Incision of achilles tendon at UPMC East
2775 Mosside Boulevard, Monroeville, PA · UPMC · · NPI 1225323983
not published by hospital
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.
not published by hospital
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.
$200.27 with UPMC Health Plan vs $3,281.43 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 | $200.27 | — |
| United Healthcare Community Plan for Families | Unison Kids | $209.37 | — |
| Geisinger | Medicaid/CHIP | $253.05 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $269.99 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $274.55 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $284.21 | — |
| PA Health & Wellness | PA Medicaid HMO | $310.27 | — |
| UPMC Work Partners | Workers Comp | $397.97 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $550.23 | — |
| Highmark BCBS of PA | Managed Care - Social Mission | $1,225.10 | — |
| UPMC Health Plan | Managed Medicare | $1,529.92 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,558.76 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $1,592.54 | — |
| Aetna of PA | Medicare | $1,602.09 | — |
| United Healthcare | Unison Advantage Non Special Needs | $1,602.09 | — |
| United Healthcare | Medicare | $1,632.61 | — |
| Highmark BCBS of PA | Managed Care | $1,640.71 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $1,647.71 | — |
| AmeriHealth Caritas | Medicare | $1,647.86 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,647.86 | — |
| Cigna | Medicare | $1,647.86 | — |
| Aetna | Medicare | $1,678.38 | — |
| United Healthcare | Unison Advantage Special Needs | $1,678.38 | — |
| UPMC Health Plan | CHIP | $1,712.93 | — |
| Highmark BCBS of PA | Commercial - Indemnity | $2,132.85 | — |
| Highmark BCBS of PA | UPMC Emergent | $3,281.43 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Incision of achilles tendon at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $4,284.60 | $231.22 – $6,069.85 |
| UPMC Cole | Coudersport | $327.00 | $151.07 – $771.51 |
| UPMC Community Osteopathic | Harrisburg | $4,284.60 | $245.78 – $6,069.85 |
| UPMC Hanover | Hanover | $4,284.60 | $231.22 – $2,446.19 |
| UPMC Lititz | Lititz | $4,284.60 | $231.22 – $2,459.41 |
| UPMC Memorial | York | $4,284.60 | $231.22 – $2,455.41 |
| UPMC Somerset | Somerset | $4,284.60 | $200.27 – $1,525.80 |
| WellSpan Surgery & Rehabilitation Hospital | York PA 17403 | $1,291.20 | $227.58 – $619.00 |