healthcosts.net
Surgical pathology level 6 gross & microscopic examination at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$1,452.60
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.
?
What you pay up front if you don't use insurance.
$2,421.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$21.00 with United Healthcare Community Plan for Families vs $2,057.85 with Humana — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $21.00 | ↓ -99% |
| UPMC Health Plan | Commercial | $57.69 | ↓ -96% |
| Highmark BCBS of PA | Medicare Advantage | $67.42 | ↓ -95% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $67.60 | ↓ -95% |
| UPMC Health Plan | Managed Medicaid | $74.36 | ↓ -95% |
| Aetna | CHIP/Medicaid | $87.88 | ↓ -94% |
| Highmark Wholecare (prev Gateway) | Medicaid | $100.25 | ↓ -93% |
| Geisinger | Medicaid/CHIP | $105.23 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $106.97 | ↓ -93% |
| Highmark BCBS of PA | Managed Care - Social Mission | $112.07 | ↓ -92% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $115.20 | ↓ -92% |
| Highmark BCBS of PA | Managed Care | $150.08 | ↓ -90% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $177.13 | ↓ -88% |
| Highmark BCBS of PA | Commercial - Indemnity | $237.22 | ↓ -84% |
| Highmark BCBS of PA | UPMC Emergent | $300.15 | ↓ -79% |
| UPMC Work Partners | Workers Comp | $393.96 | ↓ -73% |
| Multiplan | Worker's Compensation | $458.09 | ↓ -68% |
| AmeriHealth Caritas | Medicare | $841.13 | ↓ -42% |
| United Healthcare | Medicare | $841.13 | ↓ -42% |
| Cigna Lifesource | Medicare Transplant | $841.13 | ↓ -42% |
| Highmark Wholecare (prev Gateway) | Medicare | $841.13 | ↓ -42% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $841.13 | ↓ -42% |
| Aetna | Medicare | $856.70 | ↓ -41% |
| Aetna of PA | Medicare | $856.70 | ↓ -41% |
| Preferred Healthcare System | PPO | $1,573.65 | ↑ +8% |
| Coventry/First Health | Commercial | $1,694.70 | ↑ +17% |
| Fidelis | Medicare | $1,815.75 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $1,815.75 | ↑ +25% |
| Health Coalition Partners | Intergroup | $1,936.80 | ↑ +33% |
| Private Health Care Systems | PPO | $1,936.80 | ↑ +33% |
| SelectCare | Commercial | $1,936.80 | ↑ +33% |
| Multiplan | PPO | $1,936.80 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $2,057.85 | ↑ +42% |
| Health Payors Organization | Commercial | $2,057.85 | ↑ +42% |
| Humana | Commercial | $2,057.85 | ↑ +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 6 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $669.60 | $54.35 – $1,004.40 |
| UPMC Passavant-McCandless | Pittsburgh | $610.80 | $54.67 – $865.30 |
| UPMC St. Margaret | Pittsburgh | $301.20 | $54.81 – $817.76 |
| UPMC Muncy | Muncy | $619.20 | $22.40 – $825.60 |
| UPMC Northwest | Seneca | $691.20 | $54.70 – $979.20 |
| UPMC Somerset | Somerset | $1,472.40 | $20.12 – $1,840.50 |
| UPMC Wellsboro | Wellsboro | $748.80 | $22.40 – $842.40 |
| UPMC Williamsport | Williamsport | $619.20 | $22.40 – $825.60 |