healthcosts.net
Colonoscopy (with polyp removal) at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$3,349.80
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.
?
What you pay up front if you don't use insurance.
$5,583.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$294.89 with UPMC Health Plan vs $5,024.70 with Health Payors Organization — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $294.89 | ↓ -91% |
| United Healthcare Community Plan for Families | PA Medicaid | $308.29 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicaid | $397.56 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $424.21 | ↓ -87% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $456.86 | ↓ -86% |
| Private Health Care Systems | PPO | $596.00 | ↓ -82% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $729.80 | ↓ -78% |
| UPMC Health Plan | Managed Medicare | $937.06 | ↓ -72% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,153.56 | ↓ -66% |
| Aetna of PA | Medicare | $1,180.32 | ↓ -65% |
| AmeriHealth Caritas | Medicare | $1,214.04 | ↓ -64% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,214.04 | ↓ -64% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,214.04 | ↓ -64% |
| Aetna | Medicare | $1,236.52 | ↓ -63% |
| UPMC Work Partners | Workers Comp | $1,263.69 | ↓ -62% |
| UPMC Health Plan | Commercial | $1,443.45 | ↓ -57% |
| Aetna | Neighborhood Network | $1,557.66 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,643.66 | ↓ -51% |
| Aetna | Home Depot Employer Group | $1,700.02 | ↓ -49% |
| Aetna | NBR ASO/FI | $1,730.73 | ↓ -48% |
| Cigna | New Business ASO | $1,898.22 | ↓ -43% |
| Bravo | Medicare | $1,954.05 | ↓ -42% |
| Aetna | EBR FI | $2,121.54 | ↓ -37% |
| Highmark BCBS of PA | Managed Care | $2,201.11 | ↓ -34% |
| Cigna | Commercial | $2,233.20 | ↓ -33% |
| Aetna | EBR ASO | $2,233.20 | ↓ -33% |
| UPMC Health Plan | CHIP | $2,297.51 | ↓ -31% |
| Coventry/First Health | Commercial | $2,456.52 | ↓ -27% |
| InterGroup | PPO | $2,791.50 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $3,349.80 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,375.71 | ↑ +1% |
| InterGroup | Approved National Affiliated PPO Business | $4,466.40 | ↑ +33% |
| American Healthcare Group | Commercial | $4,466.40 | ↑ +33% |
| Highmark BCBS of PA | Commercial - Indemnity | $4,520.78 | ↑ +35% |
| National Provider Network | PPO | $4,578.06 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $5,024.70 | ↑ +50% |
| Health Payors Organization | Commercial | $5,024.70 | ↑ +50% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Colonoscopy (with polyp removal) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $4,705.20 | $294.89 – $6,665.70 |
| UPMC Magee | Pittsburgh | $5,583.00 | $294.89 – $8,560.60 |
| UPMC Presbyterian | Pittsburgh | $4,330.80 | $294.89 – $6,135.30 |
| UPMC St. Margaret | Pittsburgh | $4,436.40 | $294.89 – $6,284.90 |
| UPMC East | Monroeville | $3,055.20 | $294.89 – $4,073.60 |
| UPMC Hamot | Erie | $3,098.40 | $294.89 – $3,614.80 |
| UPMC Altoona | Altoona | $1,764.60 | $268.08 – $2,352.80 |
| UPMC Bedford | Everett | $1,581.00 | $281.48 – $2,371.50 |