healthcosts.net
Drainage of mouth lesion at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$3,430.80
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.
$5,718.00
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.
$25.85 with UPMC Health Plan vs $4,860.30 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 | $25.85 | ↓ -99% |
| United Healthcare Community Plan for Families | Unison Kids | $27.02 | ↓ -99% |
| Aetna | Medicaid | $28.20 | ↓ -99% |
| Highmark Wholecare (prev Gateway) | Medicaid | $34.85 | ↓ -99% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $36.69 | ↓ -99% |
| PA Health & Wellness | PA Medicaid HMO | $40.05 | ↓ -99% |
| UPMC Work Partners | Workers Comp | $290.46 | ↓ -92% |
| UPMC Health Plan | Commercial | $818.12 | ↓ -76% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,414.58 | ↓ -59% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,742.87 | ↓ -49% |
| Cigna | Commercial | $2,287.20 | ↓ -33% |
| Aetna | EBR ASO | $2,287.20 | ↓ -33% |
| UPMC Health Plan | Managed Medicare | $2,804.03 | ↓ -18% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $3,091.88 | ↓ -10% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,165.47 | ↓ -8% |
| Aetna | Medicare | $3,184.64 | ↓ -7% |
| United Healthcare | Unison Advantage Non Special Needs | $3,246.47 | ↓ -5% |
| Aetna of PA | Medicare | $3,246.47 | ↓ -5% |
| Aetna | EBR FI | $3,316.44 | ↓ -3% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,338.92 | ↓ -3% |
| AmeriHealth Caritas | Medicare | $3,339.23 | ↓ -3% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,339.23 | ↓ -3% |
| United Healthcare | Unison Advantage Special Needs | $3,401.07 | ↓ -1% |
| Aetna | Neighborhood Network | $3,430.80 | ↑ +0% |
| Aetna | Home Depot Employer Group | $3,528.01 | ↑ +3% |
| Aetna | NBR ASO/FI | $3,602.34 | ↑ +5% |
| Cigna | New Business ASO | $3,602.34 | ↑ +5% |
| InterGroup | PPO | $3,704.00 | ↑ +8% |
| Coventry/First Health | Commercial | $4,002.60 | ↑ +17% |
| Health Coalition Partners | PPO | $4,116.96 | ↑ +20% |
| Private Health Care Systems | PPO | $4,574.40 | ↑ +33% |
| Humana | Commercial | $4,860.30 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Drainage of mouth lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,202.80 | $25.85 – $4,537.30 |
| UPMC Mercy | Pittsburgh | $2,552.40 | $25.85 – $3,828.60 |
| UPMC Muncy | Muncy | $3,435.60 | $25.85 – $4,580.80 |
| UPMC Presbyterian | Pittsburgh | $4,240.80 | $25.85 – $6,007.80 |
| UPMC Somerset | Somerset | $3,971.40 | $25.85 – $4,964.25 |
| UPMC Williamsport | Williamsport | $3,435.60 | $25.85 – $4,580.80 |
| UPMC St. Margaret | Pittsburgh | not published | $25.85 – $3,401.07 |