healthcosts.net
Established Patient Office Visit (level 4) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$201.60
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.
$336.00
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.
$36.08 with Aetna of PA vs $285.60 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 |
|---|---|---|---|
| Aetna of PA | Medicare | $36.08 | ↓ -82% |
| UPMC Health Plan | Managed Medicaid | $59.86 | ↓ -70% |
| United Healthcare Community Plan for Families | Unison Kids | $62.58 | ↓ -69% |
| Cigna | Commercial | $63.91 | ↓ -68% |
| Cigna | New Business ASO | $63.91 | ↓ -68% |
| Aetna | Medicaid | $65.30 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicaid | $80.70 | ↓ -60% |
| Aetna | Medicare | $84.00 | ↓ -58% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $84.96 | ↓ -58% |
| PA Health & Wellness | PA Medicaid HMO | $92.74 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $111.59 | ↓ -45% |
| UPMC Work Partners | Workers Comp | $122.03 | ↓ -39% |
| Aetna | EBR ASO | $134.40 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $137.48 | ↓ -32% |
| Highmark Wholecare (prev Gateway) | Medicare | $168.00 | ↓ -17% |
| Aetna | EBR FI | $194.88 | ↓ -3% |
| Aetna | Neighborhood Network | $201.60 | ↑ +0% |
| Aetna | Home Depot Employer Group | $207.31 | ↑ +3% |
| Aetna | NBR ASO/FI | $211.68 | ↑ +5% |
| InterGroup | PPO | $218.40 | ↑ +8% |
| Coventry/First Health | Commercial | $235.20 | ↑ +17% |
| Health Coalition Partners | PPO | $241.92 | ↑ +20% |
| Private Health Care Systems | PPO | $268.80 | ↑ +33% |
| Humana | Commercial | $285.60 | ↑ +42% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $250.80 | $59.86 – $355.30 |
| UPMC East | Monroeville | $216.00 | $36.08 – $288.00 |
| UPMC Altoona | Altoona | $274.20 | $20.00 – $365.60 |
| UPMC Bedford | Everett | $142.20 | $36.08 – $213.30 |
| UPMC Cole | Coudersport | $273.00 | $51.57 – $190.40 |
| UPMC Hamot | Erie | $178.20 | $44.55 – $247.66 |
| UPMC Community Osteopathic | Harrisburg | $271.80 | $31.00 – $337.75 |
| UPMC Hanover | Hanover | $93.00 | $29.45 – $134.85 |