healthcosts.net
Puncture spinal lumbar diagnostic at UPMC Passavant-McCandless
9100 Babcock Boulevard, Pittsburgh, PA · UPMC · · NPI 1225047699
$1,230.60
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.
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What you pay up front if you don't use insurance.
$2,051.00
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.
$46.20 with UPMC Health Plan vs $3,281.43 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 | $46.20 | ↓ -96% |
| United Healthcare Community Plan for Families | Unison Kids | $48.30 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $62.29 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $65.57 | ↓ -95% |
| PA Health & Wellness | PA Medicaid HMO | $71.58 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $171.20 | ↓ -86% |
| Private Health Care Systems | Workers' Comp | $199.07 | ↓ -84% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $550.23 | ↓ -55% |
| UPMC Health Plan | Managed Medicare | $613.55 | ↓ -50% |
| Health Plan of Upper Ohio Valley | Medicare | $660.23 | ↓ -46% |
| Health Plan of Upper Ohio Valley | Medicaid | $660.23 | ↓ -46% |
| United Healthcare | Unison Advantage Non Special Needs | $693.24 | ↓ -44% |
| Aetna of PA | Medicare | $693.24 | ↓ -44% |
| Cigna | New Business ASO | $697.34 | ↓ -43% |
| Highmark Wholecare (prev Gateway) | Medicare | $712.98 | ↓ -42% |
| AmeriHealth Caritas | Medicare | $713.05 | ↓ -42% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $713.05 | ↓ -42% |
| Aetna | Medicare | $726.25 | ↓ -41% |
| United Healthcare | Unison Advantage Special Needs | $726.25 | ↓ -41% |
| UPMC Health Plan | Commercial | $774.14 | ↓ -37% |
| Cigna | Commercial | $820.40 | ↓ -33% |
| Health Plan of Upper Ohio Valley | Commercial | $947.56 | ↓ -23% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,225.07 | ↓ -0% |
| Coventry/First Health | Commercial | $1,435.70 | ↑ +17% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,527.18 | ↑ +24% |
| Highmark BCBS of PA | Managed Care | $1,640.71 | ↑ +33% |
| InterGroup | PPO | $1,702.33 | ↑ +38% |
| Private Health Care Systems | PPO | $1,743.35 | ↑ +42% |
| Multiplan | PPO (Includes Workers' Comp) | $1,743.35 | ↑ +42% |
| Humana | Commercial | $1,743.35 | ↑ +42% |
| Highmark BCBS of PA | Commercial - Indemnity | $2,045.33 | ↑ +66% |
| Highmark BCBS of PA | UPMC Emergent | $3,281.43 | ↑ +167% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Puncture spinal lumbar diagnostic at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $2,132.40 | $46.20 – $3,198.60 |
| UPMC Presbyterian | Pittsburgh | $2,715.60 | $46.20 – $3,847.10 |
| UPMC St. Margaret | Pittsburgh | $1,212.00 | $46.20 – $1,717.00 |
| UPMC Muncy | Muncy | $1,470.60 | $46.20 – $1,960.80 |
| UPMC Northwest | Seneca | $1,156.80 | $46.20 – $1,638.80 |
| UPMC Somerset | Somerset | $2,040.00 | $46.20 – $2,526.00 |
| UPMC Wellsboro | Wellsboro | $1,470.60 | $46.20 – $1,138.50 |
| UPMC Williamsport | Williamsport | $1,470.60 | $46.20 – $1,960.80 |