healthcosts.net
Factor ix recombinant nos 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.
$2.53
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.
$0.64 with Aetna vs $16.21 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 |
|---|---|---|---|
| Aetna | Neighborhood Network | $0.64 | — |
| UPMC Work Partners | Workers Comp | $0.65 | — |
| Aetna | Home Depot Employer Group | $0.69 | — |
| Aetna | NBR ASO/FI | $0.71 | — |
| Cigna | New Business ASO | $0.71 | — |
| Aetna | EBR FI | $0.96 | — |
| Aetna | EBR ASO | $1.01 | — |
| Cigna | Commercial | $1.01 | — |
| UPMC Health Plan | Managed Medicaid | $1.17 | — |
| UPMC Health Plan | Managed Medicare | $1.60 | — |
| Coventry/First Health | Commercial | $1.77 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $1.85 | — |
| PA Health & Wellness | PA Medicaid HMO | $1.85 | — |
| Aetna of PA | Medicare | $1.94 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $2.00 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2.00 | — |
| Private Health Care Systems | PPO | $2.02 | — |
| SelectCare | Commercial | $2.02 | — |
| Aetna | Medicare | $2.04 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $2.10 | — |
| Humana | Commercial | $2.15 | — |
| UPMC Health Plan | Commercial | $2.27 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $6.05 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $6.08 | — |
| Highmark BCBS of PA | Managed Care | $8.10 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $8.15 | — |
| Highmark BCBS of PA | UPMC Emergent | $16.21 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Factor ix recombinant nos at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $15.40 | $0.71 – $2.28 |
| UPMC Passavant-McCandless | Pittsburgh | $34.65 | $1.17 – $49.09 |
| UPMC Presbyterian | Pittsburgh | $34.65 | $1.17 – $48.45 |
| UPMC Western Psychiatric | Pittsburgh | $34.65 | $1.85 – $49.09 |
| UPMC Somerset | Somerset | $2,040.00 | $1.83 – $637.50 |
| UPMC Northwest | Seneca | not published | $0.91 – $2.15 |