healthcosts.net
New Patient Office Visit (level 5) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$526.20
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.
$877.00
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 $745.45 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 | ↓ -93% |
| Cigna | Commercial | $63.91 | ↓ -88% |
| Cigna | New Business ASO | $63.91 | ↓ -88% |
| UPMC Health Plan | Managed Medicaid | $129.29 | ↓ -75% |
| United Healthcare Community Plan for Families | Unison Kids | $135.17 | ↓ -74% |
| Aetna | Medicaid | $141.05 | ↓ -73% |
| Highmark Wholecare (prev Gateway) | Medicaid | $174.31 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $183.49 | ↓ -65% |
| PA Health & Wellness | PA Medicaid HMO | $200.31 | ↓ -62% |
| Aetna | Medicare | $219.25 | ↓ -58% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $231.76 | ↓ -56% |
| UPMC Work Partners | Workers Comp | $241.01 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $285.54 | ↓ -46% |
| Aetna | EBR ASO | $350.80 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $438.50 | ↓ -17% |
| Aetna | EBR FI | $508.66 | ↓ -3% |
| Aetna | Neighborhood Network | $526.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $541.11 | ↑ +3% |
| Aetna | NBR ASO/FI | $552.51 | ↑ +5% |
| InterGroup | PPO | $570.05 | ↑ +8% |
| Coventry/First Health | Commercial | $613.90 | ↑ +17% |
| Health Coalition Partners | PPO | $631.44 | ↑ +20% |
| Private Health Care Systems | PPO | $701.60 | ↑ +33% |
| Humana | Commercial | $745.45 | ↑ +42% |
Visitor-reported prices
Comments
New Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $663.60 | $129.29 – $940.10 |
| UPMC East | Monroeville | $516.00 | $36.08 – $688.00 |
| UPMC Hamot | Erie | $360.60 | $90.15 – $527.06 |
| UPMC Altoona | Altoona | $343.80 | $30.00 – $458.40 |
| UPMC Bedford | Everett | $355.80 | $36.08 – $533.70 |
| UPMC Cole | Coudersport | $526.20 | $65.78 – $385.60 |
| UPMC Community Osteopathic | Harrisburg | $814.80 | $149.28 – $1,133.05 |
| UPMC Horizon-Greenville | Greenville | $526.20 | $123.42 – $745.45 |