healthcosts.net
Drainage mouth roof lesion at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$1,651.80
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.
$2,753.00
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.
$22.00 with UPMC Health Plan vs $4,520.78 with Highmark BCBS of PA — 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 | $22.00 | ↓ -99% |
| United Healthcare Community Plan for Families | PA Medicaid | $23.00 | ↓ -99% |
| Highmark Wholecare (prev Gateway) | Medicaid | $29.66 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $31.65 | ↓ -98% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $34.08 | ↓ -98% |
| UPMC Health Plan | Managed Medicare | $184.55 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $189.21 | ↓ -89% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $227.19 | ↓ -86% |
| Aetna of PA | Medicare | $232.46 | ↓ -86% |
| AmeriHealth Caritas | Medicare | $239.10 | ↓ -86% |
| Highmark Wholecare (prev Gateway) | Medicare | $239.10 | ↓ -86% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $239.10 | ↓ -86% |
| Aetna | Medicare | $243.53 | ↓ -85% |
| Private Health Care Systems | PPO | $596.00 | ↓ -64% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $729.80 | ↓ -56% |
| Aetna | Neighborhood Network | $768.09 | ↓ -53% |
| Aetna | Home Depot Employer Group | $838.29 | ↓ -49% |
| Aetna | NBR ASO/FI | $853.43 | ↓ -48% |
| Cigna | New Business ASO | $936.02 | ↓ -43% |
| Bravo | Medicare | $963.55 | ↓ -42% |
| Aetna | EBR FI | $1,046.14 | ↓ -37% |
| Cigna | Commercial | $1,101.20 | ↓ -33% |
| Aetna | EBR ASO | $1,101.20 | ↓ -33% |
| Coventry/First Health | Commercial | $1,211.32 | ↓ -27% |
| InterGroup | PPO | $1,376.50 | ↓ -17% |
| UPMC Health Plan | Commercial | $1,443.77 | ↓ -13% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,643.66 | ↓ -0% |
| Cigna Behavioral Health | Commercial | $1,651.80 | ↑ +0% |
| Highmark BCBS of PA | Managed Care | $2,201.11 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $2,202.40 | ↑ +33% |
| American Healthcare Group | Commercial | $2,202.40 | ↑ +33% |
| National Provider Network | PPO | $2,257.46 | ↑ +37% |
| UPMC Health Plan | CHIP | $2,298.02 | ↑ +39% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $2,477.70 | ↑ +50% |
| Health Payors Organization | Commercial | $2,477.70 | ↑ +50% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,375.71 | ↑ +104% |
| Highmark BCBS of PA | Commercial - Indemnity | $4,520.78 | ↑ +174% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Drainage mouth roof lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,928.80 | $22.00 – $5,565.80 |
| UPMC Presbyterian | Pittsburgh | $5,288.40 | $22.00 – $7,491.90 |
| UPMC St. Margaret | Pittsburgh | $3,360.60 | $22.00 – $4,760.85 |
| UPMC Somerset | Somerset | $837.00 | $22.00 – $1,046.25 |
| UPMC Williamsport | Williamsport | $4,695.00 | $22.00 – $6,260.00 |