Mayo factor v at UPMC East
2775 Mosside Boulevard, Monroeville, PA · UPMC · · NPI 1225323983
$299.40
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.
$499.00
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.
$5.00 with Health Partners Plans (Jefferson Health Plan) vs $399.20 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 |
|---|---|---|---|
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $5.00 | ↓ -98% |
| UPMC Health Plan | Managed Medicaid | $5.50 | ↓ -98% |
| United Healthcare Community Plan for Families | Unison Kids | $5.75 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $6.95 | ↓ -98% |
| Highmark Wholecare (prev Gateway) | Medicaid | $7.42 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $7.81 | ↓ -97% |
| PA Health & Wellness | PA Medicaid HMO | $8.52 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $17.44 | ↓ -94% |
| UPMC Health Plan | Managed Medicare | $17.70 | ↓ -94% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $18.03 | ↓ -94% |
| Aetna of PA | Medicare | $18.53 | ↓ -94% |
| United Healthcare | Unison Advantage Non Special Needs | $18.53 | ↓ -94% |
| United Healthcare | Medicare | $18.89 | ↓ -94% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $19.06 | ↓ -94% |
| Cigna | Medicare | $19.06 | ↓ -94% |
| Highmark Wholecare (prev Gateway) | Medicare | $19.06 | ↓ -94% |
| AmeriHealth Caritas | Medicare | $19.06 | ↓ -94% |
| Aetna | Medicare | $19.41 | ↓ -94% |
| United Healthcare | Unison Advantage Special Needs | $19.41 | ↓ -94% |
| UPMC Health Plan | Commercial | $32.67 | ↓ -89% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $39.03 | ↓ -87% |
| Highmark BCBS of PA | Managed Care - Social Mission | $67.85 | ↓ -77% |
| Highmark BCBS of PA | Managed Care | $90.87 | ↓ -70% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $112.97 | ↓ -62% |
| UPMC Health Plan | CHIP | $118.78 | ↓ -60% |
| Highmark BCBS of PA | Commercial - Indemnity | $151.30 | ↓ -49% |
| United Healthcare | Compass Exchange | $164.67 | ↓ -45% |
| Aetna | Neighborhood Network | $175.15 | ↓ -41% |
| Highmark BCBS of PA | UPMC Emergent | $181.74 | ↓ -39% |
| Aetna | EBR FI | $189.62 | ↓ -37% |
| Aetna | Home Depot Employer Group | $190.62 | ↓ -36% |
| Cigna | NBR ASO/FI | $194.61 | ↓ -35% |
| Aetna | NBR ASO/FI | $194.61 | ↓ -35% |
| United Healthcare | All Business | $194.61 | ↓ -35% |
| Cigna | New Business ASO | $194.61 | ↓ -35% |
| Cigna | EBR | $199.60 | ↓ -33% |
| Cigna | Commercial | $199.60 | ↓ -33% |
| Aetna | EBR ASO | $199.60 | ↓ -33% |
| InterGroup | PPO | $249.50 | ↓ -17% |
| Coventry/First Health | Commercial | $349.30 | ↑ +17% |
| Private Health Care Systems | PPO | $399.20 | ↑ +33% |
Visitor-reported prices
Comments
Mayo factor v at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $90.60 | $5.00 – $128.35 |
| UPMC Community Osteopathic | Harrisburg | $90.60 | $5.00 – $128.35 |
| UPMC Hamot | Erie | $214.20 | $5.00 – $38.66 |
| UPMC Hanover | Hanover | $90.60 | $5.00 – $28.24 |
| UPMC Jameson | New Castle | $168.00 | $5.50 – $39.35 |
| UPMC Lititz | Lititz | $90.60 | $5.00 – $28.24 |
| UPMC Magee | Pittsburgh | $141.00 | $5.50 – $39.03 |
| UPMC McKeesport | Mckeesport | $441.00 | $5.50 – $39.03 |