healthcosts.net
Ghs i and d pilonidal cyst complex at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$1,246.80
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.
$2,078.00
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.
$123.75 with UPMC Health Plan vs $2,072.59 with Highmark BCBS of PA — 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 | $123.75 | ↓ -90% |
| United Healthcare Community Plan for Families | PA Medicaid | $129.38 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $166.84 | ↓ -87% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $178.02 | ↓ -86% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $191.72 | ↓ -85% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $334.58 | ↓ -73% |
| UPMC Work Partners | Workers Comp | $359.04 | ↓ -71% |
| UPMC Health Plan | Managed Medicare | $559.17 | ↓ -55% |
| Aetna | Neighborhood Network | $579.76 | ↓ -54% |
| Aetna | Home Depot Employer Group | $632.75 | ↓ -49% |
| Aetna | NBR ASO/FI | $644.18 | ↓ -48% |
| UPMC Health Plan | Commercial | $658.10 | ↓ -47% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $688.36 | ↓ -45% |
| Aetna of PA | Medicare | $704.33 | ↓ -44% |
| Cigna | New Business ASO | $706.52 | ↓ -43% |
| AmeriHealth Caritas | Medicare | $724.45 | ↓ -42% |
| Highmark Wholecare (prev Gateway) | Medicare | $724.45 | ↓ -42% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $724.45 | ↓ -42% |
| Bravo | Medicare | $727.30 | ↓ -42% |
| Aetna | Medicare | $737.87 | ↓ -41% |
| Highmark BCBS of PA | Managed Care - Social Mission | $753.55 | ↓ -40% |
| Aetna | EBR FI | $789.64 | ↓ -37% |
| Cigna | Commercial | $831.20 | ↓ -33% |
| Aetna | EBR ASO | $831.20 | ↓ -33% |
| Coventry/First Health | Commercial | $914.32 | ↓ -27% |
| Highmark BCBS of PA | Managed Care | $1,009.12 | ↓ -19% |
| InterGroup | PPO | $1,039.00 | ↓ -17% |
| UPMC Health Plan | CHIP | $1,047.48 | ↓ -16% |
| Cigna Behavioral Health | Commercial | $1,246.80 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,547.62 | ↑ +24% |
| Private Health Care Systems | PPO | $1,558.50 | ↑ +25% |
| InterGroup | Approved National Affiliated PPO Business | $1,662.40 | ↑ +33% |
| American Healthcare Group | Commercial | $1,662.40 | ↑ +33% |
| National Provider Network | PPO | $1,703.96 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $1,870.20 | ↑ +50% |
| Health Payors Organization | Commercial | $1,870.20 | ↑ +50% |
| Highmark BCBS of PA | Commercial - Indemnity | $2,072.59 | ↑ +66% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Ghs i and d pilonidal cyst complex at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,572.00 | $123.75 – $2,227.00 |
| UPMC Presbyterian | Pittsburgh | $1,549.80 | $123.75 – $2,195.55 |
| UPMC St. Margaret | Pittsburgh | $1,541.40 | $123.75 – $2,183.65 |
| UPMC Muncy | Muncy | $3,349.80 | $123.75 – $4,466.40 |
| UPMC Somerset | Somerset | $1,341.60 | $123.75 – $1,677.00 |
| UPMC Wellsboro | Wellsboro | $4,051.20 | $123.75 – $4,557.60 |