healthcosts.net
Established Patient Office Visit (level 1) at UPMC Western Psychiatric
3811 Ohara St, Pittsburgh, PA · UPMC · · NPI 1174962435
$186.60
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.
$311.00
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.
$33.36 with Highmark BCBS of PA vs $118.15 with Health Payors Organization — 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 | Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $33.36 | ↓ -82% |
| Aetna | Medicare | $34.75 | ↓ -81% |
| Aetna | Narrow Network | $41.28 | ↓ -78% |
| Aetna | Fully Insured | $45.87 | ↓ -75% |
| Aetna | Commercial | $48.65 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicare | $69.50 | ↓ -63% |
| Cigna Behavioral Health | Commercial | $83.40 | ↓ -55% |
| Fidelis | Medicare | $104.25 | ↓ -44% |
| Health Payors Organization | Commercial | $118.15 | ↓ -37% |
Visitor-reported prices
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Established Patient Office Visit (level 1) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $108.60 | $22.00 – $153.85 |
| UPMC Magee | Pittsburgh | $118.20 | $19.03 – $171.12 |
| UPMC Mercy | Pittsburgh | $100.20 | $22.00 – $150.30 |
| UPMC Presbyterian | Pittsburgh | $96.60 | $22.00 – $136.85 |
| UPMC St. Margaret | Pittsburgh | $122.40 | $22.00 – $173.40 |
| UPMC Altoona | Altoona | $174.60 | $6.00 – $232.80 |
| UPMC Bedford | Everett | $83.40 | $21.00 – $125.10 |
| UPMC Cole | Coudersport | $84.00 | $19.64 – $70.40 |