healthcosts.net
Kit lead specify 5-6-5 at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$6,860.40
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.
?
What you pay up front if you don't use insurance.
$11,434.00
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.
$2,174.09 with Highmark BCBS of PA vs $16,768.04 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 |
|---|---|---|---|
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $2,174.09 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicaid | $2,286.80 | ↓ -67% |
| Aetna | Medicare | $2,858.50 | ↓ -58% |
| Aetna | Neighborhood Network | $2,881.37 | ↓ -58% |
| Aetna | Home Depot Employer Group | $3,132.92 | ↓ -54% |
| Aetna | NBR ASO/FI | $3,201.52 | ↓ -53% |
| Cigna | New Business ASO | $3,201.52 | ↓ -53% |
| PA Health & Wellness | PA Medicaid HMO | $3,773.22 | ↓ -45% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $3,868.12 | ↓ -44% |
| Aetna | EBR FI | $4,344.92 | ↓ -37% |
| Aetna | EBR ASO | $4,573.60 | ↓ -33% |
| Cigna | Commercial | $4,573.60 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $5,717.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care - Social Mission | $6,260.44 | ↓ -9% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $6,292.53 | ↓ -8% |
| Coventry/First Health | Commercial | $8,003.80 | ↑ +17% |
| Highmark BCBS of PA | Managed Care | $8,384.02 | ↑ +22% |
| Highmark BCBS of PA | Commercial - Indemnity | $8,427.47 | ↑ +23% |
| Private Health Care Systems | PPO | $9,147.20 | ↑ +33% |
| SelectCare | Commercial | $9,147.20 | ↑ +33% |
| Humana | Commercial | $9,718.90 | ↑ +42% |
| UPMC Health Plan | Commercial | $16,161.66 | ↑ +136% |
| Highmark BCBS of PA | UPMC Emergent | $16,768.04 | ↑ +144% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
Comments
Kit lead specify 5-6-5 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $41,212.80 | $216.24 – $10,400.32 |
| UPMC Passavant-McCandless | Pittsburgh | $17,425.20 | $44.00 – $19,112.65 |
| UPMC Presbyterian | Pittsburgh | $54,950.40 | $32.04 – $21,295.03 |
| UPMC Muncy | Muncy | $11,398.80 | $120.30 – $721.80 |
| UPMC Northwest | Seneca | $7,816.20 | $212.50 – $15,937.99 |
| UPMC Wellsboro | Wellsboro | $13,784.80 | $165.60 – $828.00 |
| UPMC Williamsport | Williamsport | $12,081.00 | $160.40 – $721.80 |