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Ot evaluation low complexity patient/family at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$338.40
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.
$564.00
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.
$50.04 with Highmark BCBS of PA vs $507.60 with Multiplan — 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 |
|---|---|---|---|
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $50.04 | ↓ -85% |
| Highmark BCBS of PA | Managed Care - Social Mission | $75.57 | ↓ -78% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $76.94 | ↓ -77% |
| Highmark BCBS of PA | Managed Care | $101.20 | ↓ -70% |
| Highmark BCBS of PA | Commercial - Indemnity | $103.03 | ↓ -70% |
| UPMC Work Partners | Workers Comp | $110.62 | ↓ -67% |
| Aetna | Medicare | $141.00 | ↓ -58% |
| Aetna | Neighborhood Network | $157.36 | ↓ -53% |
| UPMC Health Plan | Commercial | $163.57 | ↓ -52% |
| Aetna | Home Depot Employer Group | $171.74 | ↓ -49% |
| Aetna | NBR ASO/FI | $174.84 | ↓ -48% |
| Cigna | New Business ASO | $191.76 | ↓ -43% |
| Bravo | Medicare | $197.40 | ↓ -42% |
| UPMC Health Plan | CHIP | $207.14 | ↓ -39% |
| Aetna | EBR FI | $214.32 | ↓ -37% |
| Aetna | EBR ASO | $225.60 | ↓ -33% |
| Cigna | Commercial | $225.60 | ↓ -33% |
| Coventry/First Health | Commercial | $248.16 | ↓ -27% |
| Highmark Wholecare (prev Gateway) | Medicare | $282.00 | ↓ -17% |
| InterGroup | PPO | $282.00 | ↓ -17% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $310.20 | ↓ -8% |
| Cigna Behavioral Health | Commercial | $338.40 | ↑ +0% |
| Private Health Care Systems | PPO | $423.00 | ↑ +25% |
| American Healthcare Group | Commercial | $451.20 | ↑ +33% |
| InterGroup | Approved National Affiliated PPO Business | $451.20 | ↑ +33% |
| National Provider Network | PPO | $462.48 | ↑ +37% |
| Health Payors Organization | Commercial | $507.60 | ↑ +50% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $507.60 | ↑ +50% |
Visitor-reported prices
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Ot evaluation low complexity patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $411.00 | $50.52 – $582.25 |
| UPMC Presbyterian | Pittsburgh | $748.80 | $50.52 – $1,060.80 |
| UPMC St. Margaret | Pittsburgh | $319.20 | $50.52 – $452.20 |
| UPMC Muncy | Muncy | $197.40 | $49.35 – $263.20 |
| UPMC Northwest | Seneca | $272.40 | $101.56 – $385.90 |
| UPMC Somerset | Somerset | $226.80 | $49.53 – $283.50 |
| UPMC Wellsboro | Wellsboro | $238.40 | $53.64 – $268.20 |
| UPMC Williamsport | Williamsport | $197.40 | $79.01 – $263.20 |