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Avul nail plate addl at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$456.60
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.
$761.00
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.
$28.32 with UPMC Health Plan vs $646.85 with InterGroup — 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 | $28.32 | ↓ -94% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $30.90 | ↓ -93% |
| Aetna | CHIP/Medicaid | $33.48 | ↓ -93% |
| Highmark Wholecare (prev Gateway) | Medicaid | $38.19 | ↓ -92% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $38.83 | ↓ -91% |
| Geisinger | Medicaid/CHIP | $40.09 | ↓ -91% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $40.75 | ↓ -91% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $43.88 | ↓ -90% |
| UPMC Work Partners | Workers Comp | $62.48 | ↓ -86% |
| Multiplan | Worker's Compensation | $72.65 | ↓ -84% |
| Highmark BCBS of PA | Medicare Advantage | $93.83 | ↓ -79% |
| UPMC Health Plan | Commercial | $107.70 | ↓ -76% |
| Aetna | Medicare | $190.25 | ↓ -58% |
| Highmark BCBS of PA | Managed Care - Social Mission | $232.58 | ↓ -49% |
| Highmark BCBS of PA | Managed Care | $311.45 | ↓ -32% |
| Highmark Wholecare (prev Gateway) | Medicare | $380.50 | ↓ -17% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $477.66 | ↑ +5% |
| Preferred Healthcare System | PPO | $494.65 | ↑ +8% |
| Coventry/First Health | Commercial | $532.70 | ↑ +17% |
| Fidelis | Medicare | $570.75 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $570.75 | ↑ +25% |
| Health Coalition Partners | Intergroup | $608.80 | ↑ +33% |
| Multiplan | PPO | $608.80 | ↑ +33% |
| Private Health Care Systems | PPO | $608.80 | ↑ +33% |
| SelectCare | Commercial | $608.80 | ↑ +33% |
| Highmark BCBS of PA | UPMC Emergent | $622.91 | ↑ +36% |
| Highmark BCBS of PA | Commercial - Indemnity | $639.69 | ↑ +40% |
| Health Payors Organization | Commercial | $646.85 | ↑ +42% |
| Humana | Commercial | $646.85 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $646.85 | ↑ +42% |
Visitor-reported prices
Comments
Avul nail plate addl at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $357.00 | $28.32 – $505.75 |
| UPMC Mercy | Pittsburgh | $388.20 | $28.32 – $582.30 |
| UPMC Muncy | Muncy | $114.00 | $28.32 – $152.00 |
| UPMC Northwest | Seneca | $571.80 | $28.32 – $810.05 |
| UPMC Somerset | Somerset | $370.80 | $28.32 – $463.50 |
| UPMC Wellsboro | Wellsboro | $31.20 | $5.04 – $58.03 |
| UPMC Williamsport | Williamsport | $114.00 | $28.32 – $152.00 |