healthcosts.net
Established Patient Office Visit (level 5) at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$200.40
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.
$334.00
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 $423.12 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 | ↓ -82% |
| Highmark BCBS of PA | Medicare Advantage | $74.33 | ↓ -63% |
| Aetna | Medicare | $83.50 | ↓ -58% |
| UPMC Health Plan | Managed Medicaid | $85.86 | ↓ -57% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $93.66 | ↓ -53% |
| Aetna | CHIP/Medicaid | $101.47 | ↓ -49% |
| Highmark Wholecare (prev Gateway) | Medicaid | $115.75 | ↓ -42% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $117.70 | ↓ -41% |
| Geisinger | Medicaid/CHIP | $121.50 | ↓ -39% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $123.51 | ↓ -38% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $133.01 | ↓ -34% |
| Highmark BCBS of PA | Managed Care - Social Mission | $157.96 | ↓ -21% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $162.45 | ↓ -19% |
| Highmark Wholecare (prev Gateway) | Medicare | $167.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care | $211.56 | ↑ +6% |
| Preferred Healthcare System | PPO | $217.10 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity | $217.57 | ↑ +9% |
| UPMC Work Partners | Workers Comp | $218.41 | ↑ +9% |
| Coventry/First Health | Commercial | $233.80 | ↑ +17% |
| Fidelis | Medicare | $250.50 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $250.50 | ↑ +25% |
| Multiplan | Worker's Compensation | $253.96 | ↑ +27% |
| Health Coalition Partners | Intergroup | $267.20 | ↑ +33% |
| Multiplan | PPO | $267.20 | ↑ +33% |
| Private Health Care Systems | PPO | $267.20 | ↑ +33% |
| SelectCare | Commercial | $267.20 | ↑ +33% |
| Health Payors Organization | Commercial | $283.90 | ↑ +42% |
| Humana | Commercial | $283.90 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $283.90 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $423.12 | ↑ +111% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $573.00 | $74.33 – $811.75 |
| UPMC Magee | Pittsburgh | $227.40 | $74.33 – $348.68 |
| UPMC Mercy | Pittsburgh | $201.60 | $36.08 – $302.40 |
| UPMC St. Margaret | Pittsburgh | $271.20 | $74.33 – $384.20 |
| UPMC Western Psychiatric | Pittsburgh | $709.20 | $72.83 – $283.90 |
| UPMC East | Monroeville | $253.80 | $36.08 – $338.40 |
| UPMC Altoona | Altoona | $343.80 | $20.00 – $458.40 |
| UPMC Bedford | Everett | $176.40 | $36.08 – $264.60 |