healthcosts.net
Stent/tib/peroneal/unilat/initial 37230 at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$40,886.40
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.
$68,144.00
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.
$644.90 with UPMC Health Plan vs $103,118.41 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 | $644.90 | ↓ -98% |
| Aetna | CHIP/Medicaid | $762.15 | ↓ -98% |
| Highmark Wholecare (prev Gateway) | Medicaid | $869.44 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $884.10 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $912.65 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $927.71 | ↓ -98% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $931.20 | ↓ -98% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $999.12 | ↓ -98% |
| UPMC Work Partners | Workers Comp | $13,883.90 | ↓ -66% |
| Highmark BCBS of PA | Medicare Advantage | $15,124.65 | ↓ -63% |
| Multiplan | Worker's Compensation | $16,144.07 | ↓ -61% |
| Aetna | Medicare | $17,036.00 | ↓ -58% |
| UPMC Health Plan | Commercial | $31,952.72 | ↓ -22% |
| Highmark Wholecare (prev Gateway) | Medicare | $34,072.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care - Social Mission | $37,492.04 | ↓ -8% |
| Preferred Healthcare System | PPO | $44,293.60 | ↑ +8% |
| Coventry/First Health | Commercial | $47,700.80 | ↑ +17% |
| Highmark BCBS of PA | Managed Care | $50,206.73 | ↑ +23% |
| Fidelis | Medicare | $51,108.00 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $51,108.00 | ↑ +25% |
| Health Coalition Partners | Intergroup | $54,515.20 | ↑ +33% |
| Multiplan | PPO | $54,515.20 | ↑ +33% |
| Private Health Care Systems | PPO | $54,515.20 | ↑ +33% |
| SelectCare | Commercial | $54,515.20 | ↑ +33% |
| Health Payors Organization | Commercial | $57,922.40 | ↑ +42% |
| Humana | Commercial | $57,922.40 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $57,922.40 | ↑ +42% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $76,999.08 | ↑ +88% |
| Highmark BCBS of PA | UPMC Emergent | $100,413.47 | ↑ +146% |
| Highmark BCBS of PA | Commercial - Indemnity | $103,118.41 | ↑ +152% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Stent/tib/peroneal/unilat/initial 37230 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $34,695.00 | $12,299.12 – $49,151.25 |
| UPMC Somerset | Somerset | $24,161.40 | $892.40 – $30,201.75 |