healthcosts.net
New Patient Office Visit (level 3) at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$255.60
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.
$426.00
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 $511.74 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 | ↓ -86% |
| UPMC Health Plan | Managed Medicaid | $59.67 | ↓ -77% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $65.10 | ↓ -75% |
| Aetna | CHIP/Medicaid | $70.53 | ↓ -72% |
| Highmark Wholecare (prev Gateway) | Medicaid | $80.45 | ↓ -69% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $81.81 | ↓ -68% |
| Geisinger | Medicaid/CHIP | $84.45 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $85.85 | ↓ -66% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $92.45 | ↓ -64% |
| Highmark BCBS of PA | Medicare Advantage | $96.92 | ↓ -62% |
| Aetna | Medicare | $106.50 | ↓ -58% |
| UPMC Work Partners | Workers Comp | $141.06 | ↓ -45% |
| Multiplan | Worker's Compensation | $164.02 | ↓ -36% |
| Highmark BCBS of PA | Managed Care - Social Mission | $191.05 | ↓ -25% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $196.48 | ↓ -23% |
| Highmark Wholecare (prev Gateway) | Medicare | $213.00 | ↓ -17% |
| Highmark BCBS of PA | Managed Care | $255.87 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Indemnity | $263.15 | ↑ +3% |
| Preferred Healthcare System | PPO | $276.90 | ↑ +8% |
| Coventry/First Health | Commercial | $298.20 | ↑ +17% |
| Fidelis | Medicare | $319.50 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $319.50 | ↑ +25% |
| Health Coalition Partners | Intergroup | $340.80 | ↑ +33% |
| Multiplan | PPO | $340.80 | ↑ +33% |
| Private Health Care Systems | PPO | $340.80 | ↑ +33% |
| SelectCare | Commercial | $340.80 | ↑ +33% |
| Health Payors Organization | Commercial | $362.10 | ↑ +42% |
| Humana | Commercial | $362.10 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $362.10 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $511.74 | ↑ +100% |
Visitor-reported prices
Comments
New Patient Office Visit (level 3) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $238.80 | $59.67 – $338.30 |
| UPMC Magee | Pittsburgh | $324.60 | $59.67 – $497.72 |
| UPMC Mercy | Pittsburgh | $225.60 | $36.08 – $338.40 |
| UPMC St. Margaret | Pittsburgh | $222.00 | $59.67 – $314.50 |
| UPMC Western Psychiatric | Pittsburgh | $259.20 | $94.97 – $346.80 |
| UPMC East | Monroeville | $330.00 | $36.08 – $440.00 |
| UPMC Hamot | Erie | $231.60 | $57.90 – $274.62 |
| UPMC Altoona | Altoona | $230.40 | $20.00 – $307.20 |