healthcosts.net
Surgical pathology level 5 gross & microscopic examination at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$1,323.60
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.
$2,206.00
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.
$13.80 with United Healthcare Community Plan for Families vs $1,875.10 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $13.80 | ↓ -99% |
| UPMC Health Plan | Commercial | $38.24 | ↓ -97% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $45.50 | ↓ -97% |
| Highmark BCBS of PA | Medicare Advantage | $49.52 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $50.05 | ↓ -96% |
| Aetna | CHIP/Medicaid | $59.15 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $67.48 | ↓ -95% |
| Geisinger | Medicaid/CHIP | $70.83 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $72.00 | ↓ -95% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $77.54 | ↓ -94% |
| Highmark BCBS of PA | Managed Care - Social Mission | $82.31 | ↓ -94% |
| Highmark BCBS of PA | Managed Care | $110.23 | ↓ -92% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $130.10 | ↓ -90% |
| Highmark BCBS of PA | Commercial - Indemnity | $174.24 | ↓ -87% |
| Highmark BCBS of PA | UPMC Emergent | $220.46 | ↓ -83% |
| UPMC Work Partners | Workers Comp | $278.36 | ↓ -79% |
| Multiplan | Worker's Compensation | $323.68 | ↓ -76% |
| AmeriHealth Caritas | Medicare | $370.39 | ↓ -72% |
| United Healthcare | Medicare | $370.39 | ↓ -72% |
| Cigna Lifesource | Medicare Transplant | $370.39 | ↓ -72% |
| Highmark Wholecare (prev Gateway) | Medicare | $370.39 | ↓ -72% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $370.39 | ↓ -72% |
| Aetna | Medicare | $377.25 | ↓ -71% |
| Aetna of PA | Medicare | $377.25 | ↓ -71% |
| Preferred Healthcare System | PPO | $1,433.90 | ↑ +8% |
| Coventry/First Health | Commercial | $1,544.20 | ↑ +17% |
| Fidelis | Medicare | $1,654.50 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $1,654.50 | ↑ +25% |
| Health Coalition Partners | Intergroup | $1,764.80 | ↑ +33% |
| Private Health Care Systems | PPO | $1,764.80 | ↑ +33% |
| SelectCare | Commercial | $1,764.80 | ↑ +33% |
| Multiplan | PPO | $1,764.80 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $1,875.10 | ↑ +42% |
| Health Payors Organization | Commercial | $1,875.10 | ↑ +42% |
| Humana | Commercial | $1,875.10 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Surgical pathology level 5 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $505.20 | $36.03 – $757.80 |
| UPMC Passavant-McCandless | Pittsburgh | $440.40 | $36.24 – $623.90 |
| UPMC St. Margaret | Pittsburgh | $888.00 | $36.33 – $1,258.00 |
| UPMC Muncy | Muncy | $408.00 | $14.72 – $544.00 |
| UPMC Northwest | Seneca | $360.60 | $36.26 – $510.85 |
| UPMC Somerset | Somerset | $664.80 | $13.22 – $251.07 |
| UPMC Wellsboro | Wellsboro | $493.60 | $14.72 – $555.30 |
| UPMC Williamsport | Williamsport | $408.00 | $14.72 – $544.00 |