healthcosts.net
Sigmoidoscopy and biopsy at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$1,550.40
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.
$2,584.00
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.
$70.04 with UPMC Health Plan vs $3,376.25 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 | $70.04 | ↓ -95% |
| United Healthcare Community Plan for Families | PA Medicaid | $73.22 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $94.42 | ↓ -94% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $100.75 | ↓ -94% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $108.51 | ↓ -93% |
| UPMC Work Partners | Workers Comp | $386.35 | ↓ -75% |
| Private Health Care Systems | PPO | $444.00 | ↓ -71% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $545.04 | ↓ -65% |
| Aetna | Neighborhood Network | $720.94 | ↓ -53% |
| UPMC Health Plan | Managed Medicare | $724.57 | ↓ -53% |
| Aetna | Home Depot Employer Group | $786.83 | ↓ -49% |
| Aetna | NBR ASO/FI | $801.04 | ↓ -48% |
| Cigna | New Business ASO | $878.56 | ↓ -43% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $891.98 | ↓ -42% |
| Bravo | Medicare | $904.40 | ↓ -42% |
| Aetna of PA | Medicare | $912.67 | ↓ -41% |
| AmeriHealth Caritas | Medicare | $938.75 | ↓ -39% |
| Highmark Wholecare (prev Gateway) | Medicare | $938.75 | ↓ -39% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $938.75 | ↓ -39% |
| Aetna | Medicare | $956.13 | ↓ -38% |
| Aetna | EBR FI | $981.92 | ↓ -37% |
| Cigna | Commercial | $1,033.60 | ↓ -33% |
| Aetna | EBR ASO | $1,033.60 | ↓ -33% |
| UPMC Health Plan | Commercial | $1,077.66 | ↓ -30% |
| Coventry/First Health | Commercial | $1,136.96 | ↓ -27% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,227.54 | ↓ -21% |
| InterGroup | PPO | $1,292.00 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $1,550.40 | ↑ +0% |
| Highmark BCBS of PA | Managed Care | $1,643.85 | ↑ +6% |
| UPMC Health Plan | CHIP | $1,715.28 | ↑ +11% |
| InterGroup | Approved National Affiliated PPO Business | $2,067.20 | ↑ +33% |
| American Healthcare Group | Commercial | $2,067.20 | ↑ +33% |
| National Provider Network | PPO | $2,118.88 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $2,325.60 | ↑ +50% |
| Health Payors Organization | Commercial | $2,325.60 | ↑ +50% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,521.08 | ↑ +63% |
| Highmark BCBS of PA | Commercial - Indemnity | $3,376.25 | ↑ +118% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Sigmoidoscopy and biopsy at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,788.60 | $70.04 – $2,533.85 |
| UPMC Presbyterian | Pittsburgh | $3,235.80 | $70.04 – $4,584.05 |
| UPMC St. Margaret | Pittsburgh | $1,864.80 | $70.04 – $2,641.80 |
| UPMC Muncy | Muncy | $3,156.60 | $70.04 – $4,208.80 |
| UPMC Northwest | Seneca | $1,558.20 | $70.04 – $2,207.45 |
| UPMC Wellsboro | Wellsboro | $3,816.80 | $70.04 – $4,293.90 |
| UPMC Williamsport | Williamsport | $3,156.60 | $70.04 – $4,208.80 |
| UPMC Somerset | Somerset | not published | $70.04 – $869.21 |