Repair av fistula ext 35190 at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
$7,765.20
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.
$12,942.00
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.
$786.98 with UPMC Health Plan vs $46,402.70 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 Health Plan | Managed Medicaid | $786.98 | ↓ -90% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $822.76 | ↓ -89% |
| Aetna | Medicaid | $858.53 | ↓ -89% |
| Geisinger | Medicaid/CHIP | $994.39 | ↓ -87% |
| Highmark Wholecare (prev Gateway) | Medicaid | $1,061.00 | ↓ -86% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $1,078.88 | ↓ -86% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $1,116.87 | ↓ -86% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $1,219.25 | ↓ -84% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,414.18 | ↓ -82% |
| Univera | Univera_Medicare_Hamot_2024 | $1,941.30 | ↓ -75% |
| BCBS of Western NY | Commercial | $2,794.87 | ↓ -64% |
| United Healthcare | Commercial | $2,849.00 | ↓ -63% |
| UPMC Work Partners | Workers Comp | $3,087.24 | ↓ -60% |
| Aetna | Commercial | $3,235.50 | ↓ -58% |
| Cigna | New Business ASO | $3,882.60 | ↓ -50% |
| Cigna | NBR ASO/FI | $3,882.60 | ↓ -50% |
| Univera | Commercial | $4,270.86 | ↓ -45% |
| Highmark BCBS of PA | Commercial - Indemnity/Commercial - Social Mission Indemnity/Managed Care/Managed Care - Social Mission | $4,273.26 | ↓ -45% |
| Cigna | EBR | $5,176.80 | ↓ -33% |
| Cigna | Commercial | $5,176.80 | ↓ -33% |
| Fidelis | Medicare | $5,948.00 | ↓ -23% |
| Aetna | Medicare | $6,066.96 | ↓ -22% |
| UPMC Health Plan | Partners/Select | $6,071.72 | ↓ -22% |
| Wellcare | Medicare Advantage | $6,126.44 | ↓ -21% |
| BCBS of Western NY | Medicare Advantage | $6,245.40 | ↓ -20% |
| United Healthcare | Medicare | $6,364.36 | ↓ -18% |
| Highmark Wholecare (prev Gateway) | Medicare | $6,423.25 | ↓ -17% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $6,423.84 | ↓ -17% |
| Cigna | Medicare | $6,423.84 | ↓ -17% |
| AmeriHealth Caritas | Medicare | $6,423.84 | ↓ -17% |
| Highmark BCBS of PA | UPMC Emergent | $6,837.16 | ↓ -12% |
| Independent Health | Medicare Advantage | $7,495.67 | ↓ -3% |
| InterGroup | Health Coalition Partners/PPO | $8,412.30 | ↑ +8% |
| Independent Health | Commercial | $8,794.63 | ↑ +13% |
| Aetna | AXA/MMO | $9,059.40 | ↑ +17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $9,059.40 | ↑ +17% |
| InterGroup | Beech Street | $10,353.60 | ↑ +33% |
| Multiplan | Complimentary Network Rate (Includes Multiplan as Payer) | $10,353.60 | ↑ +33% |
| UPMC Health Plan | Commercial | $46,402.70 | ↑ +498% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Repair av fistula ext 35190 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $9,171.00 | $715.44 – $12,228.00 |
| UPMC Bedford | Everett | $9,742.80 | $751.21 – $14,614.20 |
| UPMC Horizon-Greenville | Greenville | $7,024.20 | $786.98 – $5,565.99 |
| UPMC Presbyterian | Pittsburgh | $9,434.40 | $786.98 – $5,669.06 |
| UPMC St. Margaret | Pittsburgh | $8,080.20 | $786.98 – $5,669.06 |