Treatment of anal fissure w/dilat 46940 at UPMC Memorial
1701 Innovation Drive, York, PA · UPMC · · NPI 1063945707
not published by hospital
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.
not published by hospital
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.
$44.45 with Highmark Wholecare (prev Gateway) vs $9,539.00 with Cigna — 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $44.45 | — |
| UPMC Health Plan | Managed Medicaid | $45.50 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $47.25 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $47.67 | — |
| Geisinger | Medicaid/CHIP | $50.98 | — |
| Highmark BCBS of PA | Medicare | $166.65 | — |
| UPMC Work Partners | Workers Comp | $235.59 | — |
| UPMC Health Plan | CHIP | $653.07 | — |
| United Healthcare Community Plan for Families | PA Medicaid | $745.39 | — |
| Aetna | Medicare | $2,742.76 | — |
| Geisinger | Medicare | $2,761.16 | — |
| Cigna | Medicare | $2,761.16 | — |
| United Healthcare | Medicare | $2,813.76 | — |
| Keystone Autism Services | ACAP | $4,207.49 | — |
| Capital Blue Cross | Commercial | $7,073.85 | — |
| Capital Blue Cross | CHIP | $7,073.85 | — |
| Keystone Health Plan | Commercial | $7,105.35 | — |
| Highmark BCBS of PA | Medicaid | $8,710.55 | — |
| Highmark BCBS of PA | Commercial | $9,267.52 | — |
| Cigna | Commercial | $9,539.00 | — |
| United Healthcare | Commercial | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Treatment of anal fissure w/dilat 46940 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $257.40 | $36.75 – $2,325.85 |
| UPMC Passavant-McCandless | Pittsburgh | not published | $38.50 – $2,875.99 |