healthcosts.net
Ot re-evaluation patient/family at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$272.40
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.
$454.00
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.
$33.29 with Highmark BCBS of PA vs $385.90 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 | $33.29 | ↓ -88% |
| UPMC Health Plan | Managed Medicaid | $44.76 | ↓ -84% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $44.76 | ↓ -84% |
| Highmark BCBS of PA | Managed Care - Social Mission | $57.81 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicaid | $60.34 | ↓ -78% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $63.52 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $66.93 | ↓ -75% |
| PA Health & Wellness | PA Medicaid HMO | $69.34 | ↓ -75% |
| Highmark BCBS of PA | Managed Care | $77.42 | ↓ -72% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $96.35 | ↓ -65% |
| Aetna | Medicare | $113.50 | ↓ -58% |
| Aetna | Neighborhood Network | $114.41 | ↓ -58% |
| Aetna | Home Depot Employer Group | $124.40 | ↓ -54% |
| Aetna | NBR ASO/FI | $127.12 | ↓ -53% |
| Cigna | New Business ASO | $127.12 | ↓ -53% |
| Highmark BCBS of PA | Commercial - Indemnity | $129.04 | ↓ -53% |
| Highmark BCBS of PA | UPMC Emergent | $154.85 | ↓ -43% |
| Aetna | EBR FI | $172.52 | ↓ -37% |
| Aetna | EBR ASO | $181.60 | ↓ -33% |
| Cigna | Commercial | $181.60 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $227.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $250.88 | ↓ -8% |
| Coventry/First Health | Commercial | $317.80 | ↑ +17% |
| Private Health Care Systems | PPO | $363.20 | ↑ +33% |
| SelectCare | Commercial | $363.20 | ↑ +33% |
| Humana | Commercial | $385.90 | ↑ +42% |
Visitor-reported prices
Comments
Ot re-evaluation patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $227.40 | $32.98 – $341.10 |
| UPMC Passavant-McCandless | Pittsburgh | $138.00 | $33.29 – $195.50 |
| UPMC Presbyterian | Pittsburgh | $213.00 | $33.29 – $301.75 |
| UPMC Muncy | Muncy | $97.20 | $24.30 – $129.60 |
| UPMC Northwest | Seneca | $105.00 | $43.75 – $148.75 |
| UPMC Somerset | Somerset | $138.60 | $32.64 – $173.25 |
| UPMC Wellsboro | Wellsboro | $117.60 | $26.46 – $132.30 |
| UPMC Williamsport | Williamsport | $97.20 | $43.74 – $129.60 |