CMS Price Transparency Data

New patient office visit (30-44 min)

Facility: UPMC Presbyterian Shadyside

Billing Code: 99203 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99203
Insurance Median: $298
Cash Discount Price: $256
vs. Medicare Baseline: 2.53x Medicare

The contracted insurance negotiated median rate for a New patient office visit (30-44 min) at UPMC Presbyterian Shadyside is $298. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $256. Compared to the federal Medicare reimbursement reference rate of $117.57, this hospital’s rate is 2.53x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$256

Average discount available for prompt cash payment at this facility.

Insurance Median

$298

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$117.57

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $117.57 (100%)

Cash / Self-Pay: $256 (218%)

Insurance Median: $298 (253%)

Cash: $256 (218% of Medicare)

Ins. Median: $298 (253% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $117.57 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 253% of the Medicare baseline (a markup of 153%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Aetna	$36 - $106	31%
Upmc Health Plan	$60	51%
UnitedHealthcare	$65	55%
Highmark Wholecare (Prev Gateway)	$80 - $213	68%
Health Partners Plans (Jefferson Health Plan)	$82	70%
Geisinger	$84	71%
Amerihealth Caritas	$86	73%
Pa Health & Wellness	$92	78%
Blue Cross Blue Shield	$97 - $512	83%
Upmc Work Partners	$141	120%
Multiplan	$164 - $341	139%
Preferred Healthcare System	$277	236%
Coventry/First Health	$298	253%
Fidelis	$320	272%
Intergroup	$320 - $362	272%
Health Coalition Partners	$341	290%
Private Health Care Systems	$341	290%
Selectcare	$341	290%
Health Payors Organization	$362	308%
Humana	$362	308%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $256.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99203.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Presbyterian Shadyside is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 99203.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.