healthcosts.net
Biopsy of lip 40490 at UPMC Muncy
215 East Water Street, Muncy, PA · UPMC · · NPI 1609816198
$881.40
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.
$1,469.00
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.
$40.15 with UPMC Health Plan vs $1,395.55 with Multiplan — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $40.15 | ↓ -95% |
| Geisinger | Medicaid/CHIP | $40.15 | ↓ -95% |
| UPMC Health Plan | CHIP | $40.15 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $40.70 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC) | $41.15 | ↓ -95% |
| AmeriHealth Caritas | Medicaid | $41.15 | ↓ -95% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $62.20 | ↓ -93% |
| UPMC Work Partners | Workers Comp | $195.13 | ↓ -78% |
| Three Rivers Provider Network | All | $208.74 | ↓ -76% |
| UPMC Health Plan | Managed Medicare | $220.35 | ↓ -75% |
| Highmark Wholecare (prev Gateway) | Medicare | $220.35 | ↓ -75% |
| AmeriHealth Caritas | Medicare | $226.96 | ↓ -74% |
| Cigna | Medicare | $231.37 | ↓ -74% |
| United Healthcare | Medicare | $235.77 | ↓ -73% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $237.98 | ↓ -73% |
| Highmark BCBS of PA | Bluecare HMO/FPLIC PPO/Traditional Products | $576.14 | ↓ -35% |
| Aetna | PEBTF Custom Network | $595.68 | ↓ -32% |
| UPMC Health Plan | Commercial | $640.48 | ↓ -27% |
| Highmark BCBS of PA | Managed Care - Social Mission | $678.53 | ↓ -23% |
| United Healthcare Community Plan for Families | PA Medicaid | $687.36 | ↓ -22% |
| Aetna | Commercial | $700.71 | ↓ -21% |
| Coventry/First Health | Commercial | $735.97 | ↓ -16% |
| Wirerope Works | Commercial | $816.76 | ↓ -7% |
| Aetna | First Health | $969.54 | ↑ +10% |
| Geisinger | Commercial | $984.23 | ↑ +12% |
| Coventry/First Health | FH-Medical Rental | $988.64 | ↑ +12% |
| United Healthcare | Commercial | $1,004.80 | ↑ +14% |
| Cigna | Commercial | $1,006.26 | ↑ +14% |
| Multiplan | Auto | $1,145.82 | ↑ +30% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,145.82 | ↑ +30% |
| America's Choice | PPO | $1,175.20 | ↑ +33% |
| InterGroup | PPO | $1,175.20 | ↑ +33% |
| Multiplan | Worker's Compensation | $1,395.55 | ↑ +58% |
Visitor-reported prices
Comments
Biopsy of lip 40490 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $672.00 | $40.15 – $952.00 |
| UPMC Presbyterian | Pittsburgh | $502.20 | $40.15 – $711.45 |
| UPMC St. Margaret | Pittsburgh | $529.20 | $40.15 – $749.70 |
| UPMC Wellsboro | Wellsboro | $1,065.60 | $40.15 – $1,198.80 |