healthcosts.net
Established Patient Office Visit (level 1) at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$122.40
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.
$204.00
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.
$22.00 with UPMC Health Plan vs $173.40 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $22.00 | ↓ -82% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $22.00 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicaid | $29.66 | ↓ -76% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $31.22 | ↓ -74% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $34.04 | ↓ -72% |
| PA Health & Wellness | PA Medicaid HMO | $34.08 | ↓ -72% |
| Aetna of PA | Medicare | $36.08 | ↓ -71% |
| UPMC Work Partners | Workers Comp | $41.25 | ↓ -66% |
| Aetna | Medicare | $51.00 | ↓ -58% |
| Aetna | Neighborhood Network | $51.41 | ↓ -58% |
| Aetna | Home Depot Employer Group | $55.90 | ↓ -54% |
| Aetna | NBR ASO/FI | $57.12 | ↓ -53% |
| Cigna | New Business ASO | $59.16 | ↓ -52% |
| Highmark BCBS of PA | Managed Care - Social Mission | $63.55 | ↓ -48% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $63.87 | ↓ -48% |
| Cigna | Commercial | $63.91 | ↓ -48% |
| Aetna | EBR FI | $77.52 | ↓ -37% |
| Aetna | EBR ASO | $81.60 | ↓ -33% |
| Highmark BCBS of PA | Managed Care | $85.10 | ↓ -30% |
| Highmark BCBS of PA | Commercial - Indemnity | $85.54 | ↓ -30% |
| Highmark Wholecare (prev Gateway) | Medicare | $102.00 | ↓ -17% |
| Coventry/First Health | Commercial | $142.80 | ↑ +17% |
| Private Health Care Systems | PPO | $163.20 | ↑ +33% |
| SelectCare | Commercial | $163.20 | ↑ +33% |
| Highmark BCBS of PA | UPMC Emergent | $170.20 | ↑ +39% |
| Humana | Commercial | $173.40 | ↑ +42% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 1) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $108.60 | $22.00 – $153.85 |
| UPMC Magee | Pittsburgh | $118.20 | $19.03 – $171.12 |
| UPMC Mercy | Pittsburgh | $100.20 | $22.00 – $150.30 |
| UPMC Presbyterian | Pittsburgh | $96.60 | $22.00 – $136.85 |
| UPMC Western Psychiatric | Pittsburgh | $186.60 | $33.36 – $118.15 |
| UPMC Altoona | Altoona | $174.60 | $6.00 – $232.80 |
| UPMC Bedford | Everett | $83.40 | $21.00 – $125.10 |
| UPMC Cole | Coudersport | $84.00 | $19.64 – $70.40 |