healthcosts.net
#flow interp 9 - 15 markers at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$575.40
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.
$959.00
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.
$46.38 with UPMC Health Plan vs $815.15 with Humana — 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 | Commercial | $46.38 | ↓ -92% |
| UPMC Health Plan | Managed Medicaid | $74.04 | ↓ -87% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $74.04 | ↓ -87% |
| Highmark Wholecare (prev Gateway) | Medicaid | $99.82 | ↓ -83% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $105.08 | ↓ -82% |
| PA Health & Wellness | PA Medicaid HMO | $114.71 | ↓ -80% |
| UPMC Work Partners | Workers Comp | $153.90 | ↓ -73% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $157.89 | ↓ -73% |
| Aetna | Medicare | $239.75 | ↓ -58% |
| Aetna | Neighborhood Network | $241.67 | ↓ -58% |
| Aetna | Home Depot Employer Group | $262.77 | ↓ -54% |
| Aetna | NBR ASO/FI | $268.52 | ↓ -53% |
| Cigna | New Business ASO | $268.52 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $274.46 | ↓ -52% |
| Aetna | EBR FI | $364.42 | ↓ -37% |
| Highmark BCBS of PA | Managed Care | $367.58 | ↓ -36% |
| Aetna | EBR ASO | $383.60 | ↓ -33% |
| Cigna | Commercial | $383.60 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $456.98 | ↓ -21% |
| Highmark Wholecare (prev Gateway) | Medicare | $479.50 | ↓ -17% |
| Highmark BCBS of PA | Commercial - Indemnity | $612.03 | ↑ +6% |
| Coventry/First Health | Commercial | $671.30 | ↑ +17% |
| Highmark BCBS of PA | UPMC Emergent | $735.16 | ↑ +28% |
| Private Health Care Systems | PPO | $767.20 | ↑ +33% |
| SelectCare | Commercial | $767.20 | ↑ +33% |
| Humana | Commercial | $815.15 | ↑ +42% |
Visitor-reported prices
Comments
#flow interp 9 - 15 markers at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $777.00 | $45.99 – $1,165.50 |
| UPMC Passavant-McCandless | Pittsburgh | $627.60 | $46.27 – $333.20 |
| UPMC Presbyterian | Pittsburgh | $303.00 | $48.82 – $429.25 |
| UPMC Muncy | Muncy | $288.00 | $72.00 – $384.00 |
| UPMC Northwest | Seneca | $303.00 | $46.29 – $429.25 |
| UPMC Somerset | Somerset | $55.20 | $32.11 – $154.82 |
| UPMC Wellsboro | Wellsboro | $348.00 | $67.31 – $390.60 |
| UPMC Williamsport | Williamsport | $287.40 | $74.04 – $383.20 |