healthcosts.net
Lower Back (Lumbar Spine) X-ray at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$405.00
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.
$675.00
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.
$34.37 with UPMC Health Plan vs $573.75 with Humana — 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 |
|---|---|---|---|
| UPMC Health Plan | Commercial | $34.37 | ↓ -92% |
| UPMC Health Plan | Managed Medicaid | $35.78 | ↓ -91% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $35.78 | ↓ -91% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $43.10 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicaid | $48.24 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $50.78 | ↓ -87% |
| PA Health & Wellness | PA Medicaid HMO | $55.44 | ↓ -86% |
| UPMC Health Plan | Managed Medicare | $87.53 | ↓ -78% |
| UPMC Work Partners | Workers Comp | $92.28 | ↓ -77% |
| Highmark BCBS of PA | Managed Care - Social Mission | $95.97 | ↓ -76% |
| Aetna of PA | Medicare | $106.45 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicare | $109.48 | ↓ -73% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $109.49 | ↓ -73% |
| Aetna | Medicare | $111.52 | ↓ -72% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $124.75 | ↓ -69% |
| Highmark BCBS of PA | Managed Care | $128.53 | ↓ -68% |
| Highmark BCBS of PA | Commercial - Indemnity | $167.08 | ↓ -59% |
| Aetna | Neighborhood Network | $170.10 | ↓ -58% |
| Aetna | Home Depot Employer Group | $184.95 | ↓ -54% |
| Aetna | NBR ASO/FI | $189.00 | ↓ -53% |
| Cigna | New Business ASO | $189.00 | ↓ -53% |
| Aetna | EBR FI | $256.50 | ↓ -37% |
| Highmark BCBS of PA | UPMC Emergent | $257.06 | ↓ -37% |
| Aetna | EBR ASO | $270.00 | ↓ -33% |
| Cigna | Commercial | $270.00 | ↓ -33% |
| Coventry/First Health | Commercial | $472.50 | ↑ +17% |
| Private Health Care Systems | PPO | $540.00 | ↑ +33% |
| SelectCare | Commercial | $540.00 | ↑ +33% |
| Humana | Commercial | $573.75 | ↑ +42% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Lower Back (Lumbar Spine) X-ray at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $419.40 | $34.28 – $594.15 |
| UPMC Magee | Pittsburgh | $469.80 | $35.78 – $720.36 |
| UPMC Mercy | Pittsburgh | $456.60 | $34.08 – $684.90 |
| UPMC Presbyterian | Pittsburgh | $686.40 | $27.00 – $972.40 |
| UPMC East | Monroeville | $436.20 | $33.98 – $581.60 |
| UPMC Hamot | Erie | $438.00 | $25.96 – $511.00 |
| UPMC Carlisle | Carlisle | $262.80 | $29.48 – $372.30 |
| UPMC Altoona | Altoona | $208.80 | $22.50 – $278.40 |