How many shoppable procedure prices are published for UPMC Children's Hospital of Pittsburgh?

UPMC Children's Hospital of Pittsburgh in Pittsburgh, PA currently has 105 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do UPMC Children's Hospital of Pittsburgh's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, UPMC Children's Hospital of Pittsburgh's median negotiated commercial rate is 1.7× the regionally adjusted fair BaseRate benchmark.

Hospital Profile Children's Hospital Voluntary non-profit - Other 317 Beds · urban Updated: 2026-03-06

UPMC Children's Hospital of Pittsburgh

One Children's Hospital Drive, Pittsburgh, PA 15224 · 105 Priced Procedures

CMS Overall Rating No CMS Rating

High Markup · Shop Alternatives

1.73×vs. Fair Market Price

Typical commercial prices here are +73% above the fair benchmark (1.73×) even after accounting for local nurse/doctor wages and patient complexity.

70/100 · Corroborated

70/100Self-Pay Cash Beats Insurance 42% of the Time

File Completeness51

Price Logic64

Peer Alignment63

Clean Billing82

Real Cash Discount100

High-Markup · Check Safety

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintUpper-Quartile Spread · +101% Tail Jump

Wide Procedure Spread · Upper-Quartile Skew Pricer

UPMC Children's Hospital of Pittsburgh prices routine shoppable procedures at 2.1× Medicare (median 1.08× Fair BaseRate) while upper-quartile commercial rates jump +101% to 2.17× Fair BaseRate. Self-pay cash discounts and comparing specific CPT procedure codes before scheduling yield the strongest savings.

#124 of 134 in PA · 91st State Percentile#2,908 of 3,385 in U.S. · 85th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.96× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 42% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (54/100 safety score) with 72% patient recommendation
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (47.0% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.73× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Commercial insurance median sits at 1.08× Fair BaseRate (2.1× Medicare), so insured patients should always compare the self-pay cash price before paying.
Upper-quartile procedures (Q75 2.17×) jump +101% above the median procedure ratio (Q50 1.08×)
Unnegotiated chargemaster list prices average 15.3× Medicare (18¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

2.1× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER0.62× Divergence

1.3× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+101% Upper Tail

Q25 0.96× · Q50 1.08× · Q75 2.17×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

2.1× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.0× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

3.0× MedicareFair

Back-Door Captive ER VisitsBack-Door Captive

3.0× MedicareFair

Inpatient Lab & PathologyBack-Door Captive

4.7× MedicareWatchout

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

0.5× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

42% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 54/100Elevated

Procedure Prices at UPMC Children's Hospital of Pittsburgh

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 105 published procedures.

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Audit a Bill & 501(r) Cap ↓

Procedure & Billing Code	Self-Pay Cash	This Hospital	Fair BaseRate	vs. Fair
Spinal fusion, single level (inpatient stay) MS-DRG Code: `451`	—	$35,206	$30,775	1.1×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$21,223	$19,087	1.1×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$21,075	$19,432	1.1×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$19,214	$17,936	1.1×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$8,518	$8,223	1.0×
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$5,902	$6,109	1.0×
Inguinal hernia repair CPT Code: `49505`	—	$3,206	$3,629	0.9×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,153	$3,372	0.9×
Bunion correction surgery CPT Code: `28296`	—	$3,093	$3,446	0.9×
Breast lump removal CPT Code: `19120`	—	$2,631	$3,875	0.7×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,375	$2,540	0.9×
Trauma team activation HCPCS Code: `G0390`	$2,265	$1,375	$1,453	0.9×
MRI, brain (no contrast) CPT Code: `70551`	$3,092	$1,322	$343	unverified
MRI, brain (with and without contrast) CPT Code: `70553`	$4,699	$1,327	$511	unverified
MRI, knee or other leg joint CPT Code: `73721`	$2,125	$1,294	$369	unverified
Sleep study (overnight, in lab) CPT Code: `95810`	$3,562	$1,172	$1,021	1.1×
Colonoscopy with biopsy CPT Code: `45380`	$5,141	$1,158	$1,256	0.9×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$6,929	$1,030	$448	unverified
MRI, lower back (no contrast) CPT Code: `72148`	$3,092	$1,003	$338	unverified
Upper endoscopy with biopsy CPT Code: `43239`	$2,966	$921	$987	0.9×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,500	$896	$981	0.9×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$6,883	$659	$303	2.2×
CT scan, head (with and without contrast) CPT Code: `70470`	$3,497	$623	$258	2.4×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,906	$569	$583	1.0×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$3,224	$542	$168	3.2×
CT scan, chest (no contrast) CPT Code: `71250`	$3,442	$523	$167	3.1×
CT scan, neck (cervical spine) CPT Code: `72125`	$3,224	$523	$169	3.1×
CT scan, sinuses CPT Code: `70486`	$3,110	$509	$166	3.1×
CT scan, head (with contrast) CPT Code: `70460`	$2,903	$525	$242	2.2×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$1,003	$529	$272	unverified
CT scan, head (no contrast) CPT Code: `70450`	$2,903	$457	$160	2.9×
CT scan, pelvis CPT Code: `72192`	$3,254	$440	$163	2.7×
Hospital observation (per hour) HCPCS Code: `G0378`	$445	$445	$86	unverified
Blood transfusion CPT Code: `36430`	$525	$386	$498	0.8×
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,201	$373	$134	unverified
Ultrasound, pelvis CPT Code: `76856`	$1,200	$299	$130	2.3×
Ultrasound, thyroid and neck CPT Code: `76536`	$953	$295	$132	2.2×
Rabies immune globulin HCPCS Code: `90375`	$665	$308	$322	1.0×
Ultrasound, abdomen (limited) CPT Code: `76705`	$741	$245	$126	1.9×
Office visit, established patient (30-39 min) CPT Code: `99214`	$253	$212	$123	1.7×
New patient office visit (30-44 min) CPT Code: `99203`	$382	$219	$110	unverified
Speech therapy (group session) CPT Code: `92508`	$133	$133	$27	4.9×
Hepatitis B immune globulin HCPCS Code: `90371`	$1,407	$154	$151	1.0×
Prosthetic fitting and training CPT Code: `97761`	$278	$120	$45	2.7×
Orthotic fitting and training CPT Code: `97760`	$211	$119	$51	2.3×
Office visit, established patient (20-29 min) CPT Code: `99213`	$213	$141	$87	1.6×
X-ray, lower back CPT Code: `72110`	$551	$143	$112	1.3×
Occupational therapy (self-care training) CPT Code: `97535`	$102	$85	$38	2.2×
X-ray, neck (cervical spine) CPT Code: `72040`	$470	$104	$93	1.1×
X-ray, shoulder CPT Code: `73030`	$417	$97	$92	1.1×
Speech therapy (language evaluation) CPT Code: `92507`	$245	$89	$86	1.0×
X-ray, foot CPT Code: `73630`	$315	$94	$92	1.0×
X-ray, hand CPT Code: `73130`	$321	$94	$93	1.0×
X-ray, ankle CPT Code: `73610`	$315	$93	$93	1.0×
X-ray, chest (two views) CPT Code: `71046`	$291	$91	$93	1.0×
X-ray, hip CPT Code: `73502`	$417	$89	$93	1.0×
X-ray, pelvis CPT Code: `72170`	$202	$101	$110	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$142	$98	$201	0.5×
Blood test, comprehensive metabolic panel CPT Code: `80053`	$933	$933	$11	84.8×
Blood test, basic metabolic panel CPT Code: `80048`	$536	$536	$9	59.6×
Blood test, liver function panel CPT Code: `80076`	$469	$469	$9	unverified
Drug screening test HCPCS Code: `G0480`	$440	$440	$116	3.8×
Typhoid vaccine HCPCS Code: `90675`	$700	$353	$347	1.0×
Blood test, PSA (prostate screen) CPT Code: `84153`	$340	$340	$19	unverified
Blood test, complete blood count (CBC) CPT Code: `85025`	$172	$172	$8	21.5×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$182	$182	$10	18.2×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$202	$202	$14	14.4×
Blood test, thyroid (TSH) CPT Code: `84443`	$194	$194	$18	10.8×
Blood test, vitamin D CPT Code: `82306`	$194	$194	$31	unverified
Hepatitis C antibody test CPT Code: `86803`	$189	$189	$15	unverified
Blood test, lipase CPT Code: `83690`	$148	$148	$7	21.1×
Blood test, vitamin B12 CPT Code: `82607`	$162	$162	$16	10.1×
Culture, bacterial CPT Code: `87070`	$131	$131	$9	14.6×
Blood test, ferritin (iron stores) CPT Code: `82728`	$139	$139	$14	9.9×
Culture, blood CPT Code: `87040`	$155	$155	$11	unverified
Urinalysis (automated, with microscopy) CPT Code: `81001`	$76	$76	$3	25.3×
Blood test, glucose (blood sugar) CPT Code: `82947`	$67	$67	$4	16.8×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$67	$67	$4	16.8×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$80	$80	$5	16.0×
Blood test, hemoglobin CPT Code: `85018`	$43	$43	$3	14.3×
Blood test, calcium CPT Code: `82310`	$67	$67	$5	13.4×
Blood test, creatinine (kidney) CPT Code: `82565`	$67	$67	$5	13.4×
Blood test, potassium CPT Code: `84132`	$67	$67	$5	13.4×
Blood test, sodium CPT Code: `84295`	$67	$67	$5	13.4×
Blood test, clotting time (PTT) CPT Code: `85730`	$80	$80	$6	13.3×
Blood test, amylase CPT Code: `82150`	$67	$67	$7	9.6×
Blood test, magnesium CPT Code: `83735`	$67	$67	$7	9.6×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$112	$68	$38	1.8×
Physical therapy (functional capacity test) CPT Code: `97750`	$193	$68	$38	1.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$112	$53	$40	1.3×
X-ray, chest (single view) CPT Code: `71045`	$245	$62	$92	0.7×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$78	$29	$27	1.1×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$96	$21	$20	1.1×
Physical therapy (gait training) CPT Code: `97116`	$134	$34	$33	1.0×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$257	$56	$64	0.9×
Pneumococcal vaccine HCPCS Code: `90732`	$75	$75	$140	0.5×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$35	$44	$56	0.8×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$57	$57	$111	0.5×
Varicella (chickenpox) vaccine HCPCS Code: `90716`	$92	$79	$203	0.4×
Hepatitis B vaccine HCPCS Code: `90744`	$55	$40	$37	1.1×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$134	$34	$35	1.0×
Blood antibody screen CPT Code: `86850`	$115	$31	$46	0.7×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$38	$38	$39	unverified
Flu vaccine injection HCPCS Code: `G0008`	$12	$12	$48	0.3×
Pneumonia vaccine injection HCPCS Code: `G0009`	$12	$12	$49	0.2×

Showing top 25 high-impact procedures of 105 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 47.0%

Audit a Bill or Quote at UPMC Children's Hospital of Pittsburgh (Zero PHI Required)

CMS CCN: 393302

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $35,206

1. Amount on Your Bill or Quote ($) Pre-filled with UPMC Children's Hospital of Pittsburgh’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $39,712 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $39,712

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (47.0% of gross = $39,712).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask UPMC Children's Hospital of Pittsburgh's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$53,719 Above Fair BaseRate

Negotiate Toward $30,775 Fair BaseRate ($23,504 Medicare)

Your bill ($84,494) is $53,719 above the denoised Fair BaseRate ($30,775) and 3.6× the $23,504 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.

IRS Form 990 Schedule H & 26 U.S.C. § 501(r) 501(c)(3) Nonprofit Hospital

Financial Assistance Policy (FAP) & Amounts Generally Billed (AGB)

Free Care Eligibility BenchmarkUp to 200% FPL100% charity write-off income threshold

Discounted Care EligibilityUp to 400% FPLSliding-scale & AGB billing cap tier

Charity Care Share of ExpensesSee Schedule HNet community financial assistance reported

26 U.S.C. § 501(r)(5) AGB Benchmark Method: lookback_commercial_median

Hospital-Specific CMS HCRIS Benchmark (47.0% of gross charges)

Under 26 U.S.C. § 501(r)(5), a tax-exempt hospital organization may not bill FAP-eligible patients more than Amounts Generally Billed (AGB) to individuals with insurance covering emergency or medically necessary care. Derived from this facility’s reported CMS HCRIS cost-to-charge & insurer allowance filings. Verify your exact Financial Assistance Policy (FAP) determination directly with the billing office.

Screen your household size, income, and itemized CPT codes against 2026 HHS Federal Poverty Guidelines: Calculate Your 501(r) Cap Above ↑

CMS Care Compare Public Quality Record

Clinical Quality, Patient Experience & Infection Benchmarks

CMS Price Transparency Administrative Enforcement Log

Factual public administrative actions published by the Centers for Medicare & Medicaid Services regarding 45 CFR § 180 compliance at UPMC Children's Hospital of Pittsburgh. Prior administrative notices do not necessarily reflect current compliance status.

2025-07-22·administrative_or_closure
Met Requirements
Recorded
2023-10-09·administrative_or_closure
Closure Notice
Recorded
2023-08-30·cap_corrective_action
CAP Request
Recorded
2023-05-24·warning_notice
Warning Notice
Recorded

Source: CMS Hospital Care Compare. Clinical quality metrics summarize historical facility-wide cohorts and are not medical advice for individual care decisions.

Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

Above-Benchmark Price Tier

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for UPMC Children's Hospital of Pittsburgh.

Price Index: 2.59× regional baseline

Quality: 54/100 CMS composite

Median Household Income$76,393U.S. Census ACS

Local Uninsured Share3.9%Regional ACS estimate

200% FPL (1 Person)$31,920Common free-care ceiling

400% FPL (Family of 4)$128,600Common AGB cap ceiling

45 CFR § 180 Primary-Source Lineage & Federal Verification VeriRate 70/100 · Corroborated CMS CCN 393302

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (CMS_45_CFR_180_FILING.json) Verify on CMS Medicare.gov (CCN 393302) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-03-06

Validated Rate Rows4,031 (CMS v3.0.0)

File Integrity DigestVerified · CCN 393302

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy