healthcosts.net
Colonoscopy (with biopsy) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$2,132.40
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.
$3,554.00
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.
$247.96 with UPMC Health Plan vs $3,020.90 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 | $247.96 | ↓ -88% |
| United Healthcare Community Plan for Families | Unison Kids | $259.23 | ↓ -88% |
| Aetna | Medicaid | $270.50 | ↓ -87% |
| Highmark Wholecare (prev Gateway) | Medicaid | $334.30 | ↓ -84% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $351.90 | ↓ -83% |
| PA Health & Wellness | PA Medicaid HMO | $384.16 | ↓ -82% |
| UPMC Work Partners | Workers Comp | $845.68 | ↓ -60% |
| UPMC Health Plan | Managed Medicare | $1,019.46 | ↓ -52% |
| UPMC Health Plan | Commercial | $1,086.02 | ↓ -49% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,124.11 | ↓ -47% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,150.86 | ↓ -46% |
| Aetna | Medicare | $1,157.83 | ↓ -46% |
| United Healthcare | Unison Advantage Non Special Needs | $1,180.32 | ↓ -45% |
| Aetna of PA | Medicare | $1,180.32 | ↓ -45% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,213.93 | ↓ -43% |
| AmeriHealth Caritas | Medicare | $1,214.04 | ↓ -43% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,214.04 | ↓ -43% |
| United Healthcare | Unison Advantage Special Needs | $1,236.52 | ↓ -42% |
| Cigna | Commercial | $1,421.60 | ↓ -33% |
| Aetna | EBR ASO | $1,421.60 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,894.12 | ↓ -11% |
| Aetna | EBR FI | $2,061.32 | ↓ -3% |
| Aetna | Neighborhood Network | $2,132.40 | ↑ +0% |
| Aetna | Home Depot Employer Group | $2,192.82 | ↑ +3% |
| Aetna | NBR ASO/FI | $2,239.02 | ↑ +5% |
| Cigna | New Business ASO | $2,239.02 | ↑ +5% |
| InterGroup | PPO | $2,310.10 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,333.69 | ↑ +9% |
| Coventry/First Health | Commercial | $2,487.80 | ↑ +17% |
| Health Coalition Partners | PPO | $2,558.88 | ↑ +20% |
| Private Health Care Systems | PPO | $2,843.20 | ↑ +33% |
| Humana | Commercial | $3,020.90 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Colonoscopy (with biopsy) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $2,214.00 | $247.96 – $3,136.50 |
| UPMC East | Monroeville | $3,055.20 | $247.96 – $4,073.60 |
| UPMC Hamot | Erie | $3,099.00 | $247.96 – $3,615.50 |
| UPMC Altoona | Altoona | $1,764.60 | $225.42 – $2,352.80 |
| UPMC Bedford | Everett | $1,656.60 | $236.69 – $2,484.90 |
| UPMC Cole | Coudersport | $727.20 | $236.69 – $1,041.88 |
| UPMC Horizon-Greenville | Greenville | $2,476.20 | $247.96 – $3,507.95 |
| UPMC Jameson | New Castle | $2,476.20 | $247.96 – $3,631.76 |