healthcosts.net
Factor viii recomb obizur at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$16.20
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.
?
What you pay up front if you don't use insurance.
$27.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$2.04 with UPMC Health Plan vs $31.64 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $2.04 | ↓ -87% |
| Geisinger | Medicaid/CHIP | $3.23 | ↓ -80% |
| Highmark Wholecare (prev Gateway) | Medicaid | $3.23 | ↓ -80% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $3.23 | ↓ -80% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $3.23 | ↓ -80% |
| Aetna | CHIP/Medicaid | $3.42 | ↓ -79% |
| AmeriHealth Caritas | Medicare | $3.49 | ↓ -78% |
| United Healthcare | Medicare | $3.49 | ↓ -78% |
| Cigna Lifesource | Medicare Transplant | $3.49 | ↓ -78% |
| Highmark Wholecare (prev Gateway) | Medicare | $3.49 | ↓ -78% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3.49 | ↓ -78% |
| Aetna | Medicare | $3.55 | ↓ -78% |
| Aetna of PA | Medicare | $3.55 | ↓ -78% |
| Highmark BCBS of PA | Medicare Advantage | $3.77 | ↓ -77% |
| UPMC Health Plan | Commercial | $3.97 | ↓ -75% |
| UPMC Work Partners | Workers Comp | $8.82 | ↓ -46% |
| Multiplan | Worker's Compensation | $10.26 | ↓ -37% |
| Highmark BCBS of PA | Managed Care - Social Mission | $11.81 | ↓ -27% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $12.15 | ↓ -25% |
| Highmark BCBS of PA | Managed Care | $15.82 | ↓ -2% |
| Highmark BCBS of PA | Commercial - Indemnity | $16.27 | ↑ +0% |
| Preferred Healthcare System | PPO | $17.55 | ↑ +8% |
| Coventry/First Health | Commercial | $18.90 | ↑ +17% |
| Fidelis | Medicare | $20.25 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $20.25 | ↑ +25% |
| Health Coalition Partners | Intergroup | $21.60 | ↑ +33% |
| Private Health Care Systems | PPO | $21.60 | ↑ +33% |
| SelectCare | Commercial | $21.60 | ↑ +33% |
| Multiplan | PPO | $21.60 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $22.95 | ↑ +42% |
| Health Payors Organization | Commercial | $22.95 | ↑ +42% |
| Humana | Commercial | $22.95 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $31.64 | ↑ +95% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |