healthcosts.net
#flow interp 9 - 15 markers at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$777.00
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.
$1,295.00
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.
$45.99 with UPMC Health Plan vs $1,165.50 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 | Commercial | $45.99 | ↓ -94% |
| UPMC Health Plan | Managed Medicaid | $74.04 | ↓ -90% |
| United Healthcare Community Plan for Families | PA Medicaid | $77.41 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $99.82 | ↓ -87% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $106.51 | ↓ -86% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $114.71 | ↓ -85% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $156.40 | ↓ -80% |
| UPMC Work Partners | Workers Comp | $163.83 | ↓ -79% |
| UPMC Health Plan | CHIP | $166.71 | ↓ -79% |
| Highmark BCBS of PA | Managed Care - Social Mission | $236.20 | ↓ -70% |
| Highmark BCBS of PA | Managed Care | $316.30 | ↓ -59% |
| Aetna | Medicare | $323.75 | ↓ -58% |
| Aetna | Neighborhood Network | $361.31 | ↓ -53% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $373.33 | ↓ -52% |
| Aetna | Home Depot Employer Group | $394.33 | ↓ -49% |
| Aetna | NBR ASO/FI | $401.45 | ↓ -48% |
| Cigna | New Business ASO | $440.30 | ↓ -43% |
| Bravo | Medicare | $453.25 | ↓ -42% |
| Aetna | EBR FI | $492.10 | ↓ -37% |
| Highmark BCBS of PA | Commercial - Indemnity | $499.98 | ↓ -36% |
| Aetna | EBR ASO | $518.00 | ↓ -33% |
| Cigna | Commercial | $518.00 | ↓ -33% |
| Coventry/First Health | Commercial | $569.80 | ↓ -27% |
| Highmark Wholecare (prev Gateway) | Medicare | $647.50 | ↓ -17% |
| InterGroup | PPO | $647.50 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $777.00 | ↑ +0% |
| Private Health Care Systems | PPO | $971.25 | ↑ +25% |
| American Healthcare Group | Commercial | $1,036.00 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $1,036.00 | ↑ +33% |
| National Provider Network | PPO | $1,061.90 | ↑ +37% |
| Health Payors Organization | Commercial | $1,165.50 | ↑ +50% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $1,165.50 | ↑ +50% |
Visitor-reported prices
Comments
#flow interp 9 - 15 markers at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $627.60 | $46.27 – $333.20 |
| UPMC Presbyterian | Pittsburgh | $303.00 | $48.82 – $429.25 |
| UPMC St. Margaret | Pittsburgh | $575.40 | $46.38 – $815.15 |
| UPMC Muncy | Muncy | $288.00 | $72.00 – $384.00 |
| UPMC Northwest | Seneca | $303.00 | $46.29 – $429.25 |
| UPMC Somerset | Somerset | $55.20 | $32.11 – $154.82 |
| UPMC Wellsboro | Wellsboro | $348.00 | $67.31 – $390.60 |
| UPMC Williamsport | Williamsport | $287.40 | $74.04 – $383.20 |