healthcosts.net
Sirolimus, oral at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$1,122.00
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.
$1,870.00
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.
$0.55 with UPMC Health Plan vs $102.47 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $0.55 | ↓ -100% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $0.87 | ↓ -100% |
| Geisinger | Medicaid/CHIP | $0.87 | ↓ -100% |
| Highmark Wholecare (prev Gateway) | Medicaid | $0.87 | ↓ -100% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $0.87 | ↓ -100% |
| UPMC Health Plan | Commercial | $1.07 | ↓ -100% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $1.43 | ↓ -100% |
| Highmark BCBS of PA | Medicare Advantage | $12.22 | ↓ -99% |
| Aetna | CHIP/Medicaid | $15.30 | ↓ -99% |
| Aetna | Medicare | $21.25 | ↓ -98% |
| UPMC Work Partners | Workers Comp | $27.78 | ↓ -98% |
| Multiplan | Worker's Compensation | $32.30 | ↓ -97% |
| Highmark BCBS of PA | Managed Care - Social Mission | $38.26 | ↓ -97% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $39.34 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicare | $42.50 | ↓ -96% |
| Highmark BCBS of PA | Managed Care | $51.24 | ↓ -95% |
| Highmark BCBS of PA | Commercial - Indemnity | $52.69 | ↓ -95% |
| Preferred Healthcare System | PPO | $55.25 | ↓ -95% |
| Coventry/First Health | Commercial | $59.50 | ↓ -95% |
| Fidelis | Medicare | $63.75 | ↓ -94% |
| InterGroup | InterGroup Services Corporation | $63.75 | ↓ -94% |
| Health Coalition Partners | Intergroup | $68.00 | ↓ -94% |
| Multiplan | PPO | $68.00 | ↓ -94% |
| Private Health Care Systems | PPO | $68.00 | ↓ -94% |
| SelectCare | Commercial | $68.00 | ↓ -94% |
| Health Payors Organization | Commercial | $72.25 | ↓ -94% |
| Humana | Commercial | $72.25 | ↓ -94% |
| InterGroup | Approved National Affiliated PPO Business | $72.25 | ↓ -94% |
| Highmark BCBS of PA | UPMC Emergent | $102.47 | ↓ -91% |
Visitor-reported prices
Comments
Sirolimus, oral at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $63.00 | $0.55 – $20.70 |
| UPMC Passavant-McCandless | Pittsburgh | $300.00 | $0.55 – $24.65 |
| UPMC St. Margaret | Pittsburgh | $100.00 | $0.55 – $106.25 |
| UPMC Western Psychiatric | Pittsburgh | $300.00 | $0.87 – $425.00 |
| UPMC Muncy | Muncy | $180.00 | $0.87 – $202.50 |
| UPMC Somerset | Somerset | $20.40 | $0.87 – $11.98 |
| UPMC Wellsboro | Wellsboro | $180.00 | $0.87 – $202.50 |
| UPMC Williamsport | Williamsport | $180.00 | $0.87 – $202.50 |