healthcosts.net
Mayo factor xi at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$131.40
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.
$219.00
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.
$13.20 with UPMC Health Plan vs $186.15 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 | $13.20 | ↓ -90% |
| United Healthcare Community Plan for Families | Unison Kids | $13.80 | ↓ -89% |
| Aetna | Medicaid | $14.40 | ↓ -89% |
| UPMC Health Plan | Managed Medicare | $16.23 | ↓ -88% |
| UPMC Work Partners | Workers Comp | $17.69 | ↓ -87% |
| Highmark Wholecare (prev Gateway) | Medicaid | $17.80 | ↓ -86% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $17.90 | ↓ -86% |
| Geisinger | Medicaid/CHIP | $17.90 | ↓ -86% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $18.33 | ↓ -86% |
| Aetna | Medicare | $18.44 | ↓ -86% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $18.73 | ↓ -86% |
| United Healthcare | Unison Advantage Non Special Needs | $18.80 | ↓ -86% |
| Aetna of PA | Medicare | $18.80 | ↓ -86% |
| AmeriHealth Caritas | Medicare | $19.33 | ↓ -85% |
| Highmark Wholecare (prev Gateway) | Medicare | $19.33 | ↓ -85% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $19.33 | ↓ -85% |
| United Healthcare | Unison Advantage Special Needs | $19.69 | ↓ -85% |
| PA Health & Wellness | PA Medicaid HMO | $20.45 | ↓ -84% |
| UPMC Health Plan | Commercial | $28.55 | ↓ -78% |
| Cigna | Commercial | $87.60 | ↓ -33% |
| Aetna | EBR ASO | $87.60 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $100.35 | ↓ -24% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $123.63 | ↓ -6% |
| Aetna | EBR FI | $127.02 | ↓ -3% |
| Aetna | Neighborhood Network | $131.40 | ↑ +0% |
| Aetna | Home Depot Employer Group | $135.12 | ↑ +3% |
| Aetna | NBR ASO/FI | $137.97 | ↑ +5% |
| Cigna | New Business ASO | $137.97 | ↑ +5% |
| InterGroup | PPO | $142.35 | ↑ +8% |
| Coventry/First Health | Commercial | $153.30 | ↑ +17% |
| Health Coalition Partners | PPO | $157.68 | ↑ +20% |
| Private Health Care Systems | PPO | $175.20 | ↑ +33% |
| Humana | Commercial | $186.15 | ↑ +42% |
Visitor-reported prices
Comments
Mayo factor xi at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $201.00 | $13.20 – $284.75 |
| UPMC Mercy | Pittsburgh | $150.60 | $13.20 – $225.90 |
| UPMC Muncy | Muncy | $162.60 | $13.20 – $216.80 |
| UPMC Presbyterian | Pittsburgh | $1,503.00 | $12.00 – $2,129.25 |
| UPMC Somerset | Somerset | $91.20 | $13.20 – $61.50 |
| UPMC St. Margaret | Pittsburgh | $303.00 | $13.20 – $429.25 |
| UPMC Wellsboro | Wellsboro | $196.80 | $12.00 – $221.40 |
| UPMC Williamsport | Williamsport | $162.60 | $13.20 – $216.80 |