Foam drg >16<=48 sq in w/bdr at UPMC Jameson
1211 Wilmington Avenue, New Castle, PA · UPMC · · NPI 111471575
$12.00
Cash price Discounted cash price What a hospital charges a self-pay patient who pays directly, without going through insurance — usually well below the gross charge. Example: A CT scan has a $3,200 gross charge but an $850 discounted cash price. Ask for it by name when scheduling — hospitals don't always advertise it up front.
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What you pay up front if you don't use insurance.
$20.00
Gross charge Gross charge (chargemaster price) The hospital's full, undiscounted list price — pulled from its internal "chargemaster" price list. Almost no one actually pays this. Example: A chest X-ray has a gross charge of $1,450. The same hospital's discounted cash price for the same X-ray is $180 — the gross charge mostly anchors negotiations, not what patients pay.
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The hospital's undiscounted list price — almost no one pays this.
$6.16 with Cigna vs $40.77 with UPMC Health Plan — same scan, same building. Share
Negotiated rates by payer
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →
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Negotiated rate
The price a specific insurance plan agreed to pay the hospital for a service — it varies by insurer, and even by plan within the same insurer.
Example: The same knee MRI has a negotiated rate of $904 with one insurer's PPO plan and $1,509 with another's — identical hospital, identical scan.
Full explanation →Payer ?Payer The insurance company footing the bill — Aetna, UnitedHealthcare, Medicare, and so on. Example: "Blue Cross Blue Shield" is the payer. Its negotiated rate for an MRI might be $904, while a different payer's negotiated rate for the same scan is $1,509. Full explanation → |
Plan ?Plan The specific product an insurer sells — e.g. "Blue Cross PPO 500" — which sets your deductible, coinsurance and negotiated rates. Example: Two people both insured by Aetna can owe very different amounts for the same MRI: $50 with an HMO plan's flat copay, or the full $1,200 toward a high-deductible PPO plan's unmet deductible. Full explanation → |
Negotiated rate | vs. cash |
|---|---|---|---|
| Cigna | Commercial | $6.16 | ↓ -49% |
| United Healthcare | Commercial | $7.54 | ↓ -37% |
| UPMC Health Plan | Commercial | $9.00 | ↓ -25% |
| Aetna of PA | Medicare | $9.78 | ↓ -19% |
| Highmark Wholecare (prev Gateway) | Medicare | $10.00 | ↓ -17% |
| PA Health & Wellness | PA Medicaid HMO | $11.00 | ↓ -8% |
| Geisinger | Medicaid/CHIP | $11.00 | ↓ -8% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $13.34 | ↑ +11% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $14.38 | ↑ +20% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $15.00 | ↑ +25% |
| Humana | Commercial | $16.00 | ↑ +33% |
| National Provider Network | PPO | $17.60 | ↑ +47% |
| UPMC Health Plan | CHIP | $40.77 | ↑ +240% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
Comments
Foam drg >16<=48 sq in w/bdr at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $10.20 | $8.50 – $40.77 |
| UPMC East | Monroeville | $19.80 | $7.75 – $40.77 |
| UPMC Hamot | Erie | $15.60 | $14.13 – $14.13 |
| UPMC Horizon-Greenville | Greenville | $13.80 | $36.00 – $40.77 |
| UPMC Magee | Pittsburgh | $18.60 | $10.76 – $40.77 |
| UPMC Passavant-McCandless | Pittsburgh | $25.20 | $14.26 – $59.16 |
| UPMC Presbyterian | Pittsburgh | $34.20 | $13.92 – $65.91 |
| UPMC St. Margaret | Pittsburgh | $19.80 | $14.26 – $50.03 |