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Ercp remove duct calculi 43264 at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$2,505.00
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.
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What you pay up front if you don't use insurance.
$4,175.00
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.
$736.75 with Highmark BCBS of PA vs $4,393.81 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 |
|---|---|---|---|
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $736.75 | ↓ -71% |
| UPMC Health Plan | Commercial | $1,039.15 | ↓ -59% |
| Aetna | Neighborhood Network | $1,052.10 | ↓ -58% |
| Aetna | Home Depot Employer Group | $1,143.95 | ↓ -54% |
| Aetna | NBR ASO/FI | $1,169.00 | ↓ -53% |
| Cigna | New Business ASO | $1,169.00 | ↓ -53% |
| Aetna | EBR FI | $1,586.50 | ↓ -37% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,640.37 | ↓ -35% |
| UPMC Work Partners | Workers Comp | $1,658.61 | ↓ -34% |
| Aetna | EBR ASO | $1,670.00 | ↓ -33% |
| Cigna | Commercial | $1,670.00 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,132.40 | ↓ -15% |
| Highmark BCBS of PA | Managed Care | $2,196.91 | ↓ -12% |
| PA Health & Wellness | PA Medicaid HMO | $2,296.25 | ↓ -8% |
| Highmark BCBS of PA | Commercial - Indemnity | $2,855.88 | ↑ +14% |
| Coventry/First Health | Commercial | $2,922.50 | ↑ +17% |
| UPMC Health Plan | Managed Medicare | $3,131.69 | ↑ +25% |
| Private Health Care Systems | PPO | $3,340.00 | ↑ +33% |
| SelectCare | Commercial | $3,340.00 | ↑ +33% |
| Humana | Commercial | $3,548.75 | ↑ +42% |
| Aetna of PA | Medicare | $3,808.52 | ↑ +52% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,916.97 | ↑ +56% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,917.33 | ↑ +56% |
| Aetna | Medicare | $3,989.88 | ↑ +59% |
| Highmark BCBS of PA | UPMC Emergent | $4,393.81 | ↑ +75% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Ercp remove duct calculi 43264 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $2,490.00 | $736.75 – $3,989.88 |
| UPMC Mercy | Pittsburgh | $4,282.20 | $596.00 – $6,423.30 |
| UPMC Presbyterian | Pittsburgh | $6,117.00 | $736.75 – $8,665.75 |
| UPMC Somerset | Somerset | $4,546.20 | $722.42 – $5,682.75 |
| UPMC Wellsboro | Wellsboro | $7,896.80 | $993.28 – $8,883.90 |
| UPMC Williamsport | Williamsport | $6,529.80 | $993.28 – $8,706.40 |