healthcosts.net
Nm imaging pulmonary ventilation/perfusion at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$1,666.20
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.
$2,777.00
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.
$262.00 with UPMC Health Plan vs $2,360.45 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $262.00 | ↓ -84% |
| United Healthcare Community Plan for Families | Unison Kids | $273.91 | ↓ -84% |
| Aetna | Medicaid | $285.82 | ↓ -83% |
| Highmark Wholecare (prev Gateway) | Medicaid | $353.22 | ↓ -79% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $371.82 | ↓ -78% |
| PA Health & Wellness | PA Medicaid HMO | $405.91 | ↓ -76% |
| UPMC Work Partners | Workers Comp | $438.93 | ↓ -74% |
| UPMC Health Plan | Managed Medicare | $465.40 | ↓ -72% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $513.18 | ↓ -69% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $525.39 | ↓ -68% |
| Aetna | Medicare | $528.58 | ↓ -68% |
| United Healthcare | Unison Advantage Non Special Needs | $538.84 | ↓ -68% |
| Aetna of PA | Medicare | $538.84 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicare | $554.18 | ↓ -67% |
| AmeriHealth Caritas | Medicare | $554.23 | ↓ -67% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $554.23 | ↓ -67% |
| United Healthcare | Unison Advantage Special Needs | $564.50 | ↓ -66% |
| UPMC Health Plan | Commercial | $571.81 | ↓ -66% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $821.48 | ↓ -51% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,012.13 | ↓ -39% |
| Cigna | Commercial | $1,110.80 | ↓ -33% |
| Aetna | EBR ASO | $1,110.80 | ↓ -33% |
| Aetna | EBR FI | $1,610.66 | ↓ -3% |
| Aetna | Neighborhood Network | $1,666.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $1,713.41 | ↑ +3% |
| Aetna | NBR ASO/FI | $1,749.51 | ↑ +5% |
| Cigna | New Business ASO | $1,749.51 | ↑ +5% |
| InterGroup | PPO | $1,805.05 | ↑ +8% |
| Coventry/First Health | Commercial | $1,943.90 | ↑ +17% |
| Health Coalition Partners | PPO | $1,999.44 | ↑ +20% |
| Private Health Care Systems | PPO | $2,221.60 | ↑ +33% |
| Humana | Commercial | $2,360.45 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Nm imaging pulmonary ventilation/perfusion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,417.20 | $262.00 – $2,007.70 |
| UPMC Mercy | Pittsburgh | $1,443.00 | $262.00 – $2,164.50 |
| UPMC Muncy | Muncy | $2,217.00 | $254.48 – $2,956.00 |
| UPMC Presbyterian | Pittsburgh | $2,062.80 | $238.57 – $2,922.30 |
| UPMC Somerset | Somerset | $1,574.40 | $228.63 – $1,968.00 |
| UPMC St. Margaret | Pittsburgh | $1,378.20 | $262.00 – $1,952.45 |
| UPMC Wellsboro | Wellsboro | $2,680.80 | $254.48 – $3,015.90 |
| UPMC Williamsport | Williamsport | $2,217.00 | $254.48 – $2,956.00 |