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Clsd tx metatarsal fracture w/manip 28475 at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$4,795.80
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.
$7,993.00
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.
$129.80 with UPMC Health Plan vs $6,794.05 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 | $129.80 | ↓ -97% |
| United Healthcare Community Plan for Families | Unison Kids | $135.70 | ↓ -97% |
| Aetna | Medicaid | $141.60 | ↓ -97% |
| Highmark Wholecare (prev Gateway) | Medicaid | $174.99 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $184.21 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $201.10 | ↓ -96% |
| UPMC Health Plan | Managed Medicare | $207.41 | ↓ -96% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $228.70 | ↓ -95% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $234.14 | ↓ -95% |
| Aetna | Medicare | $235.56 | ↓ -95% |
| United Healthcare | Unison Advantage Non Special Needs | $240.13 | ↓ -95% |
| Aetna of PA | Medicare | $240.13 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicare | $246.97 | ↓ -95% |
| AmeriHealth Caritas | Medicare | $247.00 | ↓ -95% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $247.00 | ↓ -95% |
| United Healthcare | Unison Advantage Special Needs | $251.57 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $490.87 | ↓ -90% |
| UPMC Health Plan | Commercial | $1,093.93 | ↓ -77% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,894.12 | ↓ -61% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,333.69 | ↓ -51% |
| Cigna | Commercial | $3,197.20 | ↓ -33% |
| Aetna | EBR ASO | $3,197.20 | ↓ -33% |
| InterGroup | PPO | $3,704.00 | ↓ -23% |
| Aetna | EBR FI | $4,635.94 | ↓ -3% |
| Aetna | Neighborhood Network | $4,795.80 | ↑ +0% |
| Aetna | Home Depot Employer Group | $4,931.68 | ↑ +3% |
| Aetna | NBR ASO/FI | $5,035.59 | ↑ +5% |
| Cigna | New Business ASO | $5,035.59 | ↑ +5% |
| Coventry/First Health | Commercial | $5,595.10 | ↑ +17% |
| Health Coalition Partners | PPO | $5,754.96 | ↑ +20% |
| Private Health Care Systems | PPO | $6,394.40 | ↑ +33% |
| Humana | Commercial | $6,794.05 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Clsd tx metatarsal fracture w/manip 28475 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $3,321.00 | $129.80 – $4,981.50 |
| UPMC Muncy | Muncy | $534.60 | $129.80 – $993.28 |
| UPMC Presbyterian | Pittsburgh | $5,052.60 | $129.80 – $7,157.85 |
| UPMC Somerset | Somerset | $759.00 | $129.80 – $948.75 |
| UPMC Wellsboro | Wellsboro | $647.20 | $129.80 – $993.28 |
| UPMC Williamsport | Williamsport | $534.60 | $129.80 – $993.28 |
| UPMC St. Margaret | Pittsburgh | not published | $129.80 – $736.75 |