Optx clavicular fx w/int fix at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
not published by hospital
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.
not published by hospital
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.
$681.00 with Private Health Care Systems vs $7,491.76 with Aetna — 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 |
|---|---|---|---|
| Private Health Care Systems | PPO | $681.00 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $836.96 | — |
| UPMC Work Partners | Workers Comp | $1,497.60 | — |
| UPMC Health Plan | Commercial | $1,657.65 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,885.01 | — |
| Highmark BCBS of PA | Managed Care | $2,524.30 | — |
| UPMC Health Plan | CHIP | $2,638.44 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,871.38 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $5,184.59 | — |
| UPMC Health Plan | Managed Medicare | $5,677.39 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $6,989.13 | — |
| Aetna of PA | Medicare | $7,151.22 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $7,355.55 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $7,355.55 | — |
| AmeriHealth Caritas | Medicare | $7,355.55 | — |
| Aetna | Medicare | $7,491.76 | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Optx clavicular fx w/int fix at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | not published | $844.93 – $7,491.76 |
| UPMC Presbyterian | Pittsburgh | not published | $844.93 – $7,491.76 |
| UPMC Cole | Coudersport | $1,123.20 | $518.92 – $1,497.60 |
| UPMC Williamsport | Williamsport | $5,152.80 | $993.28 – $7,355.55 |
| Uniontown Hospital | Uniontown | $13,916.51 | $7,033.14 – $16,387.22 |
| UPMC Altoona | Altoona | not published | $836.96 – $7,355.55 |
| UPMC Carlisle | Carlisle | not published | $1,016.56 – $10,934.13 |
| UPMC Community Osteopathic | Harrisburg | not published | $1,016.56 – $15,488.55 |