Drainage mouth roof lesion at UPMC East
2775 Mosside Boulevard, Monroeville, PA · UPMC · · NPI 1225323983
$2,565.00
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.
$4,275.00
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.
$22.00 with UPMC Health Plan vs $4,393.81 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $22.00 | ↓ -99% |
| United Healthcare Community Plan for Families | Unison Kids | $23.00 | ↓ -99% |
| Geisinger | Medicaid/CHIP | $27.80 | ↓ -99% |
| Highmark Wholecare (prev Gateway) | Medicaid | $29.66 | ↓ -99% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $30.16 | ↓ -99% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $31.22 | ↓ -99% |
| PA Health & Wellness | PA Medicaid HMO | $34.08 | ↓ -99% |
| UPMC Work Partners | Workers Comp | $187.45 | ↓ -93% |
| UPMC Health Plan | Managed Medicare | $221.99 | ↓ -91% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $226.17 | ↓ -91% |
| Aetna of PA | Medicare | $232.46 | ↓ -91% |
| United Healthcare | Unison Advantage Non Special Needs | $232.46 | ↓ -91% |
| United Healthcare | Medicare | $236.89 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicare | $239.08 | ↓ -91% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $239.10 | ↓ -91% |
| Cigna | Medicare | $239.10 | ↓ -91% |
| AmeriHealth Caritas | Medicare | $239.10 | ↓ -91% |
| United Healthcare | Unison Advantage Special Needs | $243.53 | ↓ -91% |
| Aetna | Medicare | $243.53 | ↓ -91% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $736.75 | ↓ -71% |
| United Healthcare | Compass Exchange | $1,410.75 | ↓ -45% |
| Aetna | Neighborhood Network | $1,500.53 | ↓ -41% |
| Aetna | EBR FI | $1,624.50 | ↓ -37% |
| Aetna | Home Depot Employer Group | $1,633.05 | ↓ -36% |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,640.41 | ↓ -36% |
| United Healthcare | All Business | $1,667.25 | ↓ -35% |
| Cigna | NBR ASO/FI | $1,667.25 | ↓ -35% |
| Cigna | New Business ASO | $1,667.25 | ↓ -35% |
| Aetna | NBR ASO/FI | $1,667.25 | ↓ -35% |
| Cigna | Commercial | $1,710.00 | ↓ -33% |
| Cigna | EBR | $1,710.00 | ↓ -33% |
| Aetna | EBR ASO | $1,710.00 | ↓ -33% |
| UPMC Health Plan | Commercial | $2,096.89 | ↓ -18% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $2,132.40 | ↓ -17% |
| InterGroup | PPO | $2,137.50 | ↓ -17% |
| Highmark BCBS of PA | Managed Care | $2,196.91 | ↓ -14% |
| UPMC Health Plan | CHIP | $2,298.02 | ↓ -10% |
| Highmark BCBS of PA | Commercial - Indemnity | $2,855.88 | ↑ +11% |
| Coventry/First Health | Commercial | $2,992.50 | ↑ +17% |
| Private Health Care Systems | PPO | $3,420.00 | ↑ +33% |
| Highmark BCBS of PA | UPMC Emergent | $4,393.81 | ↑ +71% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Drainage mouth roof lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $837.00 | $25.40 – $1,185.75 |
| UPMC Cole | Coudersport | $154.80 | $21.00 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $837.00 | $25.40 – $2,298.02 |
| UPMC Hanover | Hanover | $837.00 | $25.40 – $1,016.56 |
| UPMC Horizon-Greenville | Greenville | $3,349.80 | $22.00 – $415.44 |
| UPMC Jameson | New Castle | $808.20 | $22.00 – $892.40 |
| UPMC Lititz | Lititz | $837.00 | $25.40 – $1,016.56 |
| UPMC McKeesport | Mckeesport | $2,912.40 | $22.00 – $736.75 |