healthcosts.net
Tube drain vert dev st 5-40f at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$16.80
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.
$28.00
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.
$2.16 with Aetna vs $102.22 with UPMC Health Plan — 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 |
|---|---|---|---|
| Aetna | CHIP/Medicaid | $2.16 | ↓ -87% |
| Aetna | Medicare | $3.00 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicare | $6.00 | ↓ -64% |
| Geisinger | Medicaid/CHIP | $6.60 | ↓ -61% |
| Preferred Healthcare System | PPO | $7.80 | ↓ -54% |
| Coventry/First Health | Commercial | $8.40 | ↓ -50% |
| Fidelis | Medicare | $9.00 | ↓ -46% |
| InterGroup | InterGroup Services Corporation | $9.00 | ↓ -46% |
| Health Coalition Partners | Intergroup | $9.60 | ↓ -43% |
| Multiplan | PPO | $9.60 | ↓ -43% |
| Private Health Care Systems | PPO | $9.60 | ↓ -43% |
| SelectCare | Commercial | $9.60 | ↓ -43% |
| Health Payors Organization | Commercial | $10.20 | ↓ -39% |
| Humana | Commercial | $10.20 | ↓ -39% |
| InterGroup | Approved National Affiliated PPO Business | $10.20 | ↓ -39% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $10.34 | ↓ -38% |
| Highmark BCBS of PA | Medicare Advantage | $20.23 | ↑ +20% |
| UPMC Work Partners | Workers Comp | $23.09 | ↑ +37% |
| Multiplan | Worker's Compensation | $26.85 | ↑ +60% |
| Highmark BCBS of PA | Managed Care - Social Mission | $33.62 | ↑ +100% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $34.23 | ↑ +104% |
| Highmark BCBS of PA | Managed Care | $45.03 | ↑ +168% |
| Highmark BCBS of PA | Commercial - Indemnity | $45.84 | ↑ +173% |
| Highmark BCBS of PA | UPMC Emergent | $90.05 | ↑ +436% |
| UPMC Health Plan | Commercial | $102.22 | ↑ +508% |