Bx breast 1st lesion strtctc at UPMC Altoona
620 Howard Avenue, Altoona, PA · UPMC · · NPI 112418570
$2,923.20
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.
$4,872.00
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.
$148.30 with Aetna vs $3,897.60 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 |
|---|---|---|---|
| Aetna | Medicaid | $148.30 | ↓ -95% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $155.72 | ↓ -95% |
| UPMC Health Plan | Managed Medicaid | $163.13 | ↓ -94% |
| Geisinger | Medicaid | $206.12 | ↓ -93% |
| Highmark Wholecare (prev Gateway) | Medicaid | $219.93 | ↓ -92% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $223.64 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $231.51 | ↓ -92% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $252.73 | ↓ -91% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $472.82 | ↓ -84% |
| UPMC Work Partners | Workers Comp | $900.48 | ↓ -69% |
| UPMC Health Plan | Managed Medicare | $1,575.29 | ↓ -46% |
| UPMC Health Plan | Partners/Select | $1,601.24 | ↓ -45% |
| United Healthcare | Medicare | $1,652.83 | ↓ -43% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,668.28 | ↓ -43% |
| Cigna | Medicare | $1,668.28 | ↓ -43% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,668.28 | ↓ -43% |
| AmeriHealth Caritas | Medicare | $1,668.28 | ↓ -43% |
| UPMC Health Plan | CHIP | $2,131.42 | ↓ -27% |
| UPMC Health Plan | Commercial | $2,322.41 | ↓ -21% |
| Cigna | Commercial | $2,436.00 | ↓ -17% |
| Preferred Healthcare System | PPO | $2,436.00 | ↓ -17% |
| United Healthcare | Commercial | $2,497.39 | ↓ -15% |
| Aetna | Commercial | $2,582.16 | ↓ -12% |
| Geisinger | Commercial | $2,679.60 | ↓ -8% |
| Private Health Care Systems | PPO | $3,897.60 | ↑ +33% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Bx breast 1st lesion strtctc at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $2,087.40 | $188.34 – $6,413.00 |
| UPMC Cole | Coudersport | $421.80 | $155.72 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $2,087.40 | $200.21 – $2,957.15 |
| UPMC Hamot | Erie | $7,023.60 | $163.13 – $900.48 |
| UPMC Northwest | Seneca | $5,112.00 | $163.13 – $1,621.93 |
| UPMC Hanover | Hanover | $2,087.40 | $188.34 – $2,476.51 |
| UPMC Horizon-Greenville | Greenville | $4,273.80 | $155.72 – $919.85 |
| UPMC Jameson | New Castle | $4,273.80 | $143.14 – $900.48 |