healthcosts.net
Treatment of anal fissure w/dilat 46940 at UPMC Passavant-McCandless
9100 Babcock Boulevard, Pittsburgh, PA · UPMC · · NPI 1225047699
not published by hospital
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.
not published by hospital
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.
$38.50 with UPMC Health Plan vs $2,875.99 with United Healthcare — 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 | $38.50 | — |
| United Healthcare Community Plan for Families | Unison Kids | $40.25 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $51.91 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $54.64 | — |
| PA Health & Wellness | PA Medicaid HMO | $59.65 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $206.41 | — |
| UPMC Work Partners | Workers Comp | $222.77 | — |
| Private Health Care Systems | Workers' Comp | $259.04 | — |
| UPMC Health Plan | Commercial | $295.19 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $459.58 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $572.91 | — |
| Highmark BCBS of PA | Managed Care | $615.50 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $767.29 | — |
| Highmark BCBS of PA | UPMC Emergent | $1,231.01 | — |
| UPMC Health Plan | Managed Medicare | $2,429.69 | — |
| Health Plan of Upper Ohio Valley | Medicaid | $2,614.54 | — |
| Health Plan of Upper Ohio Valley | Medicare | $2,614.54 | — |
| Aetna of PA | Medicare | $2,745.27 | — |
| United Healthcare | Unison Advantage Non Special Needs | $2,745.27 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $2,823.44 | — |
| AmeriHealth Caritas | Medicare | $2,823.70 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2,823.70 | — |
| Aetna | Medicare | $2,875.99 | — |
| United Healthcare | Unison Advantage Special Needs | $2,875.99 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |