Sm-153 lexidron ther at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
not published by hospital
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.
$8,937.50
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.
$2,252.25 with Aetna vs $57,207.07 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| Aetna | Neighborhood Network | $2,252.25 | — |
| Aetna | Home Depot Employer Group | $2,448.88 | — |
| Cigna | New Business ASO | $2,502.50 | — |
| Aetna | NBR ASO/FI | $2,502.50 | — |
| Aetna | EBR FI | $3,396.25 | — |
| Cigna | Commercial | $3,575.00 | — |
| Aetna | EBR ASO | $3,575.00 | — |
| UPMC Health Plan | Managed Medicare | $3,725.49 | — |
| Aetna of PA | Medicare | $4,530.66 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $4,659.67 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $4,660.10 | — |
| Aetna | Medicare | $4,746.40 | — |
| PA Health & Wellness | PA Medicaid HMO | $4,915.62 | — |
| Coventry/First Health | Commercial | $6,256.25 | — |
| Private Health Care Systems | PPO | $7,150.00 | — |
| SelectCare | Commercial | $7,150.00 | — |
| Humana | Commercial | $7,596.88 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $10,723.00 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $21,358.58 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $21,468.07 | — |
| Highmark BCBS of PA | Managed Care | $28,603.54 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $28,751.76 | — |
| UPMC Health Plan | Commercial | $32,486.04 | — |
| Highmark BCBS of PA | UPMC Emergent | $57,207.07 | — |
| Tricare | East Region | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Sm-153 lexidron ther at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | $7,168.80 | $4,038.32 – $10,723.00 |
| UPMC Presbyterian | Pittsburgh | $31,245.00 | $4,660.10 – $42,804.45 |
| UPMC Mercy | Pittsburgh | not published | $3,596.91 – $10,621.85 |
| UPMC Carlisle | Carlisle | $5,947.80 | $1,358.08 – $8,426.05 |
| UPMC Community Osteopathic | Harrisburg | $5,947.80 | $1,982.60 – $26,474.45 |
| UPMC Hanover | Hanover | $5,947.80 | $4,271.76 – $26,474.45 |
| UPMC Horizon-Greenville | Greenville | $20,766.60 | $3,863.14 – $8,096.93 |
| UPMC Lititz | Lititz | $5,947.80 | $4,271.76 – $26,474.45 |