healthcosts.net
New Patient Office Visit (level 4) at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$300.00
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.
$500.00
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 $636.41 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 | ↓ -88% |
| UPMC Health Plan | Managed Medicaid | $99.41 | ↓ -67% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $108.44 | ↓ -64% |
| Aetna | CHIP/Medicaid | $117.48 | ↓ -61% |
| Highmark BCBS of PA | Medicare Advantage | $124.28 | ↓ -59% |
| Aetna | Medicare | $125.00 | ↓ -58% |
| Highmark Wholecare (prev Gateway) | Medicaid | $134.02 | ↓ -55% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $136.28 | ↓ -55% |
| Geisinger | Medicaid/CHIP | $140.68 | ↓ -53% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $143.00 | ↓ -52% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $154.01 | ↓ -49% |
| UPMC Work Partners | Workers Comp | $235.33 | ↓ -22% |
| Highmark BCBS of PA | Managed Care - Social Mission | $237.59 | ↓ -21% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $244.35 | ↓ -19% |
| Highmark Wholecare (prev Gateway) | Medicare | $250.00 | ↓ -17% |
| Multiplan | Worker's Compensation | $273.64 | ↓ -9% |
| Highmark BCBS of PA | Managed Care | $318.20 | ↑ +6% |
| Preferred Healthcare System | PPO | $325.00 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity | $327.25 | ↑ +9% |
| Coventry/First Health | Commercial | $350.00 | ↑ +17% |
| Fidelis | Medicare | $375.00 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $375.00 | ↑ +25% |
| Health Coalition Partners | Intergroup | $400.00 | ↑ +33% |
| Multiplan | PPO | $400.00 | ↑ +33% |
| Private Health Care Systems | PPO | $400.00 | ↑ +33% |
| SelectCare | Commercial | $400.00 | ↑ +33% |
| Health Payors Organization | Commercial | $425.00 | ↑ +42% |
| Humana | Commercial | $425.00 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $425.00 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $636.41 | ↑ +112% |
Visitor-reported prices
Comments
New Patient Office Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $303.00 | $99.41 – $429.25 |
| UPMC Magee | Pittsburgh | $378.60 | $99.41 – $580.52 |
| UPMC Mercy | Pittsburgh | $300.00 | $36.08 – $450.00 |
| UPMC St. Margaret | Pittsburgh | $388.80 | $99.41 – $550.80 |
| UPMC Western Psychiatric | Pittsburgh | $400.80 | $121.78 – $425.00 |
| UPMC East | Monroeville | $425.40 | $36.08 – $567.20 |
| UPMC Hamot | Erie | $297.00 | $74.25 – $419.02 |
| UPMC Altoona | Altoona | $274.20 | $20.00 – $365.60 |