Foam drg >16<=48 sq in without b at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$102.00
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.
$170.00
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.
$6.84 with Aetna vs $180.18 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 | $6.84 | ↓ -93% |
| Aetna | Medicare | $9.50 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicare | $19.00 | ↓ -81% |
| Geisinger | Medicaid/CHIP | $20.90 | ↓ -80% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $21.53 | ↓ -79% |
| Preferred Healthcare System | PPO | $24.70 | ↓ -76% |
| Coventry/First Health | Commercial | $26.60 | ↓ -74% |
| Fidelis | Medicare | $28.50 | ↓ -72% |
| InterGroup | InterGroup Services Corporation | $28.50 | ↓ -72% |
| Health Coalition Partners | Intergroup | $30.40 | ↓ -70% |
| Multiplan | PPO | $30.40 | ↓ -70% |
| Private Health Care Systems | PPO | $30.40 | ↓ -70% |
| SelectCare | Commercial | $30.40 | ↓ -70% |
| InterGroup | Approved National Affiliated PPO Business | $32.30 | ↓ -68% |
| Humana | Commercial | $32.30 | ↓ -68% |
| Health Payors Organization | Commercial | $32.30 | ↓ -68% |
| Highmark BCBS of PA | Medicare Advantage | $35.65 | ↓ -65% |
| UPMC Work Partners | Workers Comp | $45.90 | ↓ -55% |
| Multiplan | Worker's Compensation | $53.37 | ↓ -48% |
| Highmark BCBS of PA | Managed Care - Social Mission | $59.26 | ↓ -42% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $60.34 | ↓ -41% |
| Highmark BCBS of PA | Managed Care | $79.36 | ↓ -22% |
| Highmark BCBS of PA | Commercial - Indemnity | $80.80 | ↓ -21% |
| Highmark BCBS of PA | UPMC Emergent | $158.72 | ↑ +56% |
| UPMC Health Plan | Commercial | $180.18 | ↑ +77% |
Visitor-reported prices
Comments
Foam drg >16<=48 sq in without b at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $171.60 | $35.32 – $88.00 |
| UPMC Passavant-McCandless | Pittsburgh | $21.60 | $35.65 – $161.71 |
| UPMC East | Monroeville | $14.40 | $6.00 – $111.44 |
| UPMC Hamot | Erie | $15.00 | $35.32 – $45.90 |
| UPMC Williamsport | Williamsport | $21.60 | $22.96 – $50.70 |