healthcosts.net
Surgical pathology level 5 gross & microscopic examination at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$360.60
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.
$601.00
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.
$36.26 with UPMC Health Plan vs $510.85 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 | Commercial | $36.26 | ↓ -90% |
| UPMC Health Plan | Managed Medicaid | $50.05 | ↓ -86% |
| United Healthcare Community Plan for Families | Unison Kids | $52.33 | ↓ -85% |
| Aetna | Medicaid | $54.60 | ↓ -85% |
| Highmark Wholecare (prev Gateway) | Medicaid | $67.48 | ↓ -81% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $71.03 | ↓ -80% |
| PA Health & Wellness | PA Medicaid HMO | $77.54 | ↓ -78% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $127.31 | ↓ -65% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $156.86 | ↓ -57% |
| Cigna | Commercial | $240.40 | ↓ -33% |
| Aetna | EBR ASO | $240.40 | ↓ -33% |
| UPMC Work Partners | Workers Comp | $275.75 | ↓ -24% |
| UPMC Health Plan | Managed Medicare | $311.02 | ↓ -14% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $342.95 | ↓ -5% |
| Geisinger | Medicaid/CHIP | $342.95 | ↓ -5% |
| Aetna | EBR FI | $348.58 | ↓ -3% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $351.11 | ↓ -3% |
| Aetna | Medicare | $353.24 | ↓ -2% |
| United Healthcare | Unison Advantage Non Special Needs | $360.10 | ↓ -0% |
| Aetna of PA | Medicare | $360.10 | ↓ -0% |
| Aetna | Neighborhood Network | $360.60 | ↑ +0% |
| Highmark Wholecare (prev Gateway) | Medicare | $370.35 | ↑ +3% |
| AmeriHealth Caritas | Medicare | $370.39 | ↑ +3% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $370.39 | ↑ +3% |
| Aetna | Home Depot Employer Group | $370.82 | ↑ +3% |
| United Healthcare | Unison Advantage Special Needs | $377.25 | ↑ +5% |
| Aetna | NBR ASO/FI | $378.63 | ↑ +5% |
| Cigna | New Business ASO | $378.63 | ↑ +5% |
| InterGroup | PPO | $390.65 | ↑ +8% |
| Coventry/First Health | Commercial | $420.70 | ↑ +17% |
| Health Coalition Partners | PPO | $432.72 | ↑ +20% |
| Private Health Care Systems | PPO | $480.80 | ↑ +33% |
| Humana | Commercial | $510.85 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Surgical pathology level 5 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $505.20 | $36.03 – $757.80 |
| UPMC Muncy | Muncy | $408.00 | $14.72 – $544.00 |
| UPMC Passavant-McCandless | Pittsburgh | $440.40 | $36.24 – $623.90 |
| UPMC Presbyterian | Pittsburgh | $1,323.60 | $13.80 – $1,875.10 |
| UPMC Somerset | Somerset | $664.80 | $13.22 – $251.07 |
| UPMC St. Margaret | Pittsburgh | $888.00 | $36.33 – $1,258.00 |
| UPMC Wellsboro | Wellsboro | $493.60 | $14.72 – $555.30 |
| UPMC Williamsport | Williamsport | $408.00 | $14.72 – $544.00 |