healthcosts.net
Complx repair enel addl 5cm/< 13153 at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$2,219.40
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.
$3,699.00
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.
$142.16 with United Healthcare Community Plan for Families vs $3,144.15 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $142.16 | ↓ -94% |
| UPMC Health Plan | Commercial | $299.63 | ↓ -86% |
| Highmark BCBS of PA | Medicare Advantage | $309.30 | ↓ -86% |
| UPMC Work Partners | Workers Comp | $317.25 | ↓ -86% |
| Multiplan | Worker's Compensation | $368.90 | ↓ -83% |
| Aetna | CHIP/Medicaid | $665.82 | ↓ -70% |
| Highmark BCBS of PA | Managed Care - Social Mission | $766.72 | ↓ -65% |
| Aetna | Medicare | $924.75 | ↓ -58% |
| Highmark BCBS of PA | Managed Care | $1,026.74 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,574.65 | ↓ -29% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,849.50 | ↓ -17% |
| Geisinger | Medicaid/CHIP | $2,034.45 | ↓ -8% |
| Highmark BCBS of PA | UPMC Emergent | $2,053.49 | ↓ -7% |
| Highmark BCBS of PA | Commercial - Indemnity | $2,108.80 | ↓ -5% |
| Preferred Healthcare System | PPO | $2,404.35 | ↑ +8% |
| Coventry/First Health | Commercial | $2,589.30 | ↑ +17% |
| Fidelis | Medicare | $2,774.25 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $2,774.25 | ↑ +25% |
| Health Coalition Partners | Intergroup | $2,959.20 | ↑ +33% |
| Multiplan | PPO | $2,959.20 | ↑ +33% |
| Private Health Care Systems | PPO | $2,959.20 | ↑ +33% |
| SelectCare | Commercial | $2,959.20 | ↑ +33% |
| Health Payors Organization | Commercial | $3,144.15 | ↑ +42% |
| Humana | Commercial | $3,144.15 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $3,144.15 | ↑ +42% |
Visitor-reported prices
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Complx repair enel addl 5cm/< 13153 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,606.80 | $287.80 – $2,276.30 |
| UPMC Mercy | Pittsburgh | $1,434.60 | $306.39 – $2,151.90 |
| UPMC St. Margaret | Pittsburgh | $1,750.80 | $287.80 – $2,480.30 |
| UPMC Muncy | Muncy | $660.00 | $151.64 – $880.00 |
| UPMC Somerset | Somerset | $319.20 | $136.24 – $471.73 |
| UPMC Wellsboro | Wellsboro | $798.40 | $151.64 – $898.20 |