Removal of breast lesion at UPMC Magee
300 Halket Street, Pittsburgh, PA · UPMC · · NPI 1952311508
$4,093.20
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.
$6,822.00
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.
$190.30 with UPMC Health Plan vs $6,276.24 with Multiplan — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $190.30 | ↓ -95% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $190.30 | ↓ -95% |
| Aetna | CHIP/Medicaid | $224.90 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $256.56 | ↓ -94% |
| Geisinger | Medicaid/CHIP | $269.31 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $273.76 | ↓ -93% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $294.83 | ↓ -93% |
| UPMC Work Partners | Workers Comp | $698.30 | ↓ -83% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $844.93 | ↓ -79% |
| UPMC Health Plan | Commercial | $1,643.73 | ↓ -60% |
| Highmark BCBS of PA | Managed Care - Social Mission | $2,444.47 | ↓ -40% |
| Aetna | Neighborhood Network | $2,455.92 | ↓ -40% |
| UPMC Health Plan | CHIP | $2,654.85 | ↓ -35% |
| Aetna | EBR FI | $2,660.58 | ↓ -35% |
| Aetna | Home Depot Employer Group | $2,674.22 | ↓ -35% |
| Cigna | New Business ASO | $2,728.80 | ↓ -33% |
| Aetna | EBR ASO | $2,728.80 | ↓ -33% |
| Aetna | NBR ASO/FI | $2,728.80 | ↓ -33% |
| Cigna | Commercial | $2,728.80 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,834.18 | ↓ -31% |
| Highmark BCBS of PA | Managed Care | $3,273.60 | ↓ -20% |
| InterGroup | PPO | $3,411.00 | ↓ -17% |
| UPMC Health Plan | Managed Medicare | $3,416.75 | ↓ -17% |
| UPMC Health Plan | Partners/Select | $3,744.95 | ↓ -9% |
| Highmark BCBS of PA | Commercial - Indemnity | $3,795.60 | ↓ -7% |
| Aetna of PA | Medicare | $3,833.30 | ↓ -6% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,942.46 | ↓ -4% |
| AmeriHealth Caritas | Medicare | $3,942.82 | ↓ -4% |
| United Healthcare | Medicare | $3,942.82 | ↓ -4% |
| Aetna | Medicare | $4,015.84 | ↓ -2% |
| Coventry/First Health | Commercial | $4,775.40 | ↑ +17% |
| Highmark BCBS of PA | UPMC Emergent | $4,910.42 | ↑ +20% |
| Preferred Healthcare System | PPO | $5,457.60 | ↑ +33% |
| Humana | Commercial | $5,798.70 | ↑ +42% |
| Private Health Care Systems | PPO | $5,798.70 | ↑ +42% |
| Multiplan | PPO | $6,276.24 | ↑ +53% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Removal of breast lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Presbyterian | Pittsburgh | not published | $190.30 – $4,015.84 |
| UPMC Cole | Coudersport | $620.40 | $181.65 – $1,192.92 |
| UPMC Community Osteopathic | Harrisburg | $1,078.20 | $233.55 – $6,850.20 |
| UPMC Somerset | Somerset | $1,078.20 | $190.30 – $3,650.76 |
| Uniontown Hospital | Uniontown | $1,480.00 | $3,795.06 – $8,842.49 |
| WellSpan Evangelical Community Hospital | Lewisburg | $5,848.80 | $190.30 – $224.90 |
| UPMC Altoona | Altoona | not published | $173.00 – $3,942.82 |
| UPMC Bedford | Everett | not published | $181.65 – $3,942.82 |