healthcosts.net
Pml/raralpha 1 breakpoint at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$1,114.20
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.
?
What you pay up front if you don't use insurance.
$1,857.00
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.
$188.01 with UPMC Health Plan vs $1,578.45 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 Medicare | $188.01 | ↓ -83% |
| UPMC Work Partners | Workers Comp | $204.89 | ↓ -82% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $207.31 | ↓ -81% |
| Geisinger | Medicaid/CHIP | $207.31 | ↓ -81% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $212.24 | ↓ -81% |
| Aetna | Medicare | $213.53 | ↓ -81% |
| United Healthcare | Unison Advantage Non Special Needs | $217.68 | ↓ -80% |
| Aetna of PA | Medicare | $217.68 | ↓ -80% |
| Highmark Wholecare (prev Gateway) | Medicare | $223.87 | ↓ -80% |
| AmeriHealth Caritas | Medicare | $223.89 | ↓ -80% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $223.89 | ↓ -80% |
| United Healthcare | Unison Advantage Special Needs | $228.04 | ↓ -80% |
| UPMC Health Plan | Managed Medicaid | $379.62 | ↓ -66% |
| United Healthcare Community Plan for Families | Unison Kids | $396.88 | ↓ -64% |
| Aetna | Medicaid | $414.13 | ↓ -63% |
| Highmark Wholecare (prev Gateway) | Medicaid | $511.80 | ↓ -54% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $538.75 | ↓ -52% |
| PA Health & Wellness | PA Medicaid HMO | $588.14 | ↓ -47% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $661.12 | ↓ -41% |
| Cigna | Commercial | $742.80 | ↓ -33% |
| Aetna | EBR ASO | $742.80 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $814.55 | ↓ -27% |
| UPMC Health Plan | Commercial | $909.57 | ↓ -18% |
| Aetna | EBR FI | $1,077.06 | ↓ -3% |
| Aetna | Neighborhood Network | $1,114.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $1,145.77 | ↑ +3% |
| Aetna | NBR ASO/FI | $1,169.91 | ↑ +5% |
| Cigna | New Business ASO | $1,169.91 | ↑ +5% |
| InterGroup | PPO | $1,207.05 | ↑ +8% |
| Coventry/First Health | Commercial | $1,299.90 | ↑ +17% |
| Health Coalition Partners | PPO | $1,337.04 | ↑ +20% |
| Private Health Care Systems | PPO | $1,485.60 | ↑ +33% |
| Humana | Commercial | $1,578.45 | ↑ +42% |
Visitor-reported prices
Comments
Pml/raralpha 1 breakpoint at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,180.80 | $192.65 – $1,672.80 |
| UPMC Mercy | Pittsburgh | $1,114.20 | $172.81 – $1,671.30 |
| UPMC Presbyterian | Pittsburgh | $1,671.60 | $204.89 – $2,368.10 |
| UPMC St. Margaret | Pittsburgh | $1,671.60 | $178.99 – $2,368.10 |