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Breast Biopsy (ultrasound-guided, percutaneous) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$3,145.20
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.
$5,242.00
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.
$152.78 with UPMC Health Plan vs $4,455.70 with Humana — 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 | $152.78 | ↓ -95% |
| United Healthcare Community Plan for Families | Unison Kids | $159.72 | ↓ -95% |
| Aetna | Medicaid | $166.67 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $205.97 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $216.82 | ↓ -93% |
| PA Health & Wellness | PA Medicaid HMO | $236.70 | ↓ -92% |
| UPMC Work Partners | Workers Comp | $893.20 | ↓ -72% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,217.22 | ↓ -61% |
| UPMC Health Plan | Managed Medicare | $1,400.89 | ↓ -55% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,499.71 | ↓ -52% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,544.70 | ↓ -51% |
| UPMC Health Plan | Commercial | $1,547.09 | ↓ -51% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,581.46 | ↓ -50% |
| Aetna | Medicare | $1,591.04 | ↓ -49% |
| United Healthcare | Unison Advantage Non Special Needs | $1,621.93 | ↓ -48% |
| Aetna of PA | Medicare | $1,621.93 | ↓ -48% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,668.12 | ↓ -47% |
| AmeriHealth Caritas | Medicare | $1,668.28 | ↓ -47% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,668.28 | ↓ -47% |
| United Healthcare | Unison Advantage Special Needs | $1,699.17 | ↓ -46% |
| Cigna | Commercial | $2,096.80 | ↓ -33% |
| Aetna | EBR ASO | $2,096.80 | ↓ -33% |
| Aetna | EBR FI | $3,040.36 | ↓ -3% |
| Aetna | Neighborhood Network | $3,145.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $3,234.31 | ↑ +3% |
| Aetna | NBR ASO/FI | $3,302.46 | ↑ +5% |
| Cigna | New Business ASO | $3,302.46 | ↑ +5% |
| InterGroup | PPO | $3,407.30 | ↑ +8% |
| Coventry/First Health | Commercial | $3,669.40 | ↑ +17% |
| Health Coalition Partners | PPO | $3,774.24 | ↑ +20% |
| Private Health Care Systems | PPO | $4,193.60 | ↑ +33% |
| Humana | Commercial | $4,455.70 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Breast Biopsy (ultrasound-guided, percutaneous) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Hamot | Erie | $4,790.40 | $152.78 – $5,588.80 |
| UPMC Carlisle | Carlisle | $2,087.40 | $176.39 – $6,413.00 |
| UPMC Altoona | Altoona | $1,945.20 | $138.89 – $2,593.60 |
| UPMC Bedford | Everett | $2,637.00 | $145.83 – $3,955.50 |
| UPMC Cole | Coudersport | $419.40 | $145.83 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $2,087.40 | $187.50 – $2,957.15 |
| UPMC Hanover | Hanover | $2,087.40 | $176.39 – $3,026.73 |
| UPMC Horizon-Greenville | Greenville | $3,146.40 | $145.83 – $4,457.40 |