healthcosts.net
Complx repair sal addl 5 cm/> 13122 at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$595.80
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.
$993.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$176.83 with UPMC Work Partners vs $1,248.58 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 Work Partners | Workers Comp | $176.83 | ↓ -70% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $209.36 | ↓ -65% |
| Aetna | Medicare | $248.25 | ↓ -58% |
| Aetna | Neighborhood Network | $250.24 | ↓ -58% |
| Aetna | Home Depot Employer Group | $272.08 | ↓ -54% |
| Aetna | NBR ASO/FI | $278.04 | ↓ -53% |
| Cigna | New Business ASO | $278.04 | ↓ -53% |
| Aetna | EBR FI | $377.34 | ↓ -37% |
| Aetna | EBR ASO | $397.20 | ↓ -33% |
| Cigna | Commercial | $397.20 | ↓ -33% |
| Highmark BCBS of PA | Managed Care - Social Mission | $466.14 | ↓ -22% |
| Highmark Wholecare (prev Gateway) | Medicare | $496.50 | ↓ -17% |
| PA Health & Wellness | PA Medicaid HMO | $546.15 | ↓ -8% |
| UPMC Health Plan | Commercial | $587.43 | ↓ -1% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $605.96 | ↑ +2% |
| Highmark BCBS of PA | Managed Care | $624.29 | ↑ +5% |
| Coventry/First Health | Commercial | $695.10 | ↑ +17% |
| Private Health Care Systems | PPO | $794.40 | ↑ +33% |
| SelectCare | Commercial | $794.40 | ↑ +33% |
| Highmark BCBS of PA | Commercial - Indemnity | $811.55 | ↑ +36% |
| Humana | Commercial | $844.05 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $1,248.58 | ↑ +110% |
Visitor-reported prices
Comments
Complx repair sal addl 5 cm/> 13122 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $478.20 | $176.83 – $677.45 |
| UPMC Mercy | Pittsburgh | $378.00 | $157.50 – $822.33 |
| UPMC Presbyterian | Pittsburgh | $1,247.40 | $87.42 – $1,767.15 |
| UPMC Muncy | Muncy | $825.60 | $93.25 – $1,100.80 |
| UPMC Northwest | Seneca | $1,128.00 | $176.83 – $1,598.00 |
| UPMC Somerset | Somerset | $828.60 | $83.78 – $1,035.75 |
| UPMC Wellsboro | Wellsboro | $998.40 | $93.25 – $1,123.20 |
| UPMC Williamsport | Williamsport | $825.60 | $93.25 – $1,100.80 |