healthcosts.net
Special physics consult at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$1,215.00
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.
$2,025.00
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.
$105.52 with UPMC Health Plan vs $1,822.50 with Health Payors Organization — 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 Medicare | $105.52 | ↓ -91% |
| UPMC Health Plan | Managed Medicaid | $106.15 | ↓ -91% |
| United Healthcare Community Plan for Families | PA Medicaid | $110.97 | ↓ -91% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $129.90 | ↓ -89% |
| Aetna of PA | Medicare | $132.91 | ↓ -89% |
| AmeriHealth Caritas | Medicare | $136.71 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicare | $136.71 | ↓ -89% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $136.71 | ↓ -89% |
| Aetna | Medicare | $139.24 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicaid | $143.11 | ↓ -88% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $149.26 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $152.70 | ↓ -87% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $164.46 | ↓ -86% |
| UPMC Health Plan | Commercial | $238.62 | ↓ -80% |
| UPMC Work Partners | Workers Comp | $329.48 | ↓ -73% |
| Highmark BCBS of PA | Managed Care - Social Mission | $336.17 | ↓ -72% |
| Highmark BCBS of PA | Managed Care | $450.18 | ↓ -63% |
| UPMC Health Plan | CHIP | $480.42 | ↓ -60% |
| Bravo | Medicare | $506.25 | ↓ -58% |
| Aetna | Neighborhood Network | $564.98 | ↓ -53% |
| Aetna | Home Depot Employer Group | $616.61 | ↓ -49% |
| Aetna | NBR ASO/FI | $627.75 | ↓ -48% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $634.06 | ↓ -48% |
| Cigna | New Business ASO | $688.50 | ↓ -43% |
| Aetna | EBR FI | $769.50 | ↓ -37% |
| Cigna | Commercial | $810.00 | ↓ -33% |
| Aetna | EBR ASO | $810.00 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity | $849.18 | ↓ -30% |
| Coventry/First Health | Commercial | $891.00 | ↓ -27% |
| InterGroup | PPO | $1,012.50 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $1,215.00 | ↑ +0% |
| Private Health Care Systems | PPO | $1,518.75 | ↑ +25% |
| InterGroup | Approved National Affiliated PPO Business | $1,620.00 | ↑ +33% |
| American Healthcare Group | Commercial | $1,620.00 | ↑ +33% |
| National Provider Network | PPO | $1,660.50 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $1,822.50 | ↑ +50% |
| Health Payors Organization | Commercial | $1,822.50 | ↑ +50% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Special physics consult at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $833.40 | $106.15 – $1,180.65 |
| UPMC Presbyterian | Pittsburgh | $1,254.00 | $106.15 – $1,776.50 |
| UPMC St. Margaret | Pittsburgh | $591.00 | $106.15 – $837.25 |
| UPMC Northwest | Seneca | $564.00 | $106.15 – $799.00 |
| UPMC Somerset | Somerset | $892.20 | $106.15 – $1,115.25 |
| UPMC Williamsport | Williamsport | $732.00 | $106.15 – $976.00 |