healthcosts.net
Pt re-evaluation patient/family at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$276.00
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.
$460.00
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.
$35.28 with Highmark BCBS of PA vs $391.00 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 | $35.28 | ↓ -87% |
| UPMC Health Plan | Managed Medicaid | $47.43 | ↓ -83% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $47.43 | ↓ -83% |
| UPMC Work Partners | Workers Comp | $50.43 | ↓ -82% |
| Highmark BCBS of PA | Managed Care - Social Mission | $61.26 | ↓ -78% |
| Highmark Wholecare (prev Gateway) | Medicaid | $63.95 | ↓ -77% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $67.31 | ↓ -76% |
| PA Health & Wellness | PA Medicaid HMO | $73.49 | ↓ -73% |
| Highmark BCBS of PA | Managed Care | $82.05 | ↓ -70% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $102.11 | ↓ -63% |
| Aetna | Medicare | $115.00 | ↓ -58% |
| Aetna | Neighborhood Network | $115.92 | ↓ -58% |
| Aetna | Home Depot Employer Group | $126.04 | ↓ -54% |
| Aetna | NBR ASO/FI | $128.80 | ↓ -53% |
| Cigna | New Business ASO | $128.80 | ↓ -53% |
| Highmark BCBS of PA | Commercial - Indemnity | $136.75 | ↓ -50% |
| Highmark BCBS of PA | UPMC Emergent | $164.10 | ↓ -41% |
| Aetna | EBR FI | $174.80 | ↓ -37% |
| Aetna | EBR ASO | $184.00 | ↓ -33% |
| Cigna | Commercial | $184.00 | ↓ -33% |
| UPMC Health Plan | Commercial | $190.89 | ↓ -31% |
| Highmark Wholecare (prev Gateway) | Medicare | $230.00 | ↓ -17% |
| Coventry/First Health | Commercial | $322.00 | ↑ +17% |
| Private Health Care Systems | PPO | $368.00 | ↑ +33% |
| SelectCare | Commercial | $368.00 | ↑ +33% |
| Humana | Commercial | $391.00 | ↑ +42% |
Visitor-reported prices
Comments
Pt re-evaluation patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $165.00 | $34.95 – $247.50 |
| UPMC Passavant-McCandless | Pittsburgh | $129.60 | $35.28 – $183.60 |
| UPMC Presbyterian | Pittsburgh | $110.40 | $35.28 – $156.40 |
| UPMC Muncy | Muncy | $97.20 | $24.30 – $129.60 |
| UPMC Northwest | Seneca | $105.00 | $43.75 – $148.75 |
| UPMC Somerset | Somerset | $139.20 | $34.59 – $174.00 |
| UPMC Wellsboro | Wellsboro | $117.60 | $26.46 – $132.30 |
| UPMC Williamsport | Williamsport | $97.20 | $43.74 – $129.60 |