healthcosts.net
Pt evaluation low complexity patient/family at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$303.00
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.
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What you pay up front if you don't use insurance.
$505.00
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.
$52.05 with Highmark BCBS of PA vs $429.25 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 | $52.05 | ↓ -83% |
| Highmark BCBS of PA | Managed Care - Social Mission | $90.40 | ↓ -70% |
| Highmark BCBS of PA | Managed Care | $121.07 | ↓ -60% |
| Aetna | Medicare | $126.25 | ↓ -58% |
| Aetna | Neighborhood Network | $127.26 | ↓ -58% |
| UPMC Work Partners | Workers Comp | $127.65 | ↓ -58% |
| Aetna | Home Depot Employer Group | $138.37 | ↓ -54% |
| Aetna | NBR ASO/FI | $141.40 | ↓ -53% |
| Cigna | New Business ASO | $141.40 | ↓ -53% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $150.66 | ↓ -50% |
| Aetna | EBR FI | $191.90 | ↓ -37% |
| Highmark BCBS of PA | Commercial - Indemnity | $201.78 | ↓ -33% |
| Aetna | EBR ASO | $202.00 | ↓ -33% |
| Cigna | Commercial | $202.00 | ↓ -33% |
| UPMC Health Plan | Commercial | $235.28 | ↓ -22% |
| Highmark BCBS of PA | UPMC Emergent | $242.13 | ↓ -20% |
| Highmark Wholecare (prev Gateway) | Medicare | $252.50 | ↓ -17% |
| PA Health & Wellness | PA Medicaid HMO | $277.75 | ↓ -8% |
| Coventry/First Health | Commercial | $353.50 | ↑ +17% |
| Private Health Care Systems | PPO | $404.00 | ↑ +33% |
| SelectCare | Commercial | $404.00 | ↑ +33% |
| Humana | Commercial | $429.25 | ↑ +42% |
Visitor-reported prices
Comments
Pt evaluation low complexity patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $382.20 | $51.56 – $573.30 |
| UPMC Passavant-McCandless | Pittsburgh | $345.00 | $52.05 – $488.75 |
| UPMC Presbyterian | Pittsburgh | $692.40 | $52.05 – $980.90 |
| UPMC Muncy | Muncy | $197.40 | $49.35 – $263.20 |
| UPMC Northwest | Seneca | $320.40 | $127.65 – $453.90 |
| UPMC Somerset | Somerset | $226.80 | $51.04 – $283.50 |
| UPMC Wellsboro | Wellsboro | $238.40 | $53.64 – $268.20 |
| UPMC Williamsport | Williamsport | $197.40 | $81.42 – $263.20 |