How many shoppable procedure prices are published for UPMC Presbyterian Shadyside?

UPMC Presbyterian Shadyside in Pittsburgh, PA currently has 115 standardized procedure price records indexed from its public 45 CFR § 180 machine-readable file.

How do UPMC Presbyterian Shadyside's commercial prices compare to the fair BaseRate?

Across scored shoppable procedures, UPMC Presbyterian Shadyside's median negotiated commercial rate is 1.9× the regionally adjusted fair BaseRate benchmark.

What is UPMC Presbyterian Shadyside's CMS Care Compare overall star rating?

CMS Care Compare assigns UPMC Presbyterian Shadyside 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 1120 Beds · rural Updated: 2026-03-06

UPMC Presbyterian Shadyside

200 Lothrop Street, Pittsburgh, PA 15213 · 115 Priced Procedures · 71% Patient Recommendation

CMS Overall Rating 4 / 5 Stars

High Markup · Shop Alternatives

1.85×vs. Fair Market Price

Typical commercial prices here are +85% above the fair benchmark (1.85×) even after accounting for local nurse/doctor wages and patient complexity.

79/100 · Corroborated

79/100Self-Pay Cash Beats Insurance 73% of the Time

File Completeness66

Price Logic89

Peer Alignment56

Clean Billing82

Real Cash Discount100

High-Markup · Check Safety

3-Star CMS clinical quality rating paired with 1.85× fair market pricing.

Behavioral Pricing FingerprintHigh Insurer Rate · Deep Cash Discount

Cash-Arbitrage Bifurcated Pricer

UPMC Presbyterian Shadyside maintains elevated commercial insurance contracts (1.85× Fair BaseRate) while offering direct self-pay cash discounts that beat commercial negotiated medians on 73% of procedures. High-deductible and uninsured patients should always request the self-pay cash rate prior to billing.

#125 of 134 in PA · 92nd State Percentile#2,986 of 3,385 in U.S. · 88th 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 73% of shoppable procedures (99/100 Cash Honesty)
4-Star CMS clinical rating with 71% patient recommendation (66/100 safety score)
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (50.0% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Even at low-cost facilities (1.85× 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.
Captive ER (1.7×) & laboratory (2.5×) services average 1.27× higher multiples than routine shoppable care (1.1×)
Upper-quartile procedures (Q75 1.26×) jump +26% above the median procedure ratio (Q50 1.00×)
Unnegotiated chargemaster list prices average 17.3× Medicare (18¢ true HCRIS cost per $1 gross)

Front-Door ShoppableElective / Imaging

1.1× Medicare

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

Back-Door Captive & ER1.27× Divergence

1.4× Medicare

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

Quantile Tail Spread+26% Upper Tail

Q25 0.87× · Q50 1.00× · Q75 1.26×

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

1.1× MedicareGood

Outpatient Surgery & ORBack-Door Captive

0.8× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

4.6× MedicareWatchout

Back-Door Captive ER VisitsBack-Door Captive

1.7× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

2.5× MedicareFair

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

0.5× MedicareGood

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

73% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

4 CMS · 66/100Fair

Procedure Prices at UPMC Presbyterian Shadyside

High-impact clinical procedures (MRIs, surgeries, inpatient stays, visits) are prioritized first. Use the category pills or search bar to filter all 115 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`	—	$33,238	$30,775	1.1×
Sepsis treatment (inpatient stay) MS-DRG Code: `871`	—	$21,883	$19,087	1.1×
Hip or knee replacement (inpatient stay) MS-DRG Code: `470`	—	$20,249	$19,432	1.0×
Heart stent placement (inpatient stay) MS-DRG Code: `322`	—	$18,386	$17,936	1.0×
Total hip replacement CPT Code: `27130`	—	$13,248	$13,413	1.0×
Total knee replacement CPT Code: `27447`	—	$13,248	$13,523	1.0×
Digestive disorders treatment (inpatient stay) MS-DRG Code: `392`	—	$9,838	$8,223	unverified
Gallbladder removal (laparoscopic) CPT Code: `47562`	—	$6,007	$6,109	1.0×
Bunion correction surgery CPT Code: `28296`	—	$3,341	$3,446	1.0×
Knee arthroscopy with meniscus repair CPT Code: `29881`	—	$2,415	$3,372	0.7×
Cataract surgery with lens implant CPT Code: `66984`	—	$2,348	$2,540	0.9×
Trauma team activation HCPCS Code: `G0390`	$8,322	$1,362	$1,453	0.9×
Inguinal hernia repair CPT Code: `49505`	$8,450	$1,348	$3,629	0.4×
Sleep study (overnight, in lab) CPT Code: `95810`	$7,862	$1,048	$1,021	1.0×
Colonoscopy with biopsy CPT Code: `45380`	$4,331	$1,042	$1,256	0.8×
Breast lump removal CPT Code: `19120`	—	$1,010	$3,875	0.3×
Upper endoscopy with biopsy CPT Code: `43239`	$4,331	$933	$987	0.9×
Colonoscopy (diagnostic) CPT Code: `45378`	$1,500	$927	$981	0.9×
MRI, knee or other leg joint CPT Code: `73721`	$6,214	$818	$369	unverified
Injection procedure for pain management HCPCS Code: `G0260`	$3,261	$720	$855	0.8×
Hospital observation (per hour) HCPCS Code: `G0378`	$1,002	$739	$86	unverified
Echocardiogram (heart ultrasound) CPT Code: `93306`	$2,600	$565	$583	1.0×
MRI, brain (with and without contrast) CPT Code: `70553`	$9,808	$528	$511	1.0×
MRI, brain (no contrast) CPT Code: `70551`	$6,214	$526	$343	unverified
MRI, lower back (no contrast) CPT Code: `72148`	$6,214	$399	$338	1.2×
CT scan, abdomen and pelvis (with contrast) CPT Code: `74177`	$8,885	$403	$448	0.9×
Blood transfusion CPT Code: `36430`	$829	$411	$498	0.8×
Rabies immune globulin HCPCS Code: `90375`	$880	$302	$322	0.9×
CT scan, head (with and without contrast) CPT Code: `70470`	$5,112	$244	$258	0.9×
Ultrasound, leg veins (duplex) CPT Code: `93970`	$2,286	$249	$272	0.9×
CT scan, abdomen and pelvis (no contrast) CPT Code: `74176`	$6,200	$258	$303	0.9×
CT scan, neck (cervical spine) CPT Code: `72125`	$2,937	$205	$169	1.2×
CT scan, head (with contrast) CPT Code: `70460`	$4,600	$205	$242	0.8×
CT scan, lower back (lumbar spine) CPT Code: `72131`	$2,937	$212	$168	unverified
CT scan, pelvis CPT Code: `72192`	$2,937	$172	$163	1.1×
CT scan, head (no contrast) CPT Code: `70450`	$2,937	$179	$160	unverified
CT scan, sinuses CPT Code: `70486`	$2,937	$199	$166	unverified
CT scan, chest (no contrast) CPT Code: `71250`	$2,937	$205	$167	unverified
Psychiatric evaluation (first visit) CPT Code: `90791`	$266	$225	$185	unverified
Family therapy session CPT Code: `90847`	$407	$212	$173	unverified
Psychotherapy session (45 minutes) CPT Code: `90834`	$235	$165	$166	1.0×
Hepatitis B immune globulin HCPCS Code: `90371`	$2,304	$145	$151	1.0×
Psychotherapy session (60 minutes) CPT Code: `90837`	$254	$165	$181	0.9×
Breathing treatment (nebulizer) CPT Code: `94640`	$337	$148	$201	0.7×
Psychological testing by technician CPT Code: `96138`	$857	$149	$395	0.4×
Electrical stimulation therapy HCPCS Code: `G0283`	$173	$173	$14	unverified
Ultrasound, abdomen (complete) CPT Code: `76700`	$1,274	$142	$134	unverified
X-ray, shoulder CPT Code: `73030`	$686	$91	$92	1.0×
X-ray, foot CPT Code: `73630`	$686	$91	$92	1.0×
X-ray, neck (cervical spine) CPT Code: `72040`	$686	$91	$93	1.0×
X-ray, hand CPT Code: `73130`	$686	$91	$93	1.0×
X-ray, hip CPT Code: `73502`	$686	$91	$93	1.0×
X-ray, ankle CPT Code: `73610`	$686	$91	$93	1.0×
X-ray, lower back CPT Code: `72110`	$1,154	$109	$112	1.0×
Ultrasound, pelvis CPT Code: `76856`	$1,263	$114	$130	0.9×
Ultrasound, abdomen (limited) CPT Code: `76705`	$1,349	$109	$126	0.9×
Ultrasound, thyroid and neck CPT Code: `76536`	$1,263	$114	$132	0.9×
Prosthetic fitting and training CPT Code: `97761`	$198	$86	$45	1.9×
New patient office visit (30-44 min) CPT Code: `99203`	$256	$95	$110	0.9×
X-ray, pelvis CPT Code: `72170`	$686	$82	$110	0.7×
Office visit, established patient (30-39 min) CPT Code: `99214`	$168	$89	$123	0.7×
Orthotic fitting and training CPT Code: `97760`	$166	$93	$51	unverified
Typhoid vaccine HCPCS Code: `90675`	$600	$339	$347	1.0×
Drug screening test HCPCS Code: `G0480`	$593	$124	$116	1.1×
Occupational therapy (self-care training) CPT Code: `97535`	$151	$50	$38	1.3×
Electrocardiogram (EKG, tracing only) CPT Code: `93005`	$436	$61	$64	1.0×
Speech therapy (language evaluation) CPT Code: `92507`	$236	$64	$86	0.7×
Office visit, established patient (20-29 min) CPT Code: `99213`	$148	$58	$87	0.7×
Psychological testing evaluation CPT Code: `96136`	$434	$71	$128	0.6×
Pneumococcal vaccine HCPCS Code: `90732`	$75	$75	$140	0.5×
Diagnostic procedure preparation HCPCS Code: `G0279`	$93	$65	$35	unverified
Prostate cancer screening (blood test) HCPCS Code: `G0103`	$96	$32	$20	1.6×
Colorectal cancer screening (alternative) HCPCS Code: `G0145`	$78	$36	$27	1.3×
Physical therapy (manual therapy) CPT Code: `97140`	$146	$36	$34	1.1×
Physical therapy (gait training) CPT Code: `97116`	$198	$26	$33	0.8×
Physical therapy (neuromuscular re-education) CPT Code: `97112`	$210	$29	$38	0.8×
Physical therapy (therapeutic exercise) CPT Code: `97110`	$178	$26	$35	0.7×
Tdap vaccine (tetanus, diphtheria, pertussis) HCPCS Code: `90715`	$32	$40	$56	0.7×
Group therapy session CPT Code: `90853`	$47	$47	$100	0.5×
Urinalysis (automated, with microscopy) CPT Code: `81001`	$469	$4	$3	1.3×
Blood test, cholesterol (lipid panel) CPT Code: `80061`	$720	$18	$14	1.3×
Blood test, ferritin (iron stores) CPT Code: `82728`	$570	$16	$14	1.1×
X-ray, chest (two views) CPT Code: `71046`	$686	$41	$93	0.4×
Blood test, amylase CPT Code: `82150`	$194	$7	$7	1.0×
X-ray, chest (single view) CPT Code: `71045`	$686	$27	$92	0.3×
Blood test, vitamin D CPT Code: `82306`	$169	$51	$31	unverified
Blood test, magnesium CPT Code: `83735`	$232	$9	$7	1.3×
Blood test, glucose (blood sugar) CPT Code: `82947`	$203	$5	$4	1.3×
Blood test, lipase CPT Code: `83690`	$281	$8	$7	1.1×
Blood test, complete blood count (CBC) CPT Code: `85025`	$241	$9	$8	1.1×
Culture, bacterial CPT Code: `87070`	$438	$10	$9	1.1×
Blood test, average blood sugar (A1c) CPT Code: `83036`	$416	$11	$10	1.1×
Blood test, vitamin B12 CPT Code: `82607`	$1,168	$17	$16	1.1×
Blood test, clotting time (PT/INR) CPT Code: `85610`	$308	$5	$5	1.0×
Physical therapy (functional capacity test) CPT Code: `97750`	$124	$29	$38	0.8×
Occupational therapy (therapeutic activities) CPT Code: `97530`	$259	$22	$40	0.6×
Flu vaccine injection HCPCS Code: `G0008`	$12	$12	$48	0.3×
Pneumonia vaccine injection HCPCS Code: `G0009`	$12	$12	$49	0.2×
Colorectal cancer screening HCPCS Code: `G0010`	$12	$12	$49	0.2×
Blood antibody screen CPT Code: `86850`	$136	$11	$46	0.2×
MMR vaccine (measles, mumps, rubella) HCPCS Code: `90707`	$49	$17	$111	0.2×
Blood test, basic metabolic panel CPT Code: `80048`	$210	$12	$9	unverified
Blood test, comprehensive metabolic panel CPT Code: `80053`	$619	$15	$11	unverified
Blood test, liver function panel CPT Code: `80076`	$436	$12	$9	unverified
Blood test, calcium CPT Code: `82310`	$97	$9	$5	unverified
Blood test, creatinine (kidney) CPT Code: `82565`	$182	$8	$5	unverified
Blood test, potassium CPT Code: `84132`	$215	$8	$5	unverified
Blood test, PSA (prostate screen) CPT Code: `84153`	$431	$29	$19	unverified
Blood test, sodium CPT Code: `84295`	$215	$8	$5	unverified
Blood test, thyroid (TSH) CPT Code: `84443`	$157	$30	$18	unverified
Blood test, urea nitrogen (BUN, kidney) CPT Code: `84520`	$173	$7	$4	unverified
Blood test, hemoglobin CPT Code: `85018`	$438	$4	$3	unverified
Blood test, clotting time (PTT) CPT Code: `85730`	$174	$9	$6	unverified
Hepatitis C antibody test CPT Code: `86803`	$670	$25	$15	unverified
Culture, blood CPT Code: `87040`	$784	$18	$11	unverified

Showing top 25 high-impact procedures of 115 total

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 50.0%

Audit a Bill or Quote at UPMC Presbyterian Shadyside (Zero PHI Required)

CMS CCN: 390164

CPT 451

Select Procedure to Audit:

Fair BaseRate™ $30,775

Medicare Rate $23,504

Self-Pay Cash Request Quote

Insurer Median $33,238

1. Amount on Your Bill or Quote ($) Pre-filled with UPMC Presbyterian Shadyside’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: $39,886 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $39,886

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (50.0% of gross = $39,886).

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

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask UPMC Presbyterian Shadyside'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 +$48,996 Above Fair BaseRate

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

Your bill ($79,771) is $48,996 above the denoised Fair BaseRate ($30,775) and 3.4× 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)

EIN: 250965480

Filing Period: 198301

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 (50.0% 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 Overall3/5 Stars (3/5)

Safety Composite66/100

Would Recommend71%

Rated 9 or 10 (HCAHPS)72%

Median ER Wait229 min

Left ER Before Seen1%

30-Day Mortality vs U.S.better

Unplanned Readmissionsame

Hip/Knee Complication Rate3.4%

Healthcare-Associated Infections (CDC NHSN / CMS HAI)

1.00 SIR = National Predicted Baseline (Lower Is Safer)

Central-Line Bloodstream Infectionsame

C. diff Hospital-Onset Infectionbetter

Source: CMS Hospital Care Compare (588 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

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

Price Index: 4.23× regional baseline

Quality: 71/100 CMS composite

Notable Payer Contract Outliers (SVD Matrix Anomalies)

Humana

+112.3%

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 79/100 · Corroborated CMS CCN 390164 EIN 250965480

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 390164) ↗ Verify IRS Form 990 (EIN 250965480) ↗ CMS HCRIS Cost Reports ↗

Published MRF FileCMS_45_CFR_180_FILING.json

Publication / Vintage2026-03-06

Validated Rate Rows4,780 (CMS v3.0.0)

File Integrity DigestVerified · CCN 390164

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