Incision of breast lesion at UPMC Bedford
10455 Lincoln Highway, Everett, PA · UPMC · · NPI 1295724193
$4,534.80
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.
$7,558.00
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.
$76.65 with United Healthcare Community Plan for Families vs $6,802.20 with Health Coalition Partners — 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 | $76.65 | ↓ -98% |
| UPMC Health Plan | Managed Medicaid | $80.30 | ↓ -98% |
| United Healthcare Community Plan for Families | Unison Kids | $83.95 | ↓ -98% |
| Aetna | Medicaid | $91.25 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $101.46 | ↓ -98% |
| Highmark Wholecare (prev Gateway) | Medicaid | $108.26 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $110.08 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $113.96 | ↓ -97% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $124.41 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $423.98 | ↓ -91% |
| Aetna of PA | Medicare | $557.33 | ↓ -88% |
| UPMC Health Plan | Commercial | $1,267.91 | ↓ -72% |
| UPMC Health Plan | Managed Medicare | $1,332.15 | ↓ -71% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,544.70 | ↓ -66% |
| Aetna | Medicare | $1,591.04 | ↓ -65% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,594.44 | ↓ -65% |
| United Healthcare | Medicare | $1,652.83 | ↓ -64% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,668.12 | ↓ -63% |
| AmeriHealth Caritas | Medicare | $1,668.28 | ↓ -63% |
| Cigna | Medicare | $1,668.28 | ↓ -63% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,668.28 | ↓ -63% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,023.84 | ↓ -55% |
| UPMC Health Plan | CHIP | $2,298.80 | ↓ -49% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,493.18 | ↓ -45% |
| Cigna | EBR | $3,023.20 | ↓ -33% |
| Cigna | Commercial | $3,023.20 | ↓ -33% |
| Aetna | EBR ASO | $3,023.20 | ↓ -33% |
| Aetna | EBR FI | $3,703.42 | ↓ -18% |
| United Healthcare | Compass Exchange | $4,156.90 | ↓ -8% |
| Aetna | Neighborhood Network | $4,685.96 | ↑ +3% |
| Aetna | Home Depot Employer Group | $4,814.45 | ↑ +6% |
| Aetna | NBR ASO/FI | $4,912.70 | ↑ +8% |
| United Healthcare | All Business | $4,912.70 | ↑ +8% |
| InterGroup | PPO | $4,912.70 | ↑ +8% |
| Cigna | New Business ASO | $4,912.70 | ↑ +8% |
| Cigna | NBR ASO/FI | $4,912.70 | ↑ +8% |
| Coventry/First Health | Commercial | $5,290.60 | ↑ +17% |
| Preferred Healthcare System | PPO | $6,046.40 | ↑ +33% |
| Humana | Commercial | $6,802.20 | ↑ +50% |
| SelectCare | Commercial | $6,802.20 | ↑ +50% |
| Private Health Care Systems | PPO | $6,802.20 | ↑ +50% |
| Health Coalition Partners | Intergroup | $6,802.20 | ↑ +50% |
| Tricare | TRICARE | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Incision of breast lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,765.20 | $73.00 – $2,353.60 |
| UPMC Carlisle | Carlisle | $2,715.60 | $92.71 – $3,847.10 |
| UPMC Cole | Coudersport | $1,693.20 | $76.65 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $2,715.60 | $92.71 – $3,847.10 |
| UPMC East | Monroeville | $3,824.40 | $80.30 – $5,099.20 |
| UPMC Hamot | Erie | $3,013.20 | $80.30 – $2,246.66 |
| UPMC Hanover | Hanover | $2,742.00 | $92.71 – $2,476.51 |
| UPMC Horizon-Greenville | Greenville | $3,508.20 | $80.30 – $1,668.28 |