healthcosts.net
Exc/pilonidal cyst/sinus/simple 11770 at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$5,481.60
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.
?
What you pay up front if you don't use insurance.
$9,136.00
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.
$166.62 with UPMC Health Plan vs $7,765.60 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $166.62 | ↓ -97% |
| United Healthcare Community Plan for Families | Unison Kids | $174.19 | ↓ -97% |
| Aetna | Medicaid | $181.76 | ↓ -97% |
| Highmark Wholecare (prev Gateway) | Medicaid | $224.63 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $236.46 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $258.14 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $755.57 | ↓ -86% |
| UPMC Health Plan | Commercial | $1,245.30 | ↓ -77% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,172.24 | ↓ -60% |
| UPMC Health Plan | Managed Medicare | $2,474.59 | ↓ -55% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,676.36 | ↓ -51% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $2,728.62 | ↓ -50% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $2,793.56 | ↓ -49% |
| Aetna | Medicare | $2,810.48 | ↓ -49% |
| United Healthcare | Unison Advantage Non Special Needs | $2,865.05 | ↓ -48% |
| Aetna of PA | Medicare | $2,865.05 | ↓ -48% |
| Highmark Wholecare (prev Gateway) | Medicare | $2,946.64 | ↓ -46% |
| AmeriHealth Caritas | Medicare | $2,946.91 | ↓ -46% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2,946.91 | ↓ -46% |
| United Healthcare | Unison Advantage Special Needs | $3,001.48 | ↓ -45% |
| Cigna | Commercial | $3,654.40 | ↓ -33% |
| Aetna | EBR ASO | $3,654.40 | ↓ -33% |
| InterGroup | PPO | $3,704.00 | ↓ -32% |
| Aetna | EBR FI | $5,298.88 | ↓ -3% |
| Aetna | Neighborhood Network | $5,481.60 | ↑ +0% |
| Aetna | Home Depot Employer Group | $5,636.91 | ↑ +3% |
| Aetna | NBR ASO/FI | $5,755.68 | ↑ +5% |
| Cigna | New Business ASO | $5,755.68 | ↑ +5% |
| Coventry/First Health | Commercial | $6,395.20 | ↑ +17% |
| Health Coalition Partners | PPO | $6,577.92 | ↑ +20% |
| Private Health Care Systems | PPO | $7,308.80 | ↑ +33% |
| Humana | Commercial | $7,765.60 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Exc/pilonidal cyst/sinus/simple 11770 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $4,251.00 | $166.62 – $6,022.25 |
| UPMC Muncy | Muncy | $7,126.80 | $166.62 – $9,502.40 |
| UPMC Presbyterian | Pittsburgh | $4,440.60 | $166.62 – $6,290.85 |
| UPMC Somerset | Somerset | $480.60 | $166.62 – $2,728.62 |
| UPMC St. Margaret | Pittsburgh | $4,284.00 | $166.62 – $6,069.00 |
| UPMC Wellsboro | Wellsboro | $8,618.40 | $166.62 – $9,695.70 |
| UPMC Mercy | Pittsburgh | not published | $166.62 – $3,001.48 |