroeville | $16.80 | $0.25 – $6.78 |
| UPMC Hamot | Erie | $0.60 | $2.16 – $2.80 |
| UPMC Northwest | Seneca | $0.60 | $2.80 – $8.20 |