Stent/tib/peroneal/unilat/initial 37230 at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
$31,604.40
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.
$52,674.00
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.
$644.90 with UPMC Health Plan vs $72,433.88 with Highmark BCBS of PA — 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 | $644.90 | ↓ -98% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $674.21 | ↓ -98% |
| Aetna | Medicaid | $703.52 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $814.86 | ↓ -97% |
| Highmark Wholecare (prev Gateway) | Medicaid | $869.44 | ↓ -97% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $884.10 | ↓ -97% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $915.23 | ↓ -97% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $999.12 | ↓ -97% |
| BCBS of Western NY | Commercial | $2,794.87 | ↓ -91% |
| United Healthcare | Commercial | $3,411.00 | ↓ -89% |
| Univera | Univera_Medicare_Hamot_2024 | $7,901.10 | ↓ -75% |
| UPMC Work Partners | Workers Comp | $12,299.12 | ↓ -61% |
| Aetna | Commercial | $13,168.50 | ↓ -58% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $14,981.98 | ↓ -53% |
| Cigna | New Business ASO | $15,802.20 | ↓ -50% |
| Cigna | NBR ASO/FI | $15,802.20 | ↓ -50% |
| Univera | Commercial | $17,382.42 | ↓ -45% |
| UPMC Health Plan | Commercial | $19,384.03 | ↓ -39% |
| Fidelis | Medicare | $19,758.14 | ↓ -37% |
| Aetna | Medicare | $20,153.30 | ↓ -36% |
| UPMC Health Plan | Partners/Select | $20,169.11 | ↓ -36% |
| Wellcare | Medicare Advantage | $20,350.88 | ↓ -36% |
| BCBS of Western NY | Medicare Advantage | $20,746.05 | ↓ -34% |
| Cigna | EBR | $21,069.60 | ↓ -33% |
| Cigna | Commercial | $21,069.60 | ↓ -33% |
| United Healthcare | Medicare | $21,141.21 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $21,336.82 | ↓ -32% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $21,338.79 | ↓ -32% |
| Cigna | Medicare | $21,338.79 | ↓ -32% |
| AmeriHealth Caritas | Medicare | $21,338.79 | ↓ -32% |
| Independent Health | Medicare Advantage | $24,899.21 | ↓ -21% |
| Independent Health | Commercial | $29,392.54 | ↓ -7% |
| InterGroup | Health Coalition Partners/PPO | $34,238.10 | ↑ +8% |
| Aetna | AXA/MMO | $36,871.80 | ↑ +17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $36,871.80 | ↑ +17% |
| Multiplan | Complimentary Network Rate (Includes Multiplan as Payer) | $42,139.20 | ↑ +33% |
| InterGroup | Beech Street | $42,139.20 | ↑ +33% |
| Highmark BCBS of PA | Commercial - Indemnity/Commercial - Social Mission Indemnity/Managed Care/Managed Care - Social Mission | $45,271.58 | ↑ +43% |
| Highmark BCBS of PA | UPMC Emergent | $72,433.88 | ↑ +129% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Stent/tib/peroneal/unilat/initial 37230 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $34,008.60 | $12,299.12 – $45,344.80 |
| UPMC Carlisle | Carlisle | $24,161.40 | $1,016.56 – $34,228.65 |
| UPMC Community Osteopathic | Harrisburg | $24,161.40 | $1,016.56 – $34,228.65 |
| UPMC East | Monroeville | $35,436.00 | $12,299.12 – $47,248.00 |
| UPMC Hanover | Hanover | $24,161.40 | $1,016.56 – $27,446.48 |
| UPMC Lititz | Lititz | $24,161.40 | $1,016.56 – $27,594.74 |
| UPMC Memorial | York | $24,161.40 | $1,016.56 – $27,549.92 |
| UPMC Passavant-McCandless | Pittsburgh | $34,695.00 | $12,299.12 – $18,831.54 |