healthcosts.net
Established Patient Office Visit (level 5) at UPMC Western Psychiatric
3811 Ohara St, Pittsburgh, PA · UPMC · · NPI 1174962435
$709.20
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.
?
What you pay up front if you don't use insurance.
$1,182.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$72.83 with Highmark BCBS of PA vs $283.90 with Health Payors Organization — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $72.83 | ↓ -90% |
| Aetna | Medicare | $83.50 | ↓ -88% |
| Aetna | Narrow Network | $99.20 | ↓ -86% |
| Aetna | Fully Insured | $110.22 | ↓ -84% |
| Aetna | Commercial | $116.90 | ↓ -84% |
| Highmark Wholecare (prev Gateway) | Medicare | $167.00 | ↓ -76% |
| Cigna Behavioral Health | Commercial | $200.40 | ↓ -72% |
| Fidelis | Medicare | $250.50 | ↓ -65% |
| Health Payors Organization | Commercial | $283.90 | ↓ -60% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $573.00 | $74.33 – $811.75 |
| UPMC Magee | Pittsburgh | $227.40 | $74.33 – $348.68 |
| UPMC Mercy | Pittsburgh | $201.60 | $36.08 – $302.40 |
| UPMC Presbyterian | Pittsburgh | $200.40 | $74.33 – $283.90 |
| UPMC St. Margaret | Pittsburgh | $271.20 | $74.33 – $384.20 |
| UPMC East | Monroeville | $253.80 | $36.08 – $338.40 |
| UPMC Altoona | Altoona | $343.80 | $20.00 – $458.40 |
| UPMC Bedford | Everett | $176.40 | $36.08 – $264.60 |