healthcosts.net
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah) at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
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.
?
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.
?
The hospital's undiscounted list price — almost no one pays this.
$517.29 with UPMC Health Plan vs $7,415.16 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $517.29 | — |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $517.29 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $697.40 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $734.12 | — |
| PA Health & Wellness | PA Medicaid HMO | $801.42 | — |
| UPMC Health Plan | Commercial | $1,118.44 | — |
| UPMC Work Partners | Workers Comp | $1,146.78 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,243.37 | — |
| UPMC Health Plan | Managed Medicare | $2,670.80 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $2,768.34 | — |
| Aetna of PA | Medicare | $3,248.02 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,340.82 | — |
| Aetna | Medicare | $3,402.68 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,598.71 | — |
| Highmark BCBS of PA | Managed Care | $3,707.58 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $4,819.69 | — |
| Highmark BCBS of PA | UPMC Emergent | $7,415.16 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Arthro shoulder surgical distal claviculectomy incl/distal art surf left (rest method ii cah) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | not published | $517.29 – $3,402.68 |
| UPMC Mercy | Pittsburgh | not published | $517.29 – $3,402.68 |
| UPMC Presbyterian | Pittsburgh | not published | $517.29 – $3,402.68 |
| UPMC Northwest | Seneca | not published | $517.29 – $3,248.02 |