healthcosts.net
New Patient Office Visit (level 5) at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$468.00
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.
?
What you pay up front if you don't use insurance.
$780.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$36.08 with Aetna of PA vs $695.27 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | ↓ -92% |
| Cigna | Commercial | $63.91 | ↓ -86% |
| Cigna | New Business ASO | $63.91 | ↓ -86% |
| UPMC Health Plan | Managed Medicaid | $129.29 | ↓ -72% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $129.29 | ↓ -72% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $150.85 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicaid | $174.31 | ↓ -63% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $183.49 | ↓ -61% |
| Aetna | Medicare | $195.00 | ↓ -58% |
| Aetna | Neighborhood Network | $196.56 | ↓ -58% |
| PA Health & Wellness | PA Medicaid HMO | $200.31 | ↓ -57% |
| Aetna | Home Depot Employer Group | $213.72 | ↓ -54% |
| Aetna | NBR ASO/FI | $218.40 | ↓ -53% |
| Highmark BCBS of PA | Managed Care - Social Mission | $259.58 | ↓ -45% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $260.91 | ↓ -44% |
| UPMC Work Partners | Workers Comp | $264.44 | ↓ -43% |
| Aetna | EBR FI | $296.40 | ↓ -37% |
| Aetna | EBR ASO | $312.00 | ↓ -33% |
| Highmark BCBS of PA | Managed Care | $347.64 | ↓ -26% |
| Highmark BCBS of PA | Commercial - Indemnity | $349.44 | ↓ -25% |
| Highmark Wholecare (prev Gateway) | Medicare | $390.00 | ↓ -17% |
| Coventry/First Health | Commercial | $546.00 | ↑ +17% |
| Private Health Care Systems | PPO | $624.00 | ↑ +33% |
| SelectCare | Commercial | $624.00 | ↑ +33% |
| Humana | Commercial | $663.00 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $695.27 | ↑ +49% |
Visitor-reported prices
Comments
New Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $663.60 | $129.29 – $940.10 |
| UPMC Magee | Pittsburgh | $456.60 | $129.29 – $700.12 |
| UPMC Mercy | Pittsburgh | $377.40 | $36.08 – $566.10 |
| UPMC Presbyterian | Pittsburgh | $362.40 | $129.29 – $513.40 |
| UPMC Western Psychiatric | Pittsburgh | $505.80 | $147.82 – $513.40 |
| UPMC East | Monroeville | $516.00 | $36.08 – $688.00 |
| UPMC Hamot | Erie | $360.60 | $90.15 – $527.06 |
| UPMC Altoona | Altoona | $343.80 | $30.00 – $458.40 |