Consultation pathology during surgery at UPMC East
2775 Mosside Boulevard, Monroeville, PA · UPMC · · NPI 1225323983
$159.60
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.
$266.00
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.
$2.73 with UPMC Health Plan vs $212.80 with Private Health Care Systems — 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 |
|---|---|---|---|
| UPMC Health Plan | Commercial | $2.73 | ↓ -98% |
| UPMC Health Plan | CHIP | $9.91 | ↓ -94% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $29.77 | ↓ -81% |
| UPMC Health Plan | Managed Medicaid | $32.75 | ↓ -79% |
| United Healthcare Community Plan for Families | Unison Kids | $34.24 | ↓ -79% |
| Geisinger | Medicaid/CHIP | $41.38 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicaid | $44.15 | ↓ -72% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $46.47 | ↓ -71% |
| PA Health & Wellness | PA Medicaid HMO | $50.73 | ↓ -68% |
| UPMC Health Plan | Managed Medicare | $56.78 | ↓ -64% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $57.85 | ↓ -64% |
| Aetna of PA | Medicare | $59.46 | ↓ -63% |
| United Healthcare | Unison Advantage Non Special Needs | $59.46 | ↓ -63% |
| United Healthcare | Medicare | $60.59 | ↓ -62% |
| Highmark Wholecare (prev Gateway) | Medicare | $61.15 | ↓ -62% |
| AmeriHealth Caritas | Medicare | $61.16 | ↓ -62% |
| Cigna | Medicare | $61.16 | ↓ -62% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $61.16 | ↓ -62% |
| Aetna | Medicare | $62.29 | ↓ -61% |
| United Healthcare | Unison Advantage Special Needs | $62.29 | ↓ -61% |
| United Healthcare | Compass Exchange | $87.78 | ↓ -45% |
| Aetna | Neighborhood Network | $93.37 | ↓ -41% |
| UPMC Work Partners | Workers Comp | $95.98 | ↓ -40% |
| Aetna | EBR FI | $101.08 | ↓ -37% |
| Aetna | Home Depot Employer Group | $101.61 | ↓ -36% |
| Cigna | NBR ASO/FI | $103.74 | ↓ -35% |
| United Healthcare | All Business | $103.74 | ↓ -35% |
| Aetna | NBR ASO/FI | $103.74 | ↓ -35% |
| Cigna | New Business ASO | $103.74 | ↓ -35% |
| Cigna | EBR | $106.40 | ↓ -33% |
| Cigna | Commercial | $106.40 | ↓ -33% |
| Aetna | EBR ASO | $106.40 | ↓ -33% |
| InterGroup | PPO | $133.00 | ↓ -17% |
| Coventry/First Health | Commercial | $186.20 | ↑ +17% |
| Private Health Care Systems | PPO | $212.80 | ↑ +33% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Consultation pathology during surgery at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $78.60 | $9.91 – $111.35 |
| UPMC Community Osteopathic | Harrisburg | $78.60 | $9.91 – $111.35 |
| UPMC Hamot | Erie | $133.80 | $4.95 – $95.98 |
| UPMC Northwest | Seneca | $63.60 | $2.75 – $89.17 |
| UPMC Hanover | Hanover | $78.60 | $9.91 – $93.32 |
| UPMC Jameson | New Castle | $55.80 | $6.11 – $89.17 |
| UPMC Lititz | Lititz | $78.60 | $9.91 – $94.72 |
| UPMC Magee | Pittsburgh | $118.20 | $2.89 – $95.98 |