healthcosts.net
Established Patient Office Visit (level 5) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$291.00
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.
?
What you pay up front if you don't use insurance.
$485.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$36.08 with Aetna of PA vs $412.25 with Humana — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | ↓ -88% |
| Cigna | Commercial | $63.91 | ↓ -78% |
| Cigna | New Business ASO | $63.91 | ↓ -78% |
| UPMC Health Plan | Managed Medicaid | $85.86 | ↓ -70% |
| United Healthcare Community Plan for Families | Unison Kids | $89.76 | ↓ -69% |
| Aetna | Medicaid | $93.66 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicaid | $115.75 | ↓ -60% |
| Aetna | Medicare | $121.25 | ↓ -58% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $121.84 | ↓ -58% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $129.68 | ↓ -55% |
| PA Health & Wellness | PA Medicaid HMO | $133.01 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $159.77 | ↓ -45% |
| UPMC Work Partners | Workers Comp | $189.08 | ↓ -35% |
| Aetna | EBR ASO | $194.00 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $242.50 | ↓ -17% |
| Aetna | EBR FI | $281.30 | ↓ -3% |
| Aetna | Neighborhood Network | $291.00 | ↑ +0% |
| Aetna | Home Depot Employer Group | $299.25 | ↑ +3% |
| Aetna | NBR ASO/FI | $305.55 | ↑ +5% |
| InterGroup | PPO | $315.25 | ↑ +8% |
| Coventry/First Health | Commercial | $339.50 | ↑ +17% |
| Health Coalition Partners | PPO | $349.20 | ↑ +20% |
| Private Health Care Systems | PPO | $388.00 | ↑ +33% |
| Humana | Commercial | $412.25 | ↑ +42% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $573.00 | $74.33 – $811.75 |
| UPMC East | Monroeville | $253.80 | $36.08 – $338.40 |
| UPMC Altoona | Altoona | $343.80 | $20.00 – $458.40 |
| UPMC Bedford | Everett | $176.40 | $36.08 – $264.60 |
| UPMC Cole | Coudersport | $367.80 | $59.28 – $256.00 |
| UPMC Hamot | Erie | $205.80 | $51.45 – $333.55 |
| UPMC Community Osteopathic | Harrisburg | $678.00 | $99.12 – $790.50 |
| UPMC Horizon-Greenville | Greenville | $268.80 | $81.95 – $380.80 |