healthcosts.net
Repair av fistula ext 35190 at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$8,080.20
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.
$13,467.00
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.
$786.98 with UPMC Health Plan vs $21,592.88 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 | $786.98 | ↓ -90% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $786.98 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $1,061.00 | ↓ -87% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $1,116.87 | ↓ -86% |
| PA Health & Wellness | PA Medicaid HMO | $1,219.25 | ↓ -85% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,427.64 | ↓ -82% |
| UPMC Work Partners | Workers Comp | $3,087.24 | ↓ -62% |
| Highmark BCBS of PA | Managed Care - Social Mission | $3,178.62 | ↓ -61% |
| Aetna | Neighborhood Network | $3,393.68 | ↓ -58% |
| Aetna | Home Depot Employer Group | $3,689.96 | ↓ -54% |
| Aetna | NBR ASO/FI | $3,770.76 | ↓ -53% |
| Cigna | New Business ASO | $3,770.76 | ↓ -53% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $4,132.06 | ↓ -49% |
| Highmark BCBS of PA | Managed Care | $4,257.06 | ↓ -47% |
| UPMC Health Plan | Managed Medicare | $4,449.70 | ↓ -45% |
| Aetna | EBR FI | $5,117.46 | ↓ -37% |
| Aetna | EBR ASO | $5,386.80 | ↓ -33% |
| Cigna | Commercial | $5,386.80 | ↓ -33% |
| Aetna of PA | Medicare | $5,411.37 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity | $5,533.98 | ↓ -32% |
| Highmark Wholecare (prev Gateway) | Medicare | $5,565.47 | ↓ -31% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $5,565.99 | ↓ -31% |
| Aetna | Medicare | $5,669.06 | ↓ -30% |
| Highmark BCBS of PA | UPMC Emergent | $8,514.11 | ↑ +5% |
| Coventry/First Health | Commercial | $9,426.90 | ↑ +17% |
| Private Health Care Systems | PPO | $10,773.60 | ↑ +33% |
| SelectCare | Commercial | $10,773.60 | ↑ +33% |
| Humana | Commercial | $11,446.95 | ↑ +42% |
| UPMC Health Plan | Commercial | $21,592.88 | ↑ +167% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Repair av fistula ext 35190 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Presbyterian | Pittsburgh | $9,434.40 | $786.98 – $13,365.40 |