DIANEAL 2.5%D LOW CA 2000ML at UPMC Hamot

Erie, PA

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Pricing by billing methodology

Price type

Payers reporting HCPCS A4277 at UPMC Hamot

Negotiated rates from the hospital’s own file: 6 payers, 23 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges	$15	$15	—	—	—	$15 – $15
2	Aetna commercial facility · percent of total billed charges · inpatientfrom % of charges	$16	$16	—	—	—	$16 – $16
3	Cigna nbr aso/fi facility · percent of total billed charges · inpatientfrom % of charges	$18	$18	—	—	—	$18 – $18
4	Cigna nbr aso/fi facility · percent of total billed charges · outpatientfrom % of charges	$18	$18	—	—	—	$18 – $18
5	Cigna new business aso facility · percent of total billed charges · inpatientfrom % of charges	$18	$18	—	—	—	$18 – $18
6	Cigna new business aso facility · percent of total billed charges · outpatientfrom % of charges	$18	$18	—	—	—	$18 – $18
7	Blue Cross Blue Shield commercial facility · percent of total billed charges · outpatientfrom % of charges	$21	$21	—	—	—	$21 – $21
8	Aetna medicare facility · percent of total billed charges · outpatientfrom % of charges	$24	$24	—	—	—	$24 – $24
9	Cigna commercial facility · percent of total billed charges · inpatientfrom % of charges	$24	$24	—	—	—	$24 – $24
10	Cigna commercial facility · percent of total billed charges · outpatientfrom % of charges	$24	$24	—	—	—	$24 – $24
11	Cigna ebr facility · percent of total billed charges · inpatientfrom % of charges	$24	$24	—	—	—	$24 – $24
12	Cigna ebr facility · percent of total billed charges · outpatientfrom % of charges	$24	$24	—	—	—	$24 – $24
13	UnitedHealthcare commercial facility · percent of total billed charges · inpatientfrom % of charges	$27	$27	—	—	—	$27 – $27
14	Highmark commercial - indemnity/commercial - social mission indemnity/managed care/managed care - social mission facility · percent of total billed charges · outpatientfrom % of charges	$29	$29	—	—	—	$29 – $29
15	Highmark complete blue medicare advantage/freedom blue medicare advantage/security blue medicare advantage facility · percent of total billed charges · outpatientfrom % of charges	$30	$30	—	—	—	$30 – $30
16	Highmark medicare facility · percent of total billed charges · outpatientfrom % of charges	$30	$30	—	—	—	$30 – $30
17	Aetna axa/mmo facility · percent of total billed charges · inpatientfrom % of charges	$42	$42	—	—	—	$42 – $42
18	Aetna axa/mmo facility · percent of total billed charges · outpatientfrom % of charges	$42	$42	—	—	—	$42 – $42
19	MultiPlan ppo (includes phcs as a payer) facility · percent of total billed charges · inpatientfrom % of charges	$42	$42	—	—	—	$42 – $42
20	MultiPlan ppo (includes phcs as a payer) facility · percent of total billed charges · outpatientfrom % of charges	$42	$42	—	—	—	$42 – $42
21	Highmark upmc emergent facility · percent of total billed charges · outpatientfrom % of charges	$47	$47	—	—	—	$47 – $47
22	MultiPlan complimentary network rate (includes multiplan as payer) facility · percent of total billed charges · inpatientfrom % of charges	$48	$48	—	—	—	$48 – $48
23	MultiPlan complimentary network rate (includes multiplan as payer) facility · percent of total billed charges · outpatientfrom % of charges	$48	$48	—	—	—	$48 – $48

Last updated: Mar 6, 2026

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