healthcosts.net
Kit lead specify 5-6-5 at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$7,816.20
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.
$13,027.00
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.
$212.50 with Aetna vs $15,937.99 with UPMC Health Plan — 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 | Medicare | $212.50 | ↓ -97% |
| PA Health & Wellness | PA Medicaid HMO | $280.50 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $287.56 | ↓ -96% |
| Aetna | EBR ASO | $340.00 | ↓ -96% |
| Cigna | Commercial | $340.00 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $340.00 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicare | $425.00 | ↓ -95% |
| Aetna | EBR FI | $493.00 | ↓ -94% |
| Aetna | Neighborhood Network | $510.00 | ↓ -93% |
| Aetna | Home Depot Employer Group | $524.45 | ↓ -93% |
| Aetna | NBR ASO/FI | $535.50 | ↓ -93% |
| Cigna | New Business ASO | $535.50 | ↓ -93% |
| InterGroup | PPO | $552.50 | ↓ -93% |
| Coventry/First Health | Commercial | $595.00 | ↓ -92% |
| Health Coalition Partners | PPO | $612.00 | ↓ -92% |
| Private Health Care Systems | PPO | $680.00 | ↓ -91% |
| Humana | Commercial | $722.50 | ↓ -91% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $5,589.39 | ↓ -28% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $6,886.54 | ↓ -12% |
| UPMC Health Plan | Commercial | $15,937.99 | ↑ +104% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
Comments
Kit lead specify 5-6-5 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $41,212.80 | $216.24 – $10,400.32 |
| UPMC Muncy | Muncy | $11,398.80 | $120.30 – $721.80 |
| UPMC Passavant-McCandless | Pittsburgh | $17,425.20 | $44.00 – $19,112.65 |
| UPMC Presbyterian | Pittsburgh | $54,950.40 | $32.04 – $21,295.03 |
| UPMC St. Margaret | Pittsburgh | $6,860.40 | $2,174.09 – $16,161.66 |
| UPMC Wellsboro | Wellsboro | $13,784.80 | $165.60 – $828.00 |
| UPMC Williamsport | Williamsport | $12,081.00 | $160.40 – $721.80 |