Incision of breast lesion at UPMC Hanover
300 Highland Avenue, Hanover, PA · UPMC · · NPI 1730158981
$2,742.00
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.
$4,570.00
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.
$92.71 with AmeriHealth Caritas vs $5,505.60 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $92.71 | ↓ -97% |
| Highmark Wholecare (prev Gateway) | Medicaid | $92.71 | ↓ -97% |
| UPMC Health Plan | Managed Medicaid | $94.90 | ↓ -97% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $99.43 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $106.33 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $124.41 | ↓ -95% |
| Premier Comp Solutions | Worker's Comp | $521.86 | ↓ -81% |
| UPMC Work Partners | Workers Comp | $521.86 | ↓ -81% |
| Capital Blue Cross | Medicare Advantage | $859.94 | ↓ -69% |
| Keystone Health Plan | Medicare Advantage | $859.94 | ↓ -69% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,075.51 | ↓ -61% |
| Prime Net | Managed Medicare | $1,095.29 | ↓ -60% |
| Highmark BCBS of PA | Medicare | $1,532.34 | ↓ -44% |
| Humana | Medicare | $1,547.82 | ↓ -44% |
| Aetna | Medicare | $1,614.38 | ↓ -41% |
| Cigna | Medicare | $1,625.21 | ↓ -41% |
| Geisinger | Medicare | $1,625.21 | ↓ -41% |
| United Healthcare | Medicare | $1,656.17 | ↓ -40% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,671.65 | ↓ -39% |
| UPMC Health Plan | CHIP | $2,298.80 | ↓ -16% |
| Keystone Autism Services | ACAP | $2,476.51 | ↓ -10% |
| Aetna | ACO | $2,570.77 | ↓ -6% |
| Geisinger | Commercial | $2,963.62 | ↑ +8% |
| Keystone Health Plan | Commercial | $3,075.87 | ↑ +12% |
| Capital Blue Cross | CHIP | $3,075.87 | ↑ +12% |
| Capital Blue Cross | Commercial | $3,075.87 | ↑ +12% |
| UPMC Health Plan | Commercial | $3,168.20 | ↑ +16% |
| Aetna | Commercial | $3,294.93 | ↑ +20% |
| United Healthcare | Commercial | $3,363.52 | ↑ +23% |
| Cigna | Commercial | $3,530.28 | ↑ +29% |
| CareFirst | Commercial | $3,847.10 | ↑ +40% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $3,847.10 | ↑ +40% |
| Wellspan Population Health | Commercial | $3,937.62 | ↑ +44% |
| Highmark BCBS of PA | Medicaid | $5,134.74 | ↑ +87% |
| Highmark BCBS of PA | Commercial | $5,505.60 | ↑ +101% |
| Tricare | East Region | 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 Bedford | Everett | $4,534.80 | $76.65 – $6,802.20 |
| 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 Horizon-Greenville | Greenville | $3,508.20 | $80.30 – $1,668.28 |