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Tx phalangeal shaft fx open prox/middle ea at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$4,706.40
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.
$7,844.00
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.
$246.40 with UPMC Health Plan vs $7,059.60 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 Medicaid | $246.40 | ↓ -95% |
| United Healthcare Community Plan for Families | PA Medicaid | $257.60 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $332.19 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $354.46 | ↓ -92% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $381.74 | ↓ -92% |
| Private Health Care Systems | PPO | $840.00 | ↓ -82% |
| UPMC Work Partners | Workers Comp | $1,023.18 | ↓ -78% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,030.96 | ↓ -78% |
| UPMC Health Plan | Commercial | $2,042.76 | ↓ -57% |
| Aetna | Neighborhood Network | $2,188.48 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $2,321.94 | ↓ -51% |
| Aetna | Home Depot Employer Group | $2,388.50 | ↓ -49% |
| Aetna | NBR ASO/FI | $2,431.64 | ↓ -48% |
| UPMC Health Plan | Managed Medicare | $2,578.62 | ↓ -45% |
| Cigna | New Business ASO | $2,666.96 | ↓ -43% |
| Bravo | Medicare | $2,745.40 | ↓ -42% |
| Aetna | EBR FI | $2,980.72 | ↓ -37% |
| Highmark BCBS of PA | Managed Care | $3,109.42 | ↓ -34% |
| Cigna | Commercial | $3,137.60 | ↓ -33% |
| Aetna | EBR ASO | $3,137.60 | ↓ -33% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,174.40 | ↓ -33% |
| Aetna of PA | Medicare | $3,248.02 | ↓ -31% |
| UPMC Health Plan | CHIP | $3,251.42 | ↓ -31% |
| AmeriHealth Caritas | Medicare | $3,340.82 | ↓ -29% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.82 | ↓ -29% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,340.82 | ↓ -29% |
| Aetna | Medicare | $3,402.68 | ↓ -28% |
| Coventry/First Health | Commercial | $3,451.36 | ↓ -27% |
| InterGroup | PPO | $3,922.00 | ↓ -17% |
| Cigna Behavioral Health | Commercial | $4,706.40 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $4,768.74 | ↑ +1% |
| InterGroup | Approved National Affiliated PPO Business | $6,275.20 | ↑ +33% |
| American Healthcare Group | Commercial | $6,275.20 | ↑ +33% |
| Highmark BCBS of PA | Commercial - Indemnity | $6,386.35 | ↑ +36% |
| National Provider Network | PPO | $6,432.08 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $7,059.60 | ↑ +50% |
| Health Payors Organization | Commercial | $7,059.60 | ↑ +50% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Tx phalangeal shaft fx open prox/middle ea at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $5,776.80 | $246.40 – $8,183.80 |
| UPMC Presbyterian | Pittsburgh | $5,854.20 | $246.40 – $8,293.45 |
| UPMC Muncy | Muncy | $6,497.40 | $246.40 – $8,663.20 |
| UPMC Northwest | Seneca | $6,170.40 | $246.40 – $8,741.40 |
| UPMC Wellsboro | Wellsboro | $6,348.00 | $246.40 – $9,522.00 |
| UPMC Williamsport | Williamsport | $6,348.00 | $246.40 – $8,464.00 |