Observation direct referral from physician office for admission at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
$138.60
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.
$231.00
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.
$34.65 with Univera vs $4,753.31 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 |
|---|---|---|---|
| Univera | Univera_Medicare_Hamot_2024 | $34.65 | ↓ -75% |
| Aetna | Commercial | $57.75 | ↓ -58% |
| Cigna | New Business ASO | $69.30 | ↓ -50% |
| Cigna | NBR ASO/FI | $69.30 | ↓ -50% |
| Univera | Commercial | $76.23 | ↓ -45% |
| Independent Health | Commercial | $80.85 | ↓ -42% |
| Cigna | EBR | $92.40 | ↓ -33% |
| Cigna | Commercial | $92.40 | ↓ -33% |
| InterGroup | Health Coalition Partners/PPO | $150.15 | ↑ +8% |
| Aetna | AXA/MMO | $161.70 | ↑ +17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $161.70 | ↑ +17% |
| Multiplan | Complimentary Network Rate (Includes Multiplan as Payer) | $184.80 | ↑ +33% |
| InterGroup | Beech Street | $184.80 | ↑ +33% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $235.00 | ↑ +70% |
| Fidelis | Medicare | $674.61 | ↑ +387% |
| Aetna | Medicare | $688.10 | ↑ +396% |
| Wellcare | Medicare Advantage | $694.85 | ↑ +401% |
| BCBS of Western NY | Medicare Advantage | $708.34 | ↑ +411% |
| United Healthcare | Medicare | $721.83 | ↑ +421% |
| Highmark Wholecare (prev Gateway) | Medicare | $728.51 | ↑ +426% |
| AmeriHealth Caritas | Medicare | $728.58 | ↑ +426% |
| Cigna | Medicare | $728.58 | ↑ +426% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $728.58 | ↑ +426% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $2,064.00 | ↑ +1389% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $2,137.42 | ↑ +1442% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $2,137.43 | ↑ +1442% |
| Geisinger | Medicaid/CHIP | $2,207.16 | ↑ +1492% |
| Independent Health | Medicare Advantage | $2,341.00 | ↑ +1589% |
| Highmark Wholecare (prev Gateway) | Medicaid | $2,569.10 | ↑ +1754% |
| UPMC Health Plan | Partners/Select | $2,795.06 | ↑ +1917% |
| UPMC Health Plan | Commercial | $2,997.78 | ↑ +2063% |
| BCBS of Western NY | Commercial | $4,753.31 | ↑ +3330% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
Comments
Observation direct referral from physician office for admission at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $117.00 | $27.00 – $2,064.00 |
| UPMC Bedford | Everett | $166.20 | $31.88 – $2,207.16 |
| UPMC Carlisle | Carlisle | $420.00 | $95.90 – $2,064.00 |
| UPMC Cole | Coudersport | $84.00 | $38.81 – $112.00 |
| UPMC Community Osteopathic | Harrisburg | $420.00 | $169.40 – $3,000.00 |
| UPMC East | Monroeville | $130.20 | $31.88 – $2,207.16 |
| UPMC Northwest | Seneca | $112.80 | $31.88 – $631.28 |
| UPMC Hanover | Hanover | $420.00 | $579.83 – $937.10 |