healthcosts.net
Observation direct referral from physician office for admission at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$133.20
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.
$222.00
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.
$31.88 with UPMC Health Plan vs $4,642.37 with UPMC Health Plan — 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 | Managed Medicaid | $31.88 | ↓ -76% |
| Aetna | Neighborhood Network | $55.94 | ↓ -58% |
| Aetna | Home Depot Employer Group | $60.83 | ↓ -54% |
| Aetna | NBR ASO/FI | $62.16 | ↓ -53% |
| Cigna | New Business ASO | $62.16 | ↓ -53% |
| Aetna | EBR FI | $84.36 | ↓ -37% |
| Aetna | EBR ASO | $88.80 | ↓ -33% |
| Cigna | Commercial | $88.80 | ↓ -33% |
| Coventry/First Health | Commercial | $155.40 | ↑ +17% |
| Private Health Care Systems | PPO | $177.60 | ↑ +33% |
| SelectCare | Commercial | $177.60 | ↑ +33% |
| Humana | Commercial | $188.70 | ↑ +42% |
| UPMC Health Plan | Managed Medicare | $504.67 | ↑ +279% |
| Aetna of PA | Medicare | $613.75 | ↑ +361% |
| Highmark Wholecare (prev Gateway) | Medicare | $631.22 | ↑ +374% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $631.28 | ↑ +374% |
| Aetna | Medicare | $642.97 | ↑ +383% |
| PA Health & Wellness | PA Medicaid HMO | $2,137.42 | ↑ +1505% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $2,137.43 | ↑ +1505% |
| Highmark Wholecare (prev Gateway) | Medicaid | $2,569.10 | ↑ +1829% |
| UPMC Health Plan | Commercial | $4,642.37 | ↑ +3385% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Observation direct referral from physician office for admission at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $85.20 | $26.56 – $631.28 |
| UPMC Passavant-McCandless | Pittsburgh | $138.00 | $31.88 – $642.97 |
| UPMC Presbyterian | Pittsburgh | $141.00 | $31.88 – $642.97 |
| UPMC Muncy | Muncy | $117.00 | $29.25 – $175.50 |
| UPMC Northwest | Seneca | $112.80 | $31.88 – $631.28 |
| UPMC Somerset | Somerset | $420.00 | $50.26 – $631.22 |
| UPMC Wellsboro | Wellsboro | $141.60 | $31.86 – $159.30 |
| UPMC Williamsport | Williamsport | $117.00 | $77.59 – $631.28 |