Excise/repair mouth lesion at UPMC Bedford
10455 Lincoln Highway, Everett, PA · UPMC · · NPI 1295724193
not published by hospital
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.
not published by hospital
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.
$68.78 with United Healthcare Community Plan for Families vs $1,861.98 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | Unison MedPLUS | $68.78 | — |
| UPMC Health Plan | Managed Medicaid | $72.05 | — |
| United Healthcare Community Plan for Families | Unison Kids | $75.33 | — |
| Aetna | Medicaid | $81.88 | — |
| Geisinger | Medicaid/CHIP | $91.04 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $97.14 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $98.77 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $102.25 | — |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $111.63 | — |
| UPMC Work Partners | Workers Comp | $385.19 | — |
| Aetna of PA | Medicare | $509.53 | — |
| UPMC Health Plan | Commercial | $954.72 | — |
| UPMC Health Plan | Managed Medicare | $1,217.90 | — |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,412.22 | — |
| Aetna | Medicare | $1,454.59 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,457.69 | — |
| United Healthcare | Medicare | $1,511.08 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,511.46 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $1,525.06 | — |
| Cigna | Medicare | $1,525.20 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,525.20 | — |
| AmeriHealth Caritas | Medicare | $1,525.20 | — |
| UPMC Health Plan | CHIP | $1,730.96 | — |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,861.98 | — |
| Tricare | TRICARE | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Excise/repair mouth lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $351.00 | $49.90 – $2,325.85 |
| Uniontown Hospital | Uniontown | $1,783.50 | $72.05 – $3,123.56 |
| UPMC Community Osteopathic | Harrisburg | not published | $88.42 – $4,217.85 |
| UPMC Hamot | Erie | not published | $72.05 – $2,053.97 |
| UPMC Wellsboro | Wellsboro | not published | $72.05 – $674.56 |
| WellSpan Ephrata Community Hospital | Ephrata | not published | $1,430.62 – $5,627.00 |