Inj, sutimlimab-jome, 10 mg 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.
$4,700.00
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.
$7.51 with Highmark BCBS of PA vs $3,995.00 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 |
|---|---|---|---|
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $7.51 | — |
| UPMC Health Plan | Managed Medicaid | $11.91 | — |
| UPMC Health Plan | Managed Medicare | $16.28 | — |
| PA Health & Wellness | PA Medicaid HMO | $18.86 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $18.86 | — |
| Aetna of PA | Medicare | $19.80 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $20.37 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $20.37 | — |
| Aetna | Medicare | $20.75 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $21.61 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $21.72 | — |
| UPMC Health Plan | Commercial | $23.20 | — |
| Highmark BCBS of PA | Managed Care | $28.95 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $29.10 | — |
| Highmark BCBS of PA | UPMC Emergent | $57.89 | — |
| Aetna | Neighborhood Network | $1,184.40 | — |
| UPMC Work Partners | Workers Comp | $1,214.01 | — |
| Aetna | Home Depot Employer Group | $1,287.80 | — |
| Cigna | New Business ASO | $1,316.00 | — |
| Aetna | NBR ASO/FI | $1,316.00 | — |
| Aetna | EBR FI | $1,786.00 | — |
| Aetna | EBR ASO | $1,880.00 | — |
| Cigna | Commercial | $1,880.00 | — |
| Coventry/First Health | Commercial | $3,290.00 | — |
| SelectCare | Commercial | $3,760.00 | — |
| Private Health Care Systems | PPO | $3,760.00 | — |
| Humana | Commercial | $3,995.00 | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Inj, sutimlimab-jome, 10 mg at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | not published | $7.44 – $20.75 |
| UPMC Northwest | Seneca | not published | $11.91 – $20.37 |