healthcosts.net
New Patient Office Visit (level 3) at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$222.00
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.
$370.00
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.
$36.08 with Aetna of PA vs $470.51 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 of PA | Medicare | $36.08 | ↓ -84% |
| UPMC Health Plan | Managed Medicaid | $59.67 | ↓ -73% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $59.67 | ↓ -73% |
| Cigna | Commercial | $63.91 | ↓ -71% |
| Cigna | New Business ASO | $63.91 | ↓ -71% |
| Highmark Wholecare (prev Gateway) | Medicaid | $80.45 | ↓ -64% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $84.69 | ↓ -62% |
| PA Health & Wellness | PA Medicaid HMO | $92.45 | ↓ -58% |
| Aetna | Medicare | $92.50 | ↓ -58% |
| Aetna | Neighborhood Network | $93.24 | ↓ -58% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $96.92 | ↓ -56% |
| Aetna | Home Depot Employer Group | $101.38 | ↓ -54% |
| Aetna | NBR ASO/FI | $103.60 | ↓ -53% |
| UPMC Work Partners | Workers Comp | $139.29 | ↓ -37% |
| Aetna | EBR FI | $140.60 | ↓ -37% |
| Aetna | EBR ASO | $148.00 | ↓ -33% |
| Highmark BCBS of PA | Managed Care - Social Mission | $175.67 | ↓ -21% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $176.57 | ↓ -20% |
| Highmark Wholecare (prev Gateway) | Medicare | $185.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care | $235.26 | ↑ +6% |
| Highmark BCBS of PA | Commercial - Indemnity | $236.47 | ↑ +7% |
| Coventry/First Health | Commercial | $259.00 | ↑ +17% |
| Private Health Care Systems | PPO | $296.00 | ↑ +33% |
| SelectCare | Commercial | $296.00 | ↑ +33% |
| Humana | Commercial | $314.50 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $470.51 | ↑ +112% |
Visitor-reported prices
Comments
New Patient Office Visit (level 3) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $238.80 | $59.67 – $338.30 |
| UPMC Magee | Pittsburgh | $324.60 | $59.67 – $497.72 |
| UPMC Mercy | Pittsburgh | $225.60 | $36.08 – $338.40 |
| UPMC Presbyterian | Pittsburgh | $255.60 | $59.67 – $362.10 |
| UPMC Western Psychiatric | Pittsburgh | $259.20 | $94.97 – $346.80 |
| UPMC East | Monroeville | $330.00 | $36.08 – $440.00 |
| UPMC Hamot | Erie | $231.60 | $57.90 – $274.62 |
| UPMC Altoona | Altoona | $230.40 | $20.00 – $307.20 |