Surgical pathology level 5 gross & microscopic examination at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
$360.60
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.
$601.00
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.
$45.50 with Health Partners Plans (Jefferson Health Plan) vs $588.42 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 |
|---|---|---|---|
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $45.50 | ↓ -87% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $49.05 | ↓ -86% |
| UPMC Health Plan | Managed Medicaid | $50.05 | ↓ -86% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $52.33 | ↓ -85% |
| Aetna | Medicaid | $54.60 | ↓ -85% |
| United Healthcare | Commercial | $60.45 | ↓ -83% |
| Geisinger | Medicaid/CHIP | $63.24 | ↓ -82% |
| UPMC Health Plan | Commercial | $65.21 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicaid | $67.48 | ↓ -81% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $71.03 | ↓ -80% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $77.54 | ↓ -78% |
| Univera | Univera_Medicare_Hamot_2024 | $90.15 | ↓ -75% |
| Highmark BCBS of PA | Commercial - Indemnity/Commercial - Social Mission Indemnity/Managed Care/Managed Care - Social Mission | $148.23 | ↓ -59% |
| Aetna | Commercial | $150.25 | ↓ -58% |
| Cigna | NBR ASO/FI | $180.30 | ↓ -50% |
| Cigna | New Business ASO | $180.30 | ↓ -50% |
| Univera | Commercial | $198.33 | ↓ -45% |
| Highmark BCBS of PA | UPMC Emergent | $237.16 | ↓ -34% |
| Cigna | Commercial | $240.40 | ↓ -33% |
| Cigna | EBR | $240.40 | ↓ -33% |
| UPMC Work Partners | Workers Comp | $269.87 | ↓ -25% |
| InterGroup | Health Coalition Partners/PPO | $390.65 | ↑ +8% |
| Fidelis | Medicare | $395.81 | ↑ +10% |
| Aetna | Medicare | $403.73 | ↑ +12% |
| UPMC Health Plan | Partners/Select | $404.04 | ↑ +12% |
| Wellcare | Medicare Advantage | $407.68 | ↑ +13% |
| BCBS of Western NY | Medicare Advantage | $415.60 | ↑ +15% |
| Multiplan | PPO (Includes PHCS as a Payer) | $420.70 | ↑ +17% |
| Aetna | AXA/MMO | $420.70 | ↑ +17% |
| Independent Health | Medicare Advantage | $420.75 | ↑ +17% |
| United Healthcare | Medicare | $423.52 | ↑ +17% |
| Highmark Wholecare (prev Gateway) | Medicare | $427.44 | ↑ +19% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $427.47 | ↑ +19% |
| AmeriHealth Caritas | Medicare | $427.47 | ↑ +19% |
| Cigna | Medicare | $427.47 | ↑ +19% |
| InterGroup | Beech Street | $480.80 | ↑ +33% |
| Multiplan | Complimentary Network Rate (Includes Multiplan as Payer) | $480.80 | ↑ +33% |
| Independent Health | Commercial | $560.37 | ↑ +55% |
| BCBS of Western NY | Commercial | $588.42 | ↑ +63% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Surgical pathology level 5 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $234.60 | $11.50 – $312.80 |
| UPMC Bedford | Everett | $189.60 | $36.42 – $284.40 |
| UPMC Carlisle | Carlisle | $664.80 | $15.06 – $941.80 |
| UPMC Cole | Coudersport | $572.40 | $47.77 – $763.20 |
| UPMC Community Osteopathic | Harrisburg | $664.80 | $15.06 – $378.62 |
| UPMC East | Monroeville | $379.20 | $35.92 – $505.60 |
| UPMC Northwest | Seneca | $360.60 | $36.26 – $360.10 |
| UPMC Hanover | Hanover | $664.80 | $15.06 – $549.82 |