healthcosts.net
Kit ipg optimizer smart at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$74,319.00
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.
$123,865.00
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.
$14,773.92 with Highmark Wholecare (prev Gateway) vs $125,578.32 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $14,773.92 | ↓ -80% |
| Aetna | CHIP/Medicaid | $22,160.88 | ↓ -70% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $23,392.04 | ↓ -69% |
| Aetna | Medicare | $30,779.00 | ↓ -59% |
| Geisinger | Medicaid/CHIP | $40,628.28 | ↓ -45% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $41,650.14 | ↓ -44% |
| UPMC Health Plan | Commercial | $57,729.09 | ↓ -22% |
| Aetna | First Health | $61,558.00 | ↓ -17% |
| Highmark BCBS of PA | Medicare Advantage | $61,558.00 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $61,558.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care | $62,789.16 | ↓ -16% |
| Highmark BCBS of PA | Managed Care - Social Mission | $62,789.16 | ↓ -16% |
| Highmark BCBS of PA | Commercial - Indemnity | $65,251.48 | ↓ -12% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $65,251.48 | ↓ -12% |
| Preferred Healthcare System | PPO | $80,025.40 | ↑ +8% |
| Coventry/First Health | Commercial | $86,181.20 | ↑ +16% |
| Fidelis | Medicare | $92,337.00 | ↑ +24% |
| InterGroup | InterGroup Services Corporation | $92,337.00 | ↑ +24% |
| Health Coalition Partners | Intergroup | $98,492.80 | ↑ +33% |
| Multiplan | PPO | $98,492.80 | ↑ +33% |
| Private Health Care Systems | PPO | $98,492.80 | ↑ +33% |
| SelectCare | Commercial | $98,492.80 | ↑ +33% |
| Health Payors Organization | Commercial | $104,648.60 | ↑ +41% |
| Humana | Commercial | $104,648.60 | ↑ +41% |
| InterGroup | Approved National Affiliated PPO Business | $104,648.60 | ↑ +41% |
| Highmark BCBS of PA | UPMC Emergent | $125,578.32 | ↑ +69% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Multiplan | Worker's Compensation | not published by hospital | — |
Visitor-reported prices
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Kit ipg optimizer smart at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $55,402.80 | $20,314.36 – $78,487.30 |