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Oropharyngeal biopsy 42800 at UPMC Williamsport
700 High Street, Williamsport, PA · UPMC · · NPI 164974648
$836.40
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.
$1,394.00
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.
$59.95 with UPMC Health Plan vs $1,525.20 with PA Health & Wellness — 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 | $59.95 | ↓ -93% |
| Geisinger | Medicaid/CHIP | $59.95 | ↓ -93% |
| UPMC Health Plan | CHIP | $59.95 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $61.45 | ↓ -93% |
| Highmark Wholecare (prev Gateway) | Medicaid | $76.57 | ↓ -91% |
| PA Health & Wellness | PA Medicaid HMO | $92.88 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $207.79 | ↓ -75% |
| Three Rivers Provider Network | All | $222.29 | ↓ -73% |
| Multiplan | Worker's Compensation | $229.54 | ↓ -73% |
| Highmark BCBS of PA | Managed Care - Social Mission | $554.67 | ↓ -34% |
| Aetna | PEBTF Custom Network | $565.27 | ↓ -32% |
| UPMC Health Plan | Commercial | $607.78 | ↓ -27% |
| Highmark BCBS of PA | Bluecare HMO/FPLIC PPO/Traditional Products | $653.23 | ↓ -22% |
| Aetna | Commercial | $664.94 | ↓ -20% |
| Coventry/First Health | Commercial | $698.39 | ↓ -17% |
| Wirerope Works | Commercial | $775.06 | ↓ -7% |
| Aetna | First Health | $920.04 | ↑ +10% |
| Geisinger | Commercial | $933.98 | ↑ +12% |
| Coventry/First Health | FH-Medical Rental | $938.16 | ↑ +12% |
| United Healthcare | Commercial | $953.50 | ↑ +14% |
| Cigna | Commercial | $954.89 | ↑ +14% |
| United Healthcare Community Plan for Families | PA Medicaid | $993.28 | ↑ +19% |
| Multiplan | Auto | $1,087.32 | ↑ +30% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,087.32 | ↑ +30% |
| America's Choice | PPO | $1,115.20 | ↑ +33% |
| InterGroup | PPO | $1,115.20 | ↑ +33% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,426.06 | ↑ +70% |
| UPMC Health Plan | Managed Medicare | $1,440.46 | ↑ +72% |
| AmeriHealth Caritas | Medicare | $1,454.59 | ↑ +74% |
| Aetna | Medicare | $1,454.59 | ↑ +74% |
| United Healthcare | Medicare | $1,511.08 | ↑ +81% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,525.06 | ↑ +82% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,525.20 | ↑ +82% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Oropharyngeal biopsy 42800 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $720.00 | $59.95 – $1,482.83 |
| UPMC Presbyterian | Pittsburgh | $1,012.80 | $59.95 – $1,553.44 |
| UPMC St. Margaret | Pittsburgh | $681.60 | $59.95 – $1,482.83 |