Repair av fistula ext 35190 at UPMC Horizon-Greenville
110 N Main St, Greenville, PA · UPMC · · NPI 1225048838
$7,024.20
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.
$11,707.00
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 Aetna vs $37,375.24 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 |
|---|---|---|---|
| Aetna | Medicaid | $786.98 | ↓ -89% |
| UPMC Health Plan | Managed Medicaid | $786.98 | ↓ -89% |
| Anthem Blue Cross Blue Shield | Blue Access PPO/Blue Preferred HMO/HIC | $979.00 | ↓ -86% |
| Geisinger | Medicaid/CHIP | $994.39 | ↓ -86% |
| Highmark Wholecare (prev Gateway) | Medicaid | $1,061.00 | ↓ -85% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $1,078.88 | ↓ -85% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $1,116.87 | ↓ -84% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $1,219.25 | ↓ -83% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,751.20 | ↓ -61% |
| UPMC Work Partners | Workers Comp | $3,024.25 | ↓ -57% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $3,389.82 | ↓ -52% |
| United Healthcare | Compass Exchange | $3,863.31 | ↓ -45% |
| Anthem Blue Cross Blue Shield | Traditional | $3,992.09 | ↓ -43% |
| Aetna | Neighborhood Network | $4,331.59 | ↓ -38% |
| Aetna | Home Depot Employer Group | $4,472.07 | ↓ -36% |
| United Healthcare | All Business | $4,565.73 | ↓ -35% |
| Cigna | New Business ASO | $4,565.73 | ↓ -35% |
| Aetna | NBR ASO/FI | $4,565.73 | ↓ -35% |
| Cigna | NBR ASO/FI | $4,565.73 | ↓ -35% |
| UPMC Health Plan | Managed Medicare | $4,614.10 | ↓ -34% |
| Cigna | Commercial | $4,682.80 | ↓ -33% |
| Cigna | EBR | $4,682.80 | ↓ -33% |
| Aetna | EBR ASO | $4,682.80 | ↓ -33% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $5,307.27 | ↓ -24% |
| Aetna | Medicare | $5,308.30 | ↓ -24% |
| United Healthcare Community Plan for Families | Unison MedPLUS | $5,411.37 | ↓ -23% |
| Aetna of PA | Medicare | $5,411.37 | ↓ -23% |
| United Healthcare Community Plan for Families | Unison Kids | $5,411.37 | ↓ -23% |
| United Healthcare | Medicare | $5,514.45 | ↓ -21% |
| Highmark Wholecare (prev Gateway) | Medicare | $5,565.47 | ↓ -21% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $5,565.99 | ↓ -21% |
| Cigna | Medicare | $5,565.99 | ↓ -21% |
| AmeriHealth Caritas | Medicare | $5,565.99 | ↓ -21% |
| Aetna | EBR FI | $7,024.20 | ↑ +0% |
| InterGroup | PPO | $7,609.55 | ↑ +8% |
| Coventry/First Health | Commercial | $7,726.62 | ↑ +10% |
| Health Coalition Partners | PPO | $8,194.90 | ↑ +17% |
| Private Health Care Systems | PPO | $9,365.60 | ↑ +33% |
| Prime Net | Commercial | $9,599.74 | ↑ +37% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $9,670.90 | ↑ +38% |
| Humana | Commercial | $9,950.95 | ↑ +42% |
| UPMC Health Plan | Commercial | $20,937.48 | ↑ +198% |
| UPMC Health Plan | CHIP | $37,375.24 | ↑ +432% |
| 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 Hamot | Erie | $7,765.20 | $786.98 – $7,495.67 |
| UPMC Presbyterian | Pittsburgh | $9,434.40 | $786.98 – $5,669.06 |
| UPMC St. Margaret | Pittsburgh | $8,080.20 | $786.98 – $5,669.06 |