UPMC Northwest Standard Charges

The Charge Description Master (CDM) file is a hospital's regularly updated database containing the list of Standard Charges assigned to procedures, services, drugs, and supplies associated with the delivery of medical care at that hospital or facility

The standard dollar amount a UPMC provider sets for services rendered before negotiating any discounts. The charge can be different from the amount paid.

Standard charges are reflective of the clinical services directly involved in your care (e.g. nurses, technicians, and other staff providing care), as well as the drugs and supplies used to provide care. Standard charges also reflect support areas not directly related to your care such as housekeeping, facilities maintenance, information technology, medical records, etc.

Additionally, hospital charges allow for future investments in cutting-edge diagnostic and therapeutic services, improvements to hospital facilities, and the expansion of clinical programs & services that are needed to provide world-class medical care.

No, the standard charge amount assigned in the CDM is the same regardless of type of insurance or payer coverage. All patients at a hospital receive the same charge amount for the same service.

No, if you have in-network insurance coverage your out-of-pocket payment responsibility is based on the benefits of your insurance plan. Your insurance determines the copay, coinsurance, and deductible amounts that you will be responsible for paying out-of-pocket. Copay, coinsurance, and deductible amounts are determined by your insurance company and are not affected by standard charges.

Similarly, your coinsurance and deductible amounts are determined by the contracted payment rates your insurance company has made with the hospital (called the “allowable”), not on the standard charge in the CDM.

Because your insurance plan benefits determine your out-of-pocket costs and payment for your services is based upon contracted rates, the hospital CDM file of standard charges is not a useful tool for determining the cost of your health care.

If you would like an estimate of how much a procedure will cost before you schedule your appointment, please contact the UPMC Price Estimator team and ask for an estimate for the cost of your planned services.

Please call 1-800-371-8359 option 5 to request a price estimate.

Note that the actual amount of your out-of-pocket costs for UPMC services included in the estimate may be greater or less than the estimate provided to you via the UPMC Price Estimator team for such services or procedures.

If you have insurance that is not contracted with UPMC, please contact your insurance company for more information on out-of-network benefits. You can also contact the UPMC Price Estimator team for an estimate of out-of-pocket costs as well.

No, for nearly all hospital clinical services and visit types.

For patients that have no insurance, there are multiple options for providing help for paying your health care costs. Please see UPMC's Financial Services web page for more information on financial assistance, screening for medical assistance, and payment plans.