healthcosts.net
Kit case 4.2mm spinejack at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$12,441.00
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.
?
What you pay up front if you don't use insurance.
$20,735.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$2,488.20 with Highmark Wholecare (prev Gateway) vs $17,624.75 with InterGroup — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $2,488.20 | ↓ -80% |
| Aetna | CHIP/Medicaid | $3,732.30 | ↓ -70% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $3,939.65 | ↓ -68% |
| Aetna | Medicare | $5,183.75 | ↓ -58% |
| Geisinger | Medicaid/CHIP | $6,842.55 | ↓ -45% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $7,014.65 | ↓ -44% |
| UPMC Health Plan | Commercial | $9,722.64 | ↓ -22% |
| Aetna | First Health | $10,367.50 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $10,367.50 | ↓ -17% |
| Preferred Healthcare System | PPO | $13,477.75 | ↑ +8% |
| Coventry/First Health | Commercial | $14,514.50 | ↑ +17% |
| Fidelis | Medicare | $15,551.25 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $15,551.25 | ↑ +25% |
| Health Coalition Partners | Intergroup | $16,588.00 | ↑ +33% |
| Multiplan | PPO | $16,588.00 | ↑ +33% |
| Private Health Care Systems | PPO | $16,588.00 | ↑ +33% |
| SelectCare | Commercial | $16,588.00 | ↑ +33% |
| Health Payors Organization | Commercial | $17,624.75 | ↑ +42% |
| Humana | Commercial | $17,624.75 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $17,624.75 | ↑ +42% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Multiplan | Worker's Compensation | not published by hospital | — |
Visitor-reported prices
Comments
Kit case 4.2mm spinejack at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $7,833.60 | $2,872.32 – $11,097.60 |
| UPMC Muncy | Muncy | $7,686.60 | $1,743.00 – $10,458.00 |