healthcosts.net
Sig w/tndsc balloon dilation at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$2,736.60
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.
$4,561.00
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.
$109.36 with UPMC Health Plan vs $4,104.90 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 | $109.36 | ↓ -96% |
| United Healthcare Community Plan for Families | PA Medicaid | $114.33 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $147.44 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $157.32 | ↓ -94% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $169.43 | ↓ -94% |
| Private Health Care Systems | PPO | $444.00 | ↓ -84% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $584.39 | ↓ -79% |
| UPMC Work Partners | Workers Comp | $688.71 | ↓ -75% |
| UPMC Health Plan | Commercial | $845.80 | ↓ -69% |
| UPMC Health Plan | Managed Medicare | $937.06 | ↓ -66% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,153.56 | ↓ -58% |
| Aetna of PA | Medicare | $1,180.32 | ↓ -57% |
| AmeriHealth Caritas | Medicare | $1,214.04 | ↓ -56% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,214.04 | ↓ -56% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,214.04 | ↓ -56% |
| Aetna | Medicare | $1,236.52 | ↓ -55% |
| Aetna | Neighborhood Network | $1,272.52 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,316.16 | ↓ -52% |
| UPMC Health Plan | CHIP | $1,346.24 | ↓ -51% |
| Aetna | Home Depot Employer Group | $1,388.82 | ↓ -49% |
| Aetna | NBR ASO/FI | $1,413.91 | ↓ -48% |
| Cigna | New Business ASO | $1,550.74 | ↓ -43% |
| Bravo | Medicare | $1,596.35 | ↓ -42% |
| Aetna | EBR FI | $1,733.18 | ↓ -37% |
| Highmark BCBS of PA | Managed Care | $1,762.53 | ↓ -36% |
| Cigna | Commercial | $1,824.40 | ↓ -33% |
| Aetna | EBR ASO | $1,824.40 | ↓ -33% |
| Coventry/First Health | Commercial | $2,006.84 | ↓ -27% |
| InterGroup | PPO | $2,280.50 | ↓ -17% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,703.09 | ↓ -1% |
| Cigna Behavioral Health | Commercial | $2,736.60 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Indemnity | $3,620.01 | ↑ +32% |
| InterGroup | Approved National Affiliated PPO Business | $3,648.80 | ↑ +33% |
| American Healthcare Group | Commercial | $3,648.80 | ↑ +33% |
| National Provider Network | PPO | $3,740.02 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $4,104.90 | ↑ +50% |
| Health Payors Organization | Commercial | $4,104.90 | ↑ +50% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Sig w/tndsc balloon dilation at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,763.20 | $109.36 – $5,331.20 |
| UPMC Presbyterian | Pittsburgh | $9,642.00 | $109.36 – $13,659.50 |
| UPMC St. Margaret | Pittsburgh | $4,032.00 | $109.36 – $5,712.00 |
| UPMC Wellsboro | Wellsboro | $3,933.60 | $109.36 – $4,425.30 |
| UPMC Williamsport | Williamsport | $3,097.80 | $109.36 – $4,130.40 |