healthcosts.net
Tx closed distal humerus fx at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$342.00
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.
$570.00
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.
$18.77 with Highmark BCBS of PA vs $484.50 with Humana — 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 | $18.77 | ↓ -95% |
| UPMC Health Plan | Commercial | $27.69 | ↓ -92% |
| Highmark BCBS of PA | Managed Care - Social Mission | $41.78 | ↓ -88% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $54.31 | ↓ -84% |
| Highmark BCBS of PA | Managed Care | $55.95 | ↓ -84% |
| Highmark BCBS of PA | Commercial - Indemnity | $72.74 | ↓ -79% |
| Highmark BCBS of PA | UPMC Emergent | $111.91 | ↓ -67% |
| Aetna | Neighborhood Network | $143.64 | ↓ -58% |
| Aetna | Home Depot Employer Group | $156.18 | ↓ -54% |
| Aetna | NBR ASO/FI | $159.60 | ↓ -53% |
| Cigna | New Business ASO | $159.60 | ↓ -53% |
| UPMC Health Plan | Managed Medicare | $197.46 | ↓ -42% |
| Aetna | EBR FI | $216.60 | ↓ -37% |
| Aetna | EBR ASO | $228.00 | ↓ -33% |
| Cigna | Commercial | $228.00 | ↓ -33% |
| Aetna of PA | Medicare | $240.13 | ↓ -30% |
| Highmark Wholecare (prev Gateway) | Medicare | $246.97 | ↓ -28% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $247.00 | ↓ -28% |
| Aetna | Medicare | $251.57 | ↓ -26% |
| PA Health & Wellness | PA Medicaid HMO | $313.50 | ↓ -8% |
| Coventry/First Health | Commercial | $399.00 | ↑ +17% |
| Private Health Care Systems | PPO | $456.00 | ↑ +33% |
| SelectCare | Commercial | $456.00 | ↑ +33% |
| Humana | Commercial | $484.50 | ↑ +42% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Tx closed distal humerus fx at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $90.60 | $18.77 – $251.57 |
| UPMC Mercy | Pittsburgh | $75.60 | $18.59 – $247.00 |
| UPMC Presbyterian | Pittsburgh | $337.20 | $18.77 – $477.70 |
| UPMC Muncy | Muncy | $114.60 | $28.65 – $171.90 |
| UPMC Northwest | Seneca | $134.40 | $34.54 – $247.00 |
| UPMC Wellsboro | Wellsboro | $153.60 | $34.56 – $172.80 |
| UPMC Williamsport | Williamsport | not published | $161.64 – $247.00 |