Pml/raralpha 1 breakpoint at UPMC East
2775 Mosside Boulevard, Monroeville, PA · UPMC · · NPI 1225323983
$1,009.20
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.
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What you pay up front if you don't use insurance.
$1,682.00
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.
$204.89 with UPMC Work Partners vs $3,276.06 with UPMC Health Plan — 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 Work Partners | Workers Comp | $204.89 | ↓ -80% |
| UPMC Health Plan | Managed Medicare | $207.87 | ↓ -79% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $211.79 | ↓ -79% |
| Aetna of PA | Medicare | $217.68 | ↓ -78% |
| United Healthcare | Unison Advantage Non Special Needs | $217.68 | ↓ -78% |
| United Healthcare | Medicare | $221.82 | ↓ -78% |
| Highmark Wholecare (prev Gateway) | Medicare | $223.87 | ↓ -78% |
| Cigna | Medicare | $223.89 | ↓ -78% |
| AmeriHealth Caritas | Medicare | $223.89 | ↓ -78% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $223.89 | ↓ -78% |
| Aetna | Medicare | $228.04 | ↓ -77% |
| United Healthcare | Unison Advantage Special Needs | $228.04 | ↓ -77% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $257.16 | ↓ -75% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $345.11 | ↓ -66% |
| UPMC Health Plan | Managed Medicaid | $379.62 | ↓ -62% |
| United Healthcare Community Plan for Families | Unison Kids | $396.88 | ↓ -61% |
| Highmark BCBS of PA | Managed Care - Social Mission | $447.02 | ↓ -56% |
| Geisinger | Medicaid/CHIP | $479.67 | ↓ -52% |
| Highmark Wholecare (prev Gateway) | Medicaid | $511.80 | ↓ -49% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $538.75 | ↓ -47% |
| United Healthcare | Compass Exchange | $555.06 | ↓ -45% |
| PA Health & Wellness | PA Medicaid HMO | $588.14 | ↓ -42% |
| Aetna | Neighborhood Network | $590.38 | ↓ -42% |
| Highmark BCBS of PA | Managed Care | $598.69 | ↓ -41% |
| Aetna | EBR FI | $639.16 | ↓ -37% |
| Aetna | Home Depot Employer Group | $642.52 | ↓ -36% |
| Cigna | New Business ASO | $655.98 | ↓ -35% |
| United Healthcare | All Business | $655.98 | ↓ -35% |
| Cigna | NBR ASO/FI | $655.98 | ↓ -35% |
| Aetna | NBR ASO/FI | $655.98 | ↓ -35% |
| Aetna | EBR ASO | $672.80 | ↓ -33% |
| Cigna | EBR | $672.80 | ↓ -33% |
| Cigna | Commercial | $672.80 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $744.29 | ↓ -26% |
| InterGroup | PPO | $841.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $901.21 | ↓ -11% |
| Highmark BCBS of PA | Commercial - Indemnity | $996.82 | ↓ -1% |
| Coventry/First Health | Commercial | $1,177.40 | ↑ +17% |
| Highmark BCBS of PA | UPMC Emergent | $1,197.37 | ↑ +19% |
| Private Health Care Systems | PPO | $1,345.60 | ↑ +33% |
| UPMC Health Plan | CHIP | $3,276.06 | ↑ +225% |
Visitor-reported prices
Comments
Pml/raralpha 1 breakpoint at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,534.20 | $204.89 – $2,045.60 |
| UPMC Northwest | Seneca | $1,114.20 | $188.01 – $396.88 |
| UPMC Magee | Pittsburgh | $1,114.20 | $194.02 – $588.14 |
| UPMC McKeesport | Mckeesport | $1,671.60 | $192.16 – $379.62 |
| UPMC Mercy | Pittsburgh | $1,114.20 | $172.81 – $396.88 |
| UPMC Passavant-McCandless | Pittsburgh | $1,180.80 | $192.65 – $396.88 |
| UPMC Presbyterian | Pittsburgh | $1,671.60 | $204.89 – $537.23 |
| UPMC St. Margaret | Pittsburgh | $1,671.60 | $178.99 – $538.75 |