healthcosts.net
Established Patient Office Visit (level 4) at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$168.00
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.
$280.00
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 $364.09 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 | ↓ -79% |
| UPMC Health Plan | Managed Medicaid | $59.86 | ↓ -64% |
| Highmark BCBS of PA | Medicare Advantage | $63.73 | ↓ -62% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $65.30 | ↓ -61% |
| Aetna | Medicare | $70.00 | ↓ -58% |
| Aetna | CHIP/Medicaid | $70.75 | ↓ -58% |
| Highmark Wholecare (prev Gateway) | Medicaid | $80.70 | ↓ -52% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $82.07 | ↓ -51% |
| Geisinger | Medicaid/CHIP | $84.72 | ↓ -50% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $86.11 | ↓ -49% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $92.74 | ↓ -45% |
| Highmark BCBS of PA | Managed Care - Social Mission | $135.93 | ↓ -19% |
| UPMC Work Partners | Workers Comp | $138.03 | ↓ -18% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $139.79 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $140.00 | ↓ -17% |
| Multiplan | Worker's Compensation | $160.50 | ↓ -4% |
| Preferred Healthcare System | PPO | $182.00 | ↑ +8% |
| Highmark BCBS of PA | Managed Care | $182.04 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity | $187.22 | ↑ +11% |
| Coventry/First Health | Commercial | $196.00 | ↑ +17% |
| Fidelis | Medicare | $210.00 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $210.00 | ↑ +25% |
| Health Coalition Partners | Intergroup | $224.00 | ↑ +33% |
| Multiplan | PPO | $224.00 | ↑ +33% |
| Private Health Care Systems | PPO | $224.00 | ↑ +33% |
| SelectCare | Commercial | $224.00 | ↑ +33% |
| Health Payors Organization | Commercial | $238.00 | ↑ +42% |
| Humana | Commercial | $238.00 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $238.00 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $364.09 | ↑ +117% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $250.80 | $59.86 – $355.30 |
| UPMC Magee | Pittsburgh | $194.40 | $59.86 – $298.08 |
| UPMC Mercy | Pittsburgh | $168.00 | $36.08 – $252.00 |
| UPMC St. Margaret | Pittsburgh | $228.60 | $59.86 – $323.85 |
| UPMC Western Psychiatric | Pittsburgh | $568.20 | $62.45 – $238.00 |
| UPMC East | Monroeville | $216.00 | $36.08 – $288.00 |
| UPMC Altoona | Altoona | $274.20 | $20.00 – $365.60 |
| UPMC Bedford | Everett | $142.20 | $36.08 – $213.30 |