Oropharyngeal biopsy 42800 at UPMC Chautauqua
207 Foote Avenue, Jamestown, NY · UPMC · · NPI 1770573222
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.
$68.12 with UPMC Health Plan vs $5,586.63 with BCBS of Western NY — 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 | CHIP | $68.12 | — |
| UPMC Health Plan | Managed Medicaid | $68.12 | — |
| Geisinger | Medicaid/CHIP | $75.75 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $82.19 | — |
| MagnaCare | No Fault | $152.78 | — |
| MagnaCare | Workers Compensation | $152.78 | — |
| Univera | Essential Plan | $622.00 | — |
| Univera | Medicare Advantage | $987.00 | — |
| UNITED BEHAVIORAL HEALTH | MEDICARE | $1,809.86 | — |
| Beacon | Medicare Advantage | $1,809.86 | — |
| Fidelis | Medicare | $1,809.86 | — |
| United Healthcare | Medicare | $1,809.86 | — |
| UPMC Health Plan | Managed Medicare | $1,809.86 | — |
| Humana | Medicare | $1,809.86 | — |
| Independent Health | Commercial | $1,824.62 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,846.06 | — |
| Wellcare | Medicare | $1,864.16 | — |
| Aetna | Medicare | $1,882.25 | — |
| Independent Health | Medicare Advantage | $2,230.11 | — |
| Beacon | Commercial | $2,262.32 | — |
| BCBS of Western NY | Medicaid | $2,904.64 | — |
| BCBS of Western NY | Commercial | $5,586.63 | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Oropharyngeal biopsy 42800 at other New-york hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| NewYork-Presbyterian Queens | Flushing | $4,921.00 | $181.00 – $1,840.44 |
| Bellevue Hospital Center | NY 10016 | $1,752.89 | $0.01 – $2,905.23 |
| Harlem Hospital Center | New York | $1,752.89 | $0.01 – $2,188.60 |
| Kings County Hospital Center | Brooklyn | $1,752.89 | $0.01 – $2,905.23 |
| Lincoln Medical Center | Bronx | $1,752.89 | $0.01 – $2,188.60 |
| Metropolitan Hospital Center | New York | $1,752.89 | $0.01 – $2,188.60 |
| Queens Hospital Center | Jamaica | $1,752.89 | $0.01 – $2,905.23 |
| Woodhull Medical Center | Brooklyn | $1,752.89 | $0.01 – $2,905.23 |