healthcosts.net
Ghs simple repair 7.6 - 12.5 cm - 12004 at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$1,341.60
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.
$2,236.00
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.
$53.35 with UPMC Health Plan vs $1,900.60 with Humana — 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 | $53.35 | ↓ -96% |
| Aetna | CHIP/Medicaid | $63.05 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $71.93 | ↓ -95% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $73.14 | ↓ -95% |
| Geisinger | Medicaid/CHIP | $75.50 | ↓ -94% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $76.75 | ↓ -94% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $82.65 | ↓ -94% |
| AmeriHealth Caritas | Medicare | $204.60 | ↓ -85% |
| United Healthcare | Medicare | $204.60 | ↓ -85% |
| Cigna Lifesource | Medicare Transplant | $204.60 | ↓ -85% |
| Highmark Wholecare (prev Gateway) | Medicare | $204.60 | ↓ -85% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $204.60 | ↓ -85% |
| Highmark BCBS of PA | Medicare Advantage | $206.41 | ↓ -85% |
| Aetna | Medicare | $208.38 | ↓ -84% |
| Aetna of PA | Medicare | $208.38 | ↓ -84% |
| UPMC Health Plan | Commercial | $241.83 | ↓ -82% |
| UPMC Work Partners | Workers Comp | $268.39 | ↓ -80% |
| Multiplan | Worker's Compensation | $312.08 | ↓ -77% |
| Highmark BCBS of PA | Managed Care - Social Mission | $511.68 | ↓ -62% |
| Highmark BCBS of PA | Managed Care | $685.20 | ↓ -49% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $885.60 | ↓ -34% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,050.85 | ↓ -22% |
| Highmark BCBS of PA | UPMC Emergent | $1,370.40 | ↑ +2% |
| Highmark BCBS of PA | Commercial - Indemnity | $1,407.32 | ↑ +5% |
| Preferred Healthcare System | PPO | $1,453.40 | ↑ +8% |
| Coventry/First Health | Commercial | $1,565.20 | ↑ +17% |
| Fidelis | Medicare | $1,677.00 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $1,677.00 | ↑ +25% |
| Health Coalition Partners | Intergroup | $1,788.80 | ↑ +33% |
| Private Health Care Systems | PPO | $1,788.80 | ↑ +33% |
| SelectCare | Commercial | $1,788.80 | ↑ +33% |
| Multiplan | PPO | $1,788.80 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $1,900.60 | ↑ +42% |
| Health Payors Organization | Commercial | $1,900.60 | ↑ +42% |
| Humana | Commercial | $1,900.60 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Ghs simple repair 7.6 - 12.5 cm - 12004 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,070.40 | $53.35 – $1,516.40 |
| UPMC Mercy | Pittsburgh | $510.00 | $53.35 – $765.00 |
| UPMC St. Margaret | Pittsburgh | $753.00 | $53.35 – $1,066.75 |
| UPMC Muncy | Muncy | $589.80 | $53.35 – $944.64 |
| UPMC Northwest | Seneca | $610.80 | $53.35 – $865.30 |
| UPMC Somerset | Somerset | $808.20 | $53.35 – $1,010.25 |
| UPMC Wellsboro | Wellsboro | $712.80 | $53.35 – $944.64 |
| UPMC Williamsport | Williamsport | $589.80 | $53.35 – $944.64 |