▸ Hospital · · CCN 390055

UPMC Shadyside

Compliance grade
A
100/100
Procedures tracked
172
of 209 target codes
Payers
21
with negotiated rates
Rates published
69,290
last crawl 2026-05-24

Procedures & rates

ProcedureTypeCodePayersGrossCashNeg minNeg medianNeg max
behavioral
PsychosesMS-DRG8856$10,904$14,545$29,135
Psychiatric diagnostic evaluationCPT9079119$443$265.8$31.5$332.25$1,931.02
Psychiatric eval with medical servicesCPT9079220$1,070$642$82.5$749$2,055.6
Psychotherapy 30 minutesCPT9083220$292$175.2$28.6$211.7$797.32
Psychotherapy 45 minutesCPT9083420$392$235.2$42.9$284.2$1,177.3
Psychotherapy 60 minutesCPT9083720$424$254.4$57.2$307.4$1,719.23
emergency
ED visit level 1CPT9928119$514$308.4$52.16$359.8$464.52
ED visit level 2CPT9928220$1,034$620.4$36.28$672.1$878.9
ED visit level 3CPT9928320$2,240$1,344$62.31$946.03$1,904
ED visit level 4CPT9928420$3,257$1,954.2$104.86$1,202.3$2,768.45
ED visit level 5CPT9928520$6,053$3,631.8$152.61$1,475.25$5,145.05
Critical care, first hourCPT9929120$7,948$4,768.8$166.79$1,613.77$6,755.8
imaging
CT head without contrastCPT7045020$4,895$2,937$93$2,295.27$4,160.75
CT head with contrastCPT7046020$7,666$4,599.6$96$3,594.59$6,516.1
CT head with and without contrastCPT7047020$8,520$5,112$120$3,995.03$7,242
CT neck with contrastCPT7049120$7,666$4,599.6$99$3,594.59$6,516.1
MRI brain without contrastCPT7055121$10,357$6,214.2$248.89$4,329.2$8,803.45
MRI brain with contrastCPT7055221$13,340$8,004$322.8$5,410.72$11,339
MRI brain with and without contrastCPT7055321$16,347$9,808.2$322.8$7,862.79$13,895
Chest X-ray single viewCPT7104520$1,144$686.4$6.49$536.42$972.4
Chest X-ray 2 viewsCPT7104620$1,144$686.4$11.9$536.42$972.4
Chest X-ray 3 viewsCPT7104720$1,144$686.4$15.12$536.42$972.4
CT chest without contrastCPT7125020$4,895$2,937$99.72$2,295.27$4,160.75
CT chest with contrastCPT7126020$7,666$4,599.6$105$3,594.59$6,516.1
CT chest with and without contrastCPT7127020$8,520$5,112$124.2$3,995.03$7,242
MRI chest without contrastCPT7155021$10,357$6,214.2$248.89$4,355.67$8,803.45
MRI chest with contrastCPT7155121$13,340$8,004$374.64$4,940.73$11,339
MRI chest with and without contrastCPT7155221$16,347$9,808.2$367.72$7,164.63$13,895
Lumbosacral spine X-rayCPT7210020$1,144$686.4$27$536.42$972.4
CT cervical spine without contrastCPT7212520$4,895$2,937$99.72$2,295.27$4,160.75
CT thoracic spine without contrastCPT7212820$4,895$2,937$108.72$2,295.27$4,160.75
CT lumbar spine without contrastCPT7213120$4,895$2,937$105.72$2,295.27$4,160.75
MRI cervical spine without contrastCPT7214121$10,357$6,214.2$248.89$4,355.67$8,803.45
MRI thoracic spine without contrastCPT7214621$10,357$6,214.2$224.64$4,530.59$8,803.45
MRI lumbar spine without contrastCPT7214821$10,357$6,214.2$224.64$4,504.17$8,803.45
MRI lumbar spine with and without contrastCPT7214921$13,340$8,004$322.8$5,410.72$11,339
MRI cervical spine with and without contrastCPT7215621$16,347$9,808.2$322.8$7,911.97$13,895
MRI lumbar spine with contrastCPT7215821$16,347$9,808.2$322.8$7,862.79$13,895
CT pelvis without contrastCPT7219220$4,895$2,937$81$2,295.27$4,160.75
CT pelvis with contrastCPT7219320$7,666$4,599.6$103.8$3,594.59$6,516.1
Shoulder X-rayCPT7303019$1,144$686.4$19.8$743.6$972.4
Humerus X-rayCPT7306019$1,144$686.4$13.8$743.6$972.4
Hand X-ray 3 viewsCPT7313019$1,144$686.4$13.8$743.6$972.4
MRI upper extremity joint without contrastCPT7322120$10,357$6,214.2$248.89$6,732.05$8,803.45
MRI upper extremity joint with and without contrastCPT7322320$16,347$9,808.2$367.72$10,626$13,895
Knee X-ray 1-2 viewsCPT7356019$1,144$686.4$19.8$743.6$972.4
Ankle X-ray 3 viewsCPT7361019$1,144$686.4$22.48$743.6$972.4
MRI lower extremity joint without contrastCPT7372120$10,357$6,214.2$248.89$6,732.05$8,803.45
MRI lower extremity joint with and without contrastCPT7372320$16,347$9,808.2$367.72$10,626$13,895
CT abdomen without contrastCPT7415020$4,895$2,937$93$2,295.27$4,160.75
CT abdomen with contrastCPT7416020$7,666$4,599.6$108$3,594.59$6,516.1
CT abdomen with and without contrastCPT7417020$8,520$5,112$133.8$3,995.03$7,242
CT abdomen and pelvis without contrastCPT7417620$10,334$6,200.4$121.28$4,845.61$8,783.9
CT abdomen and pelvis with contrastCPT7417720$14,808$8,884.8$231.28$6,943.47$12,587
CT abdomen and pelvis with and without contrastCPT7417820$14,808$8,884.8$305.64$6,943.47$12,587
MRI abdomen without contrastCPT7418121$10,357$6,214.2$248.89$4,355.67$8,803.45
MRI abdomen with and without contrastCPT7418321$16,347$9,808.2$367.72$7,186.62$13,895
Abdominal ultrasound completeCPT7670020$2,124$1,274.4$69$995.94$1,805.4
Abdominal ultrasound limitedCPT7670520$2,248$1,348.8$45$1,054.09$1,910.8
Retroperitoneal ultrasound completeCPT7677020$2,105$1,263$58.8$987.03$1,789.25
Obstetric ultrasound first trimesterCPT7680120$3,033$1,819.8$46.07$1,422.17$2,578.05
Obstetric ultrasound after first trimesterCPT7680520$3,033$1,819.8$55.8$1,422.17$2,578.05
Transvaginal ultrasoundCPT7683020$3,855$2,313$55.8$1,807.61$3,276.75
Pelvic ultrasound completeCPT7685620$2,105$1,263$55.8$987.03$1,789.25
Scrotal ultrasoundCPT7687020$2,024$1,214.4$52.8$949.05$1,720.4
Diagnostic mammography unilateralCPT7706518$905$543$58.27$633.5$769.25
EKG tracing onlyCPT9300520$727$436.2$11.51$181.75$617.95
Transthoracic echocardiogram completeCPT9330620$4,333$2,599.8$117.77$2,279.98$3,683.05
Transthoracic echocardiogramCPT9330720$5,911$3,546.6$114$1,236.48$5,024.35
Stress echocardiogramCPT9335020$8,613$5,167.8$55.8$1,119.29$7,321.05
inpatient
Intracranial hemorrhage/CVA w MCCMS-DRG0648$10,293$20,896$76,175
Intracranial hemorrhage/CVA w CCMS-DRG0658$6,064.23$10,768$47,853
Intracranial hemorrhage/CVA w/o CC/MCCMS-DRG0668$6,075$7,887.22$37,382
Respiratory infections & inflammations w MCCMS-DRG1778$9,648.67$16,359$58,705
COPD w MCCMS-DRG1908$8,026.99$11,753$39,607
COPD w CCMS-DRG1918$8,325.01$10,219$52,870
COPD w/o CC/MCCMS-DRG1928$6,458.57$9,009.59$27,942
Simple pneumonia & pleurisy w CCMS-DRG1948$7,980.54$9,995.88$33,150
Simple pneumonia & pleurisy w/o CC/MCCMS-DRG1958$6,333.22$8,442.08$29,413
AMI discharged alive w MCCMS-DRG2808$8,053.32$16,778$59,464
AMI discharged alive w CCMS-DRG2818$5,198.93$10,114$41,017
AMI discharged alive w/o CC/MCCMS-DRG2828$4,267.82$8,317.76$37,002
Heart failure & shock w MCCMS-DRG2918$6,106.11$13,536$45,955
Heart failure & shock w CCMS-DRG2928$8,380.74$10,255$32,550
Heart failure & shock w/o CC/MCCMS-DRG2938$5,752.87$8,552.25$28,050
Cardiac arrhythmia w MCCMS-DRG3088$10,293$13,668$42,645
Cardiac arrhythmia w CCMS-DRG3098$7,328.65$9,197.05$26,857
Cardiac arrhythmia w/o CC/MCCMS-DRG3108$5,753.79$7,335.59$20,997
GI hemorrhage w CCMS-DRG3788$8,439.89$10,468$41,777
GI hemorrhage w/o CC/MCCMS-DRG3798$3,834.57$7,286.49$29,461
Esophagitis/gastroenteritis w/o MCCMS-DRG3928$7,736.3$9,837.61$38,323
Fractures of femur w/o MCCMS-DRG5336$15,054$17,714$82,903
Kidney/UTI w MCCMS-DRG6896$11,271$13,182$49,481
Kidney/UTI w/o MCCMS-DRG6906$8,013.95$9,278.94$27,074
Septicemia or severe sepsis w MV 96+ hrsMS-DRG8716$18,535$21,883$76,066
Septicemia or severe sepsis w/o MV 96+ hrsMS-DRG8726$9,999.25$11,657$38,847
lab
Basic metabolic panel (BMP)CPT8004820$350$210$8.36$101$297.5
Electrolyte panelCPT8005120$259$155.4$6.92$80.95$220.15
Comprehensive metabolic panelCPT8005320$1,031$618.6$10.43$126.14$876.35
Lipid panelCPT8006120$1,200$720$13.24$122.38$1,020
Renal function panelCPT8006920$707$424.2$8.58$103.59$600.95
Hepatic function panelCPT8007620$727$436.2$8.08$97.49$617.95
Urinalysis non-automatedCPT8100220$36$21.6$3.44$23.4$31.24
Urinalysis automatedCPT8100320$82$49.2$2.22$27.48$69.7
Glucose quantitativeCPT8294720$338$202.8$3.89$34.17$287.3
Hemoglobin A1cCPT8303620$694$416.4$7$173.5$589.9
Thyroid stimulating hormone (TSH)CPT8444320$364$218.4$16.6$126.4$309.4
Complete blood count with automated differentialCPT8502520$402$241.2$6$67.5$341.7
Complete blood count without differentialCPT8502720$350$210$6.39$56.22$297.5
Urine culture bacterialCPT8708620$817$490.2$7.98$571.9$694.45
Urine culture identificationCPT8708820$127$76.2$8$70.26$107.95
Tissue exam by pathologist level IVCPT8830520$1,377$826.2$10.8$198.94$1,170.45
maternity
Fetal non-stress testCPT5902520$1,495$897$5.66$872.07$1,270.75
Vaginal delivery onlyCPT5940919$18,801$11,281$630.14$12,691$15,981
office
Office visit, new patient, 15-29 minCPT9920219$334$200.4$36.08$233.8$397.15
Office visit, new patient, 30-44 minutesCPT9920319$426$255.6$36.08$298.2$511.74
Office visit, new patient, 45-59 minCPT9920419$500$300$36.08$350$636.41
Office visit, new patient, 60-74 minCPT9920519$604$362.4$36.08$422.8$756.2
Office visit, established patient, 5 minCPT9921119$161$96.6$22$112.7$185.11
Office visit, established patient, 10-19 minCPT9921219$186$111.6$28.6$130.2$234.7
Office visit, established patient, 20-29 minutesCPT9921319$246$147.6$36.08$172.2$302.38
Office visit, established patient, 30-39 minutesCPT9921419$280$168$36.08$196$364.09
Office visit, established patient, 40-54 minCPT9921519$334$200.4$36.08$233.8$423.12
preventive
Upper GI endoscopy diagnosticCPT4323520$5,393$3,235.8$137.74$3,505.45$4,584.05
Upper GI endoscopy with biopsyCPT4323920$7,218$4,330.8$163.44$4,691.7$6,135.3
Sigmoidoscopy diagnosticCPT4533020$1,248$748.8$58.47$938.75$2,302.88
Sigmoidoscopy with biopsyCPT4533120$5,393$3,235.8$70.04$3,505.45$4,584.05
Colonoscopy diagnosticCPT4537820$2,500$1,500$198.55$1,750$5,023.1
Colonoscopy with biopsyCPT4538020$7,218$4,330.8$247.96$4,691.7$6,135.3
Colonoscopy with polyp removalCPT4538520$7,218$4,330.8$294.89$4,691.7$6,135.3
surgery
Total shoulder arthroplastyCPT234729$931.2$15,500$19,286
PCI w drug-eluting stent w MCCMS-DRG2462$6,617.15$8,454.85$10,293
PCI w drug-eluting stent w/o MCCMS-DRG2472$6,620.74$8,456.65$10,293
Total hip replacementCPT271309$931.2$13,248$23,215
Total knee replacementCPT274479$931.2$13,248$23,215
Shoulder arthroscopy with decompressionCPT298265$652.2$2,644.32$5,760.66
Shoulder arthroscopy with rotator cuff repairCPT298279$931.2$6,921.14$8,687.12
Knee arthroscopy with meniscectomyCPT2988111$597.85$2,415.33$7,095.95
ACL reconstructionCPT298889$844.93$4,955.54$7,491.76
Major small/large bowel procedures w MCCMS-DRG3298$5,135.5$47,065$153,991
Major small/large bowel procedures w CCMS-DRG3308$3,474.33$24,805$96,087
Major small/large bowel procedures w/o CC/MCCMS-DRG3318$10,293$17,575$72,214
Laparoscopic cholecystectomy w/o CDE w MCCMS-DRG4188$10,293$17,663$69,230
Laparoscopic cholecystectomy w/o CDE w CCMS-DRG4198$10,293$14,366$57,565
Laparoscopic cholecystectomy w/o CDE w/o CC/MCCMS-DRG4208$7,621.27$35,027$178,694
Open appendectomyCPT449509$931.2$6,424.76$11,229
Laparoscopic appendectomyCPT449709$931.2$6,007.35$11,229
Spinal fusion (non-cervical) w MCCMS-DRG4592$10,293$15,644$20,996
Spinal fusion (non-cervical) w/o MCCMS-DRG4602$10,293$11,144$11,996
Major joint replacement w MCCMS-DRG4697$10,293$31,529$118,755
Major joint replacement w/o MCCMS-DRG4707$10,293$20,249$65,432
Laparoscopic cholecystectomyCPT475629$931.2$6,007.35$11,229
Lap cholecystectomy with cholangiographyCPT475639$931.2$6,007.35$11,229
Hip & femur procedures except major joint w MCCMS-DRG4808$10,293$32,672$218,514
Hip & femur procedures except major joint w CCMS-DRG4818$10,293$23,574$183,203
Hip & femur procedures except major joint w/o CC/MCCMS-DRG4828$10,293$18,418$70,261
Lap inguinal hernia repairCPT496509$914.33$5,652.97$7,095.95
Lap salpingo-oophorectomyCPT5866119$17,166$10,300$931.2$11,587$14,591
OR procedure for obesity w MCCMS-DRG6196$27,309$32,395$116,991
OR procedure for obesity w CCMS-DRG6206$15,357$18,076$69,284
OR procedure for obesity w/o CC/MCCMS-DRG6216$14,504$17,054$55,938
Complex cataract surgeryCPT669829$1,135.81$2,348.35$9,940.91
Cataract surgery with lens implantCPT6698411$662.78$2,348.35$9,940.91
Intravitreal injectionCPT6702820$4,347$2,608.2$116.47$2,467.92$3,694.95
Uterine & adnexa procedures w CC/MCCMS-DRG7436$12,018$14,076$47,365
Uterine & adnexa procedures w/o CC/MCCMS-DRG7446$19,525$21,282$55,287
PCI single major coronary arteryCPT9292016$35,714$21,428$860.28$25,893$30,357
PCI with drug-eluting stentCPT9292816$54,251$32,551$931.2$39,332$46,113
PCI bypass graftCPT9293716$54,251$32,551$517.93$39,332$46,113
Left heart catheterizationCPT9345219$19,097$11,458$931.2$12,890$16,232
Coronary angiography with cathCPT9345519$13,657$8,194.2$931.2$9,218.48$11,608
Coronary angiography with bypass cathCPT9345819$18,936$11,362$931.2$12,782$16,096

Payer mix (top 21)

PayerCodes coveredMedian rate
Blue Cross Blue Shield168$1,462.99
upmc health plan168$536.42
UnitedHealthcare168$248.89
Aetna167$286
pa health & wellness164$248.89
amerihealth caritas164$235.49
upmc work partners160$878.14
Multiplan159$1,601.88
geisinger113$207.96
Humana111$2,768.45
intergroup111$2,673.25
Cigna111$183.3
health payors organization111$2,768.45
fidelis111$2,442.75
health coalition partners111$2,605.6
preferred healthcare system111$2,117.05
private health care systems111$2,605.6
selectcare111$2,605.6
First Health111$2,279.9
health partners plans (jefferson health plan)94$143.72
premier comp solutions18$1,344.83