healthcosts.net
Colonoscopy w/balloon dilat at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$2,890.20
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.
$4,817.00
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.
$255.45 with UPMC Health Plan vs $4,726.74 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $255.45 | ↓ -91% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $255.45 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicaid | $344.40 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $362.53 | ↓ -87% |
| PA Health & Wellness | PA Medicaid HMO | $395.77 | ↓ -86% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $792.58 | ↓ -73% |
| UPMC Health Plan | Commercial | $811.29 | ↓ -72% |
| UPMC Health Plan | Managed Medicare | $970.56 | ↓ -66% |
| Aetna of PA | Medicare | $1,180.32 | ↓ -59% |
| Aetna | Neighborhood Network | $1,213.88 | ↓ -58% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,213.93 | ↓ -58% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,214.04 | ↓ -58% |
| Aetna | Medicare | $1,236.52 | ↓ -57% |
| Aetna | Home Depot Employer Group | $1,319.86 | ↓ -54% |
| Aetna | NBR ASO/FI | $1,348.76 | ↓ -53% |
| Cigna | New Business ASO | $1,348.76 | ↓ -53% |
| UPMC Work Partners | Workers Comp | $1,348.86 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,764.66 | ↓ -39% |
| Aetna | EBR FI | $1,830.46 | ↓ -37% |
| Aetna | EBR ASO | $1,926.80 | ↓ -33% |
| Cigna | Commercial | $1,926.80 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,293.98 | ↓ -21% |
| Highmark BCBS of PA | Managed Care | $2,363.37 | ↓ -18% |
| Highmark BCBS of PA | Commercial - Indemnity | $3,072.28 | ↑ +6% |
| Coventry/First Health | Commercial | $3,371.90 | ↑ +17% |
| Private Health Care Systems | PPO | $3,853.60 | ↑ +33% |
| SelectCare | Commercial | $3,853.60 | ↑ +33% |
| Humana | Commercial | $4,094.45 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $4,726.74 | ↑ +64% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Colonoscopy w/balloon dilat at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,876.80 | $255.45 – $2,658.80 |
| UPMC Mercy | Pittsburgh | $3,349.80 | $255.45 – $5,024.70 |
| UPMC Presbyterian | Pittsburgh | $4,659.00 | $255.45 – $6,600.25 |
| UPMC Wellsboro | Wellsboro | $3,933.60 | $255.45 – $4,425.30 |
| UPMC Williamsport | Williamsport | $3,252.60 | $255.45 – $4,336.80 |
| UPMC Somerset | Somerset | not published | $255.45 – $1,348.86 |