CMS Price Transparency Data

Drug screening test

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: G0480 (HCPCS)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: G0480
Insurance Median: $345
Cash Discount Price: $440
vs. Medicare Baseline: 3.01x Medicare

The contracted insurance negotiated median rate for a Drug screening test at UPMC Children's Hospital of Pittsburgh is $345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $440. Compared to the federal Medicare reimbursement reference rate of $114.43, this hospital’s rate is 3.01x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$440

Average discount available for prompt cash payment at this facility.

Insurance Median

$345

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$114.43

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $114.43 (100%)

Cash / Self-Pay: $440 (385%)

Insurance Median: $345 (301%)

Cash: $440 (385% of Medicare)

Ins. Median: $345 (301% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $114.43 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 301% of the Medicare baseline (a markup of 201%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$102 - $404	89%
Health Plan of Upper Ohio Valley	$114 - $477	100%
Blue Cross Blue Shield	$121 - $239	106%
Amerihealth Caritas	$124 - $239	108%
Cigna	$124 - $404	108%
UPMC Health Plan	$148 - $307	129%
Health Partners Plans (Jefferson Health Plan)	$247	216%
UnitedHealthcare	$254 - $345	222%
Highmark Wholecare (Prev Gateway)	$258	225%
PA Health & Wellness	$259	226%
Geisinger	$263 - $330	230%
Intergroup	$477 - $624	417%
Coventry/First Health	$587	513%
Saudi Armed Forces	$587	513%
Health Payors Organization	$624	545%
Multiplan	$624	545%
Private Health Care Systems	$661	578%
National Provider Network	$661	578%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $440.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify HCPCS Code matches exactly: G0480.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Children's Hospital of Pittsburgh is fully in-network.
Ask your insurer if "Prior Authorization" is required for HCPCS code G0480.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.