Breast punct aspir cyst, bil at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
$543.00
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.
$905.00
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.
$40.15 with UPMC Health Plan vs $1,147.00 with United Healthcare — 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 | $40.15 | ↓ -93% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $41.98 | ↓ -92% |
| Aetna | Medicaid | $43.80 | ↓ -92% |
| Geisinger | Medicaid/CHIP | $50.73 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicaid | $54.13 | ↓ -90% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $55.04 | ↓ -90% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $56.98 | ↓ -90% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $62.20 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $126.57 | ↓ -77% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $130.12 | ↓ -76% |
| Univera | Univera_Medicare_Hamot_2024 | $135.75 | ↓ -75% |
| Aetna | Commercial | $226.25 | ↓ -58% |
| Cigna | New Business ASO | $271.50 | ↓ -50% |
| Cigna | NBR ASO/FI | $271.50 | ↓ -50% |
| Univera | Commercial | $298.65 | ↓ -45% |
| Cigna | EBR | $362.00 | ↓ -33% |
| Cigna | Commercial | $362.00 | ↓ -33% |
| Aetna | Medicare | $362.00 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity/Commercial - Social Mission Indemnity/Managed Care/Managed Care - Social Mission | $393.18 | ↓ -28% |
| Highmark Wholecare (prev Gateway) | Medicare | $452.50 | ↓ -17% |
| BCBS of Western NY | Commercial | $494.99 | ↓ -9% |
| UPMC Health Plan | Commercial | $499.34 | ↓ -8% |
| InterGroup | Health Coalition Partners/PPO | $588.25 | ↑ +8% |
| Highmark BCBS of PA | UPMC Emergent | $629.08 | ↑ +16% |
| Aetna | AXA/MMO | $633.50 | ↑ +17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $633.50 | ↑ +17% |
| InterGroup | Beech Street | $724.00 | ↑ +33% |
| Multiplan | Complimentary Network Rate (Includes Multiplan as Payer) | $724.00 | ↑ +33% |
| Fidelis | Medicare | $774.17 | ↑ +43% |
| UPMC Health Plan | Partners/Select | $790.27 | ↑ +46% |
| Wellcare | Medicare Advantage | $797.40 | ↑ +47% |
| BCBS of Western NY | Medicare Advantage | $812.88 | ↑ +50% |
| United Healthcare | Medicare | $828.36 | ↑ +53% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $836.10 | ↑ +54% |
| Cigna | Medicare | $836.10 | ↑ +54% |
| AmeriHealth Caritas | Medicare | $836.10 | ↑ +54% |
| Independent Health | Medicare Advantage | $975.61 | ↑ +80% |
| Independent Health | Commercial | $1,110.44 | ↑ +105% |
| United Healthcare | Commercial | $1,147.00 | ↑ +111% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Breast punct aspir cyst, bil at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $489.00 | $36.50 – $652.00 |
| UPMC Bedford | Everett | $808.20 | $38.33 – $1,212.30 |
| UPMC Carlisle | Carlisle | $924.60 | $46.35 – $1,309.85 |
| UPMC Community Osteopathic | Harrisburg | $924.60 | $46.35 – $1,309.85 |
| UPMC Northwest | Seneca | $777.00 | $40.15 – $704.33 |
| UPMC Hanover | Hanover | $924.60 | $46.35 – $1,075.42 |
| UPMC Horizon-Greenville | Greenville | $910.20 | $38.33 – $253.13 |
| UPMC Jameson | New Castle | $858.60 | $37.15 – $132.41 |