healthcosts.net
Athrectomy fem/pop/unilateral 37225 at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$35,674.80
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.
$59,458.00
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.
$571.49 with UPMC Health Plan vs $132,221.75 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $571.49 | ↓ -98% |
| Aetna | CHIP/Medicaid | $675.40 | ↓ -98% |
| Highmark Wholecare (prev Gateway) | Medicaid | $770.48 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $783.47 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $808.77 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $822.12 | ↓ -98% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $885.40 | ↓ -98% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $931.20 | ↓ -97% |
| UPMC Health Plan | Commercial | $11,591.61 | ↓ -68% |
| Aetna | Medicare | $14,864.50 | ↓ -58% |
| UPMC Work Partners | Workers Comp | $17,820.77 | ↓ -50% |
| Highmark BCBS of PA | Medicare Advantage | $19,393.31 | ↓ -46% |
| Multiplan | Worker's Compensation | $20,721.83 | ↓ -42% |
| Highmark Wholecare (prev Gateway) | Medicare | $29,729.00 | ↓ -17% |
| Preferred Healthcare System | PPO | $38,647.70 | ↑ +8% |
| Coventry/First Health | Commercial | $41,620.60 | ↑ +17% |
| Fidelis | Medicare | $44,593.50 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $44,593.50 | ↑ +25% |
| Health Coalition Partners | Intergroup | $47,566.40 | ↑ +33% |
| Multiplan | PPO | $47,566.40 | ↑ +33% |
| Private Health Care Systems | PPO | $47,566.40 | ↑ +33% |
| SelectCare | Commercial | $47,566.40 | ↑ +33% |
| Highmark BCBS of PA | Managed Care - Social Mission | $48,073.50 | ↑ +35% |
| Health Payors Organization | Commercial | $50,539.30 | ↑ +42% |
| Humana | Commercial | $50,539.30 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $50,539.30 | ↑ +42% |
| Highmark BCBS of PA | Managed Care | $64,376.69 | ↑ +80% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $98,730.70 | ↑ +177% |
| Highmark BCBS of PA | UPMC Emergent | $128,753.38 | ↑ +261% |
| Highmark BCBS of PA | Commercial - Indemnity | $132,221.75 | ↑ +271% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Athrectomy fem/pop/unilateral 37225 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $34,695.00 | $11,399.11 – $49,151.25 |
| UPMC Mercy | Pittsburgh | $34,849.20 | $571.49 – $52,273.80 |
| UPMC St. Margaret | Pittsburgh | $35,730.60 | $11,817.71 – $50,618.35 |
| UPMC Northwest | Seneca | $120,934.20 | $14,741.00 – $171,323.45 |
| UPMC Somerset | Somerset | $17,281.80 | $892.40 – $21,602.25 |
| UPMC Williamsport | Williamsport | $11,535.60 | $993.28 – $18,487.43 |