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Ghs simple repair 7.6 - 12.5 cm - 12004 at UPMC Passavant-McCandless
9100 Babcock Boulevard, Pittsburgh, PA · UPMC · · NPI 1225047699
$1,070.40
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.
$1,784.00
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.
$53.35 with UPMC Health Plan vs $1,516.40 with Humana — 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 | $53.35 | ↓ -95% |
| United Healthcare Community Plan for Families | Unison Kids | $55.77 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $71.93 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $75.71 | ↓ -93% |
| PA Health & Wellness | PA Medicaid HMO | $82.65 | ↓ -92% |
| UPMC Health Plan | Managed Medicare | $176.05 | ↓ -84% |
| Health Plan of Upper Ohio Valley | Medicare | $189.44 | ↓ -82% |
| Health Plan of Upper Ohio Valley | Medicaid | $189.44 | ↓ -82% |
| United Healthcare | Unison Advantage Non Special Needs | $198.91 | ↓ -81% |
| Aetna of PA | Medicare | $198.91 | ↓ -81% |
| Highmark Wholecare (prev Gateway) | Medicare | $204.58 | ↓ -81% |
| AmeriHealth Caritas | Medicare | $204.60 | ↓ -81% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $204.60 | ↓ -81% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $206.41 | ↓ -81% |
| Aetna | Medicare | $208.38 | ↓ -81% |
| United Healthcare | Unison Advantage Special Needs | $208.38 | ↓ -81% |
| UPMC Health Plan | Commercial | $287.32 | ↓ -73% |
| UPMC Work Partners | Workers Comp | $333.58 | ↓ -69% |
| Private Health Care Systems | Workers' Comp | $387.88 | ↓ -64% |
| Highmark BCBS of PA | Managed Care - Social Mission | $459.58 | ↓ -57% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $572.91 | ↓ -46% |
| Cigna | New Business ASO | $606.56 | ↓ -43% |
| Highmark BCBS of PA | Managed Care | $615.50 | ↓ -42% |
| Cigna | Commercial | $713.60 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity | $767.29 | ↓ -28% |
| Health Plan of Upper Ohio Valley | Commercial | $824.21 | ↓ -23% |
| Highmark BCBS of PA | UPMC Emergent | $1,231.01 | ↑ +15% |
| Coventry/First Health | Commercial | $1,248.80 | ↑ +17% |
| InterGroup | PPO | $1,480.72 | ↑ +38% |
| Private Health Care Systems | PPO | $1,516.40 | ↑ +42% |
| Multiplan | PPO (Includes Workers' Comp) | $1,516.40 | ↑ +42% |
| Humana | Commercial | $1,516.40 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Ghs simple repair 7.6 - 12.5 cm - 12004 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $510.00 | $53.35 – $765.00 |
| UPMC Presbyterian | Pittsburgh | $1,341.60 | $53.35 – $1,900.60 |
| UPMC St. Margaret | Pittsburgh | $753.00 | $53.35 – $1,066.75 |
| UPMC Muncy | Muncy | $589.80 | $53.35 – $944.64 |
| UPMC Northwest | Seneca | $610.80 | $53.35 – $865.30 |
| UPMC Somerset | Somerset | $808.20 | $53.35 – $1,010.25 |
| UPMC Wellsboro | Wellsboro | $712.80 | $53.35 – $944.64 |
| UPMC Williamsport | Williamsport | $589.80 | $53.35 – $944.64 |