healthcosts.net
Ot re-evaluation patient/family at UPMC Presbyterian
200 Lothrop Street, Pittsburgh, PA · UPMC · · NPI 119473412
$213.00
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.
$355.00
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.
$33.29 with Highmark BCBS of PA vs $330.57 with UPMC Health Plan — 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $33.29 | ↓ -84% |
| UPMC Health Plan | Managed Medicaid | $44.76 | ↓ -79% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $48.83 | ↓ -77% |
| Aetna | CHIP/Medicaid | $52.90 | ↓ -75% |
| Highmark BCBS of PA | Managed Care - Social Mission | $55.33 | ↓ -74% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $56.34 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicaid | $60.34 | ↓ -72% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $61.36 | ↓ -71% |
| Geisinger | Medicaid/CHIP | $63.34 | ↓ -70% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $64.39 | ↓ -70% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $69.34 | ↓ -67% |
| UPMC Work Partners | Workers Comp | $73.13 | ↓ -66% |
| Highmark BCBS of PA | Managed Care | $74.10 | ↓ -65% |
| Highmark BCBS of PA | Commercial - Indemnity | $75.44 | ↓ -65% |
| Multiplan | Worker's Compensation | $85.04 | ↓ -60% |
| Aetna | Medicare | $88.75 | ↓ -58% |
| Highmark BCBS of PA | UPMC Emergent | $148.20 | ↓ -30% |
| Highmark Wholecare (prev Gateway) | Medicare | $177.50 | ↓ -17% |
| Preferred Healthcare System | PPO | $230.75 | ↑ +8% |
| Coventry/First Health | Commercial | $248.50 | ↑ +17% |
| Fidelis | Medicare | $266.25 | ↑ +25% |
| InterGroup | InterGroup Services Corporation | $266.25 | ↑ +25% |
| Health Coalition Partners | Intergroup | $284.00 | ↑ +33% |
| Multiplan | PPO | $284.00 | ↑ +33% |
| Private Health Care Systems | PPO | $284.00 | ↑ +33% |
| SelectCare | Commercial | $284.00 | ↑ +33% |
| Health Payors Organization | Commercial | $301.75 | ↑ +42% |
| Humana | Commercial | $301.75 | ↑ +42% |
| InterGroup | Approved National Affiliated PPO Business | $301.75 | ↑ +42% |
| UPMC Health Plan | Commercial | $330.57 | ↑ +55% |
Visitor-reported prices
Comments
Ot re-evaluation patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $227.40 | $32.98 – $341.10 |
| UPMC Passavant-McCandless | Pittsburgh | $138.00 | $33.29 – $195.50 |
| UPMC St. Margaret | Pittsburgh | $272.40 | $33.29 – $385.90 |
| UPMC Muncy | Muncy | $97.20 | $24.30 – $129.60 |
| UPMC Northwest | Seneca | $105.00 | $43.75 – $148.75 |
| UPMC Somerset | Somerset | $138.60 | $32.64 – $173.25 |
| UPMC Wellsboro | Wellsboro | $117.60 | $26.46 – $132.30 |
| UPMC Williamsport | Williamsport | $97.20 | $43.74 – $129.60 |