healthcosts.net
Caloric vstblr test w/rec at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$559.80
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.
$933.00
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.
$3.03 with Highmark BCBS of PA vs $423.00 with Health Payors Organization — 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 |
|---|---|---|---|
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $3.03 | ↓ -99% |
| Highmark BCBS of PA | Managed Care - Social Mission | $6.82 | ↓ -99% |
| Highmark BCBS of PA | Managed Care | $9.14 | ↓ -98% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $12.83 | ↓ -98% |
| Highmark BCBS of PA | Commercial - Indemnity | $17.18 | ↓ -97% |
| UPMC Health Plan | Managed Medicaid | $17.68 | ↓ -97% |
| United Healthcare Community Plan for Families | PA Medicaid | $18.48 | ↓ -97% |
| Highmark Wholecare (prev Gateway) | Medicaid | $23.83 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $25.43 | ↓ -95% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $27.39 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $29.44 | ↓ -95% |
| Aetna | Medicare | $117.50 | ↓ -79% |
| UPMC Health Plan | Managed Medicare | $124.35 | ↓ -78% |
| Aetna | Neighborhood Network | $131.13 | ↓ -77% |
| Aetna | Home Depot Employer Group | $143.12 | ↓ -74% |
| Aetna | NBR ASO/FI | $145.70 | ↓ -74% |
| UPMC Health Plan | Commercial | $149.55 | ↓ -73% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $153.08 | ↓ -73% |
| Aetna of PA | Medicare | $156.63 | ↓ -72% |
| Cigna | New Business ASO | $159.80 | ↓ -71% |
| AmeriHealth Caritas | Medicare | $161.10 | ↓ -71% |
| Highmark Wholecare (prev Gateway) | Medicare | $161.10 | ↓ -71% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $161.10 | ↓ -71% |
| Bravo | Medicare | $164.50 | ↓ -71% |
| Aetna | EBR FI | $178.60 | ↓ -68% |
| Cigna | Commercial | $188.00 | ↓ -66% |
| Aetna | EBR ASO | $188.00 | ↓ -66% |
| UPMC Health Plan | CHIP | $189.39 | ↓ -66% |
| Coventry/First Health | Commercial | $206.80 | ↓ -63% |
| InterGroup | PPO | $235.00 | ↓ -58% |
| Cigna Behavioral Health | Commercial | $282.00 | ↓ -50% |
| Private Health Care Systems | PPO | $352.50 | ↓ -37% |
| InterGroup | Approved National Affiliated PPO Business | $376.00 | ↓ -33% |
| American Healthcare Group | Commercial | $376.00 | ↓ -33% |
| National Provider Network | PPO | $385.40 | ↓ -31% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $423.00 | ↓ -24% |
| Health Payors Organization | Commercial | $423.00 | ↓ -24% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Caloric vstblr test w/rec at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Presbyterian | Pittsburgh | $753.60 | $3.06 – $535.50 |