How many shoppable procedure prices are published for UPMC Pinnacle Hospitals?

UPMC Pinnacle Hospitals in Harrisburg, PA currently has 110 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do UPMC Pinnacle Hospitals's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, UPMC Pinnacle Hospitals's median negotiated commercial rate is 1.1× the regionally adjusted fair BaseRate benchmark.

What is UPMC Pinnacle Hospitals's CMS Care Compare overall star rating?

CMS Care Compare assigns UPMC Pinnacle Hospitals an overall hospital quality rating of 4 out of 5 stars based on public federal clinical and patient-experience measures.

Hospital Profile Acute Care Hospital Voluntary non-profit - Private 530 Beds · rural Updated: 3/6/2026

UPMC Pinnacle Hospitals

409 South Second Street, Harrisburg, PA 17104 · 110 Priced Procedures · 73% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

Above Fair Market · Negotiate

1.08×vs. Fair Market Price

Typical commercial prices here are +8% above the fair benchmark (1.08×) even after accounting for local nurse/doctor wages and patient complexity.

84/100 · Corroborated

84/100Self-Pay Cash Beats Insurance 72% of the Time

File Completeness66

Price Logic89

Peer Alignment71

Clean Billing95

Real Cash Discount100

Premium Quality Tier

3-Star CMS clinical quality rating paired with 1.08× fair market pricing.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

UPMC Pinnacle Hospitals maintains elevated commercial insurance contracts (1.08× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 72% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#92 of 134 in PA · 67th State Percentile#1,630 of 3,385 in U.S. · 48th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Bottom-quartile procedures (Q25) price at 0.87× the peer BaseRate benchmark
Self-pay cash beats commercial insurance on 72% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 73% patient recommendation (70/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (46.6% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.2× markup over Medicare rates
Captive ER (1.7×) & laboratory (1.9×) services average 1.17× higher multiples than routine shoppable care (1.2×)
Upper-quartile procedures (Q75 1.31×) jump +34% above the median procedure ratio (Q50 0.98×)
Consolidated metro market (HHI 2,968) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

1.2× Medicare

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

Back-Door Captive & ER1.17× Divergence

1.4× Medicare

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

Quantile Tail Spread+34% Upper Tail

Q25 0.87× · Q50 0.98× · Q75 1.31×

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

1.2× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.2× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

1.3× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.7× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.9× MedicareGood

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

0.5× MedicareGood

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

72% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 70/100Fair

Procedure Prices at UPMC Pinnacle Hospitals

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 110 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`	—	$28,614	$30,775	0.9×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$17,607	$19,432	0.9×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$17,561	$19,087	0.9×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$15,929	$17,936	0.9×
Total knee replacement CPT Code: `27447`	—	$12,878	$13,523	1.0×
Total hip replacement CPT Code: `27130`	—	$12,719	$13,413	0.9×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$7,402	$8,223	0.9×
C-section delivery (full package) CPT Code: `59510`	$10,034	$4,257	$2,975	1.4×
Bunion correction surgery CPT Code: `28296`	—	$3,431	$3,446	1.0×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$3,340	$3,372	1.0×
Gallbladder removal (laparoscopic) CPT Code: `47562`	$2,270	$2,270	$6,109	0.4×
Inguinal hernia repair CPT Code: `49505`	$1,697	$1,697	$3,629	0.5×
Injection procedure for pain management HCPCS Code: `G0260`	$2,647	$1,486	$855	unverified
Colonoscopy with biopsy CPT Code: `45380`	—	$1,229	$1,256	1.0×
MRI, knee or other leg joint CPT Code: `73721`	$1,656	$1,165	$369	unverified
Breast lump removal CPT Code: `19120`	$1,078	$1,078	$3,875	0.3×
Upper endoscopy with biopsy CPT Code: `43239`	$2,051	$968	$987	1.0×
Colonoscopy (diagnostic) CPT Code: `45378`	$887	$942	$981	1.0×
Echocardiogram (heart ultrasound) CPT Code: `93306`	$1,505	$563	$583	1.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$2,855	$478	$511	0.9×
Blood transfusion CPT Code: `36430`	$1,476	$446	$498	0.9×
MRI, brain (no contrast) CPT Code: `70551`	$959	$444	$343	unverified
MRI, lower back (no contrast) CPT Code: `72148`	$1,656	$361	$338	1.1×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$1,662	$378	$448	0.8×
Diagnostic mammogram (both breasts) CPT Code: `77066`	$310	$324	$148	unverified
Rabies immune globulin HCPCS Code: `90375`	$408	$297	$322	0.9×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$450	$249	$272	0.9×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$1,822	$256	$303	0.8×
Screening mammogram (both breasts) CPT Code: `77067`	$257	$268	$123	unverified
CT scan, head (with and without contrast) CPT Code: `70470`	$1,298	$224	$258	0.9×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$876	$195	$168	1.2×
CT scan, chest (no contrast) CPT Code: `71250`	$575	$188	$167	1.1×
CT scan, neck (cervical spine) CPT Code: `72125`	$797	$188	$169	1.1×
CT scan, sinuses CPT Code: `70486`	$797	$183	$166	1.1×
Breathing treatment (nebulizer) CPT Code: `94640`	$418	$200	$201	1.0×
CT scan, head (with contrast) CPT Code: `70460`	$1,295	$192	$242	0.8×
CT scan, head (no contrast) CPT Code: `70450`	$951	$165	$160	1.0×
Ultrasound, abdomen (complete) CPT Code: `76700`	$298	$134	$134	1.0×
CT scan, pelvis CPT Code: `72192`	$551	$159	$163	1.0×
Psychiatric evaluation (first visit) CPT Code: `90791`	$514	$166	$185	0.9×
Hepatitis B immune globulin HCPCS Code: `90371`	$106	$140	$151	0.9×
Psychotherapy session (60 minutes) CPT Code: `90837`	$302	$161	$181	0.9×
X-ray, lower back CPT Code: `72110`	$210	$111	$112	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$188	$90	$93	1.0×
Ultrasound, thyroid and neck CPT Code: `76536`	$382	$112	$132	0.8×
X-ray, chest (two views) CPT Code: `71046`	$153	$86	$93	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$298	$111	$126	0.9×
Ultrasound, pelvis CPT Code: `76856`	$337	$112	$130	0.9×
Occupational therapy (self-care training) CPT Code: `97535`	$97	$84	$38	2.2×
X-ray, pelvis CPT Code: `72170`	$263	$92	$110	0.8×
New patient office visit (30-44 min) CPT Code: `99203`	$160	$92	$110	0.8×
Office visit, established patient (30-39 min) CPT Code: `99214`	$93	$93	$123	0.8×
Hospital observation (per hour) HCPCS Code: `G0378`	$112	$112	$86	unverified
Typhoid vaccine HCPCS Code: `90675`	$254	$328	$347	0.9×
Drug screening test HCPCS Code: `G0480`	$137	$120	$116	1.0×
Orthotic fitting and training CPT Code: `97760`	$61	$74	$51	1.5×
X-ray, shoulder CPT Code: `73030`	$188	$77	$92	0.8×
X-ray, foot CPT Code: `73630`	$188	$73	$92	0.8×
X-ray, hand CPT Code: `73130`	$188	$73	$93	0.8×
X-ray, ankle CPT Code: `73610`	$188	$73	$93	0.8×
X-ray, hip CPT Code: `73502`	$188	$55	$93	0.6×
X-ray, chest (single view) CPT Code: `71045`	$153	$52	$92	0.6×
Blood test, vitamin D CPT Code: `82306`	$140	$54	$31	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$56	$15	$11	1.4×
Blood test, basic metabolic panel CPT Code: `80048`	$51	$12	$9	1.3×
Electrocardiogram (ECG/EKG) CPT Code: `93000`	$147	$33	$25	1.3×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$22	$4	$3	1.3×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$83	$18	$14	1.3×
Physical therapy (manual therapy) CPT Code: `97140`	$55	$36	$34	1.1×
Hepatitis B vaccine HCPCS Code: `90744`	$33	$36	$37	1.0×
Colorectal cancer screening HCPCS Code: `G0010`	$99	$46	$49	0.9×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$197	$60	$64	0.9×
Pneumonia vaccine injection HCPCS Code: `G0009`	$47	$43	$49	0.9×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$54	$49	$56	0.9×
Office visit, established patient (20-29 min) CPT Code: `99213`	$132	$60	$87	0.7×
Psychological testing evaluation CPT Code: `96136`	$55	$55	$128	0.4×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$54	$43	$111	0.4×
Diagnostic procedure preparation HCPCS Code: `G0279`	$65	$63	$35	unverified
Blood test, sodium CPT Code: `84295`	$23	$9	$5	1.8×
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$21	$7	$4	1.8×
Blood test, potassium CPT Code: `84132`	$22	$8	$5	1.6×
Blood test, magnesium CPT Code: `83735`	$37	$10	$7	1.4×
Blood test, glucose (blood sugar) CPT Code: `82947`	$21	$5	$4	1.3×
Blood test, ferritin (iron stores) CPT Code: `82728`	$64	$16	$14	1.1×
Blood test, vitamin B12 CPT Code: `82607`	$71	$17	$16	1.1×
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$87	$21	$20	1.1×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$150	$28	$27	1.0×
Speech therapy (language evaluation) CPT Code: `92507`	$298	$37	$86	0.4×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$48	$10	$10	1.0×
Blood test, lipase CPT Code: `83690`	$38	$7	$7	1.0×
Blood test, complete blood count (CBC) CPT Code: `85025`	$42	$8	$8	1.0×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$78	$29	$38	0.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$65	$22	$40	0.6×
Physical therapy (gait training) CPT Code: `97116`	$44	$14	$33	0.4×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$59	$14	$35	0.4×
Blood antibody screen CPT Code: `86850`	$65	$11	$46	0.2×
Blood test, PSA (prostate screen) CPT Code: `84153`	$113	$32	$19	unverified
Blood test, clotting time (PT/INR) CPT Code: `85610`	$22	$5	$5	1.0×
Culture, bacterial CPT Code: `87070`	$47	$9	$9	1.0×
DTaP vaccine (diphtheria, tetanus, pertussis) HCPCS Code: `90700`	$32	$34	$39	0.9×
Blood test, amylase CPT Code: `82150`	$35	$7	$7	1.0×
Flu vaccine injection HCPCS Code: `G0008`	$13	$13	$48	0.3×
Blood test, liver function panel CPT Code: `80076`	$50	$12	$9	unverified
Blood test, calcium CPT Code: `82310`	$26	$9	$5	unverified
Blood test, creatinine (kidney) CPT Code: `82565`	$26	$8	$5	unverified
Blood test, thyroid (TSH) CPT Code: `84443`	$78	$30	$18	unverified
Blood test, hemoglobin CPT Code: `85018`	$13	$4	$3	unverified
Blood test, clotting time (PTT) CPT Code: `85730`	$33	$10	$6	unverified
Hepatitis C antibody test CPT Code: `86803`	$108	$25	$15	unverified
Culture, blood CPT Code: `87040`	$57	$18	$11	unverified

Showing top 25 high-impact procedures of 110 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 46.6%

Audit a Bill or Quote at UPMC Pinnacle Hospitals (Zero PHI Required)

CMS CCN: 390067

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $28,614

1. Amount on Your Bill or Quote ($) Pre-filled with UPMC Pinnacle Hospitals’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: $31,995 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $31,995

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (46.6% of gross = $31,995).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask UPMC Pinnacle Hospitals'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 +$37,899 Above Fair BaseRate

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

Your bill ($68,674) is $37,899 above the denoised Fair BaseRate ($30,775) and 2.9× 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 (46.6% 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 Overall3/5 Stars (3/5)

Safety Composite70/100

Would Recommend73%

Rated 9 or 10 (HCAHPS)73%

Median ER Wait213 min

Left ER Before Seen1%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate3%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionbetter

C. diff Hospital-Onset Infectionbetter

Source: CMS Hospital Care Compare (448 completed HCAHPS patient surveys). 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

Higher-Quality, Above-Median Price Tier Pareto Frontier (Price + Quality)

2D regional comparison of commercial negotiated price index against CMS clinical quality composite for UPMC Pinnacle Hospitals.

Price Index: 1.23× regional baseline

Quality: 77/100 CMS composite

Median Household Income$74,159U.S. Census ACS

Local Uninsured Share6.3%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 84/100 · Corroborated CMS CCN 390067

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 390067) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage3/6/2026

Validated Rate Rows4,173 (CMS v3.0.0)

File Integrity DigestVerified · CCN 390067

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