healthcosts.net
ER Visit (level 5, high severity) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$703.20
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.
$1,172.00
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.
$152.61 with UPMC Health Plan vs $996.20 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 | $152.61 | ↓ -78% |
| United Healthcare Community Plan for Families | Unison Kids | $159.55 | ↓ -77% |
| Aetna | Medicaid | $166.49 | ↓ -76% |
| Highmark Wholecare (prev Gateway) | Medicaid | $205.75 | ↓ -71% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $216.59 | ↓ -69% |
| PA Health & Wellness | PA Medicaid HMO | $236.44 | ↓ -66% |
| UPMC Work Partners | Workers Comp | $265.77 | ↓ -62% |
| UPMC Health Plan | Commercial | $368.75 | ↓ -48% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $452.13 | ↓ -36% |
| Cigna | Commercial | $468.80 | ↓ -33% |
| Aetna | EBR ASO | $468.80 | ↓ -33% |
| UPMC Health Plan | Managed Medicare | $530.10 | ↓ -25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $557.06 | ↓ -21% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $584.52 | ↓ -17% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $598.43 | ↓ -15% |
| Aetna | Medicare | $602.06 | ↓ -14% |
| United Healthcare | Unison Advantage Non Special Needs | $613.75 | ↓ -13% |
| Aetna of PA | Medicare | $613.75 | ↓ -13% |
| Highmark Wholecare (prev Gateway) | Medicare | $631.22 | ↓ -10% |
| AmeriHealth Caritas | Medicare | $631.28 | ↓ -10% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $631.28 | ↓ -10% |
| United Healthcare | Unison Advantage Special Needs | $642.97 | ↓ -9% |
| Aetna | EBR FI | $679.76 | ↓ -3% |
| Aetna | Neighborhood Network | $703.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $723.12 | ↑ +3% |
| Aetna | NBR ASO/FI | $738.36 | ↑ +5% |
| Cigna | New Business ASO | $738.36 | ↑ +5% |
| InterGroup | PPO | $761.80 | ↑ +8% |
| Coventry/First Health | Commercial | $820.40 | ↑ +17% |
| Health Coalition Partners | PPO | $843.84 | ↑ +20% |
| Private Health Care Systems | PPO | $937.60 | ↑ +33% |
| Humana | Commercial | $996.20 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
ER Visit (level 5, high severity) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC East | Monroeville | $1,371.00 | $152.61 – $1,828.00 |
| UPMC Passavant-McCandless | Pittsburgh | $1,798.20 | $152.61 – $2,547.45 |
| UPMC Hamot | Erie | $2,165.40 | $152.61 – $2,526.30 |
| UPMC Carlisle | Carlisle | $1,828.80 | $65.00 – $2,590.80 |
| UPMC Altoona | Altoona | $1,449.00 | $174.21 – $1,932.00 |
| UPMC Bedford | Everett | $903.60 | $145.68 – $1,355.40 |
| UPMC Cole | Coudersport | $630.00 | $56.38 – $553.93 |
| UPMC Community Osteopathic | Harrisburg | $1,828.80 | $65.00 – $645.31 |