Drainage of mouth lesion at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
not published by hospital
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.
not published by hospital
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.
$25.85 with UPMC Health Plan vs $3,401.07 with Aetna — 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 | $25.85 | — |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $25.85 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $34.85 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $36.69 | — |
| PA Health & Wellness | PA Medicaid HMO | $40.05 | — |
| UPMC Work Partners | Workers Comp | $299.52 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $550.23 | — |
| UPMC Health Plan | Commercial | $777.26 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,225.07 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,592.54 | — |
| Highmark BCBS of PA | Managed Care | $1,640.71 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $2,132.85 | — |
| UPMC Health Plan | Managed Medicare | $2,669.53 | — |
| Aetna of PA | Medicare | $3,246.47 | — |
| Highmark BCBS of PA | UPMC Emergent | $3,281.43 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $3,338.92 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,339.23 | — |
| Aetna | Medicare | $3,401.07 | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Drainage of mouth lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $2,552.40 | $25.85 – $3,401.07 |
| UPMC Passavant-McCandless | Pittsburgh | $3,202.80 | $25.85 – $3,401.07 |
| UPMC Presbyterian | Pittsburgh | $4,240.80 | $25.85 – $3,401.07 |
| UPMC Community Osteopathic | Harrisburg | $3,971.40 | $29.84 – $5,626.15 |
| UPMC East | Monroeville | $2,815.20 | $25.85 – $3,753.60 |
| UPMC Hamot | Erie | $3,332.40 | $25.85 – $4,496.91 |
| UPMC Northwest | Seneca | $3,430.80 | $25.85 – $3,246.47 |
| UPMC Hanover | Hanover | $3,971.40 | $29.84 – $4,956.96 |