healthcosts.net
New Patient Office Visit (level 5) at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$362.40
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.
$604.00
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 $756.20 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 | ↓ -90% |
| UPMC Health Plan | Managed Medicaid | $129.29 | ↓ -64% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $141.05 | ↓ -61% |
| Highmark BCBS of PA | Medicare Advantage | $150.85 | ↓ -58% |
| Aetna | Medicare | $151.00 | ↓ -58% |
| Aetna | CHIP/Medicaid | $152.80 | ↓ -58% |
| Highmark Wholecare (prev Gateway) | Medicaid | $174.31 | ↓ -52% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $177.25 | ↓ -51% |
| Geisinger | Medicaid/CHIP | $182.97 | ↓ -50% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $186.00 | ↓ -49% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $200.31 | ↓ -45% |
| UPMC Work Partners | Workers Comp | $280.88 | ↓ -22% |
| Highmark BCBS of PA | Managed Care - Social Mission | $282.31 | ↓ -22% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $290.34 | ↓ -20% |
| Highmark Wholecare (prev Gateway) | Medicare | $302.00 | ↓ -17% |
| Multiplan | Worker's Compensation | $326.61 | ↓ -10% |
| Highmark BCBS of PA | Managed Care | $378.10 | ↑ +4% |
| Highmark BCBS of PA | Commercial - Indemnity | $388.85 | ↑ +7% |
| Preferred Healthcare System | PPO | $392.60 | ↑ +8% |
| Coventry/First Health | Commercial | $422.80 | ↑ +17% |
| Fidelis | Medicare | $453.00 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $453.00 | ↑ +25% |
| Health Coalition Partners | Intergroup | $483.20 | ↑ +33% |
| Multiplan | PPO | $483.20 | ↑ +33% |
| Private Health Care Systems | PPO | $483.20 | ↑ +33% |
| SelectCare | Commercial | $483.20 | ↑ +33% |
| Health Payors Organization | Commercial | $513.40 | ↑ +42% |
| Humana | Commercial | $513.40 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $513.40 | ↑ +42% |
| Highmark BCBS of PA | UPMC Emergent | $756.20 | ↑ +109% |
Visitor-reported prices
Comments
New Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $663.60 | $129.29 – $940.10 |
| UPMC Magee | Pittsburgh | $456.60 | $129.29 – $700.12 |
| UPMC Mercy | Pittsburgh | $377.40 | $36.08 – $566.10 |
| UPMC St. Margaret | Pittsburgh | $468.00 | $129.29 – $663.00 |
| UPMC Western Psychiatric | Pittsburgh | $505.80 | $147.82 – $513.40 |
| UPMC East | Monroeville | $516.00 | $36.08 – $688.00 |
| UPMC Hamot | Erie | $360.60 | $90.15 – $527.06 |
| UPMC Altoona | Altoona | $343.80 | $30.00 – $458.40 |