healthcosts.net
Oral everolimus at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$1,208.40
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.
?
What you pay up front if you don't use insurance.
$2,014.00
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.
$0.87 with UPMC Health Plan vs $1,711.90 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 | $0.87 | ↓ -100% |
| Geisinger | Medicaid/CHIP | $1.37 | ↓ -100% |
| Highmark Wholecare (prev Gateway) | Medicaid | $1.37 | ↓ -100% |
| PA Health & Wellness | PA Medicaid HMO | $1.37 | ↓ -100% |
| UPMC Health Plan | Commercial | $1.69 | ↓ -100% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $15.05 | ↓ -99% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $18.54 | ↓ -98% |
| Aetna | Medicare | $503.50 | ↓ -58% |
| UPMC Work Partners | Workers Comp | $727.26 | ↓ -40% |
| Aetna | EBR ASO | $805.60 | ↓ -33% |
| Cigna | Commercial | $805.60 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,007.00 | ↓ -17% |
| Aetna | EBR FI | $1,168.12 | ↓ -3% |
| Aetna | Neighborhood Network | $1,208.40 | ↑ +0% |
| Aetna | Home Depot Employer Group | $1,242.64 | ↑ +3% |
| Aetna | NBR ASO/FI | $1,268.82 | ↑ +5% |
| Cigna | New Business ASO | $1,268.82 | ↑ +5% |
| InterGroup | PPO | $1,309.10 | ↑ +8% |
| Coventry/First Health | Commercial | $1,409.80 | ↑ +17% |
| Health Coalition Partners | PPO | $1,450.08 | ↑ +20% |
| Private Health Care Systems | PPO | $1,611.20 | ↑ +33% |
| Humana | Commercial | $1,711.90 | ↑ +42% |
Visitor-reported prices
Comments
Oral everolimus at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $1,208.40 | $0.87 – $29.70 |
| UPMC Muncy | Muncy | $115.20 | $1.37 – $172.80 |
| UPMC Passavant-McCandless | Pittsburgh | $1,281.00 | $0.87 – $26.35 |
| UPMC Presbyterian | Pittsburgh | $1,610.40 | $0.87 – $42.50 |
| UPMC St. Margaret | Pittsburgh | $1,208.40 | $0.87 – $22.95 |
| UPMC Wellsboro | Wellsboro | $115.20 | $1.37 – $172.80 |
| UPMC Williamsport | Williamsport | $1,152.00 | $1.37 – $1,728.00 |