healthcosts.net
Rx metab gen seq alys pnl 6 at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$2,427.00
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.
$4,045.00
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.
$831.70 with UPMC Health Plan vs $3,438.25 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 Medicare | $831.70 | ↓ -66% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $888.73 | ↓ -63% |
| UPMC Work Partners | Workers Comp | $906.37 | ↓ -63% |
| Geisinger | Medicaid/CHIP | $917.08 | ↓ -62% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $917.08 | ↓ -62% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $938.91 | ↓ -61% |
| Aetna | Medicare | $944.59 | ↓ -61% |
| Aetna of PA | Medicare | $962.93 | ↓ -60% |
| United Healthcare | Unison Advantage Non Special Needs | $962.93 | ↓ -60% |
| Highmark Wholecare (prev Gateway) | Medicare | $990.35 | ↓ -59% |
| AmeriHealth Caritas | Medicare | $990.45 | ↓ -59% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $990.45 | ↓ -59% |
| United Healthcare | Unison Advantage Special Needs | $1,008.79 | ↓ -58% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,094.99 | ↓ -55% |
| Aetna | EBR ASO | $1,618.00 | ↓ -33% |
| Cigna | Commercial | $1,618.00 | ↓ -33% |
| PA Health & Wellness | PA Medicaid HMO | $2,224.75 | ↓ -8% |
| Aetna | EBR FI | $2,346.10 | ↓ -3% |
| Aetna | Neighborhood Network | $2,427.00 | ↑ +0% |
| Aetna | Home Depot Employer Group | $2,495.76 | ↑ +3% |
| Aetna | NBR ASO/FI | $2,548.35 | ↑ +5% |
| Cigna | New Business ASO | $2,548.35 | ↑ +5% |
| InterGroup | PPO | $2,629.25 | ↑ +8% |
| Coventry/First Health | Commercial | $2,831.50 | ↑ +17% |
| Health Coalition Partners | PPO | $2,912.40 | ↑ +20% |
| UPMC Health Plan | Commercial | $3,085.12 | ↑ +27% |
| Private Health Care Systems | PPO | $3,236.00 | ↑ +33% |
| Humana | Commercial | $3,438.25 | ↑ +42% |