healthcosts.net
Tx open dstl phlngl fx f/t internal fixation ea at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$5,734.80
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.
$9,558.00
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.
$195.80 with UPMC Health Plan vs $8,124.30 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 | $195.80 | ↓ -97% |
| United Healthcare Community Plan for Families | Unison Kids | $204.70 | ↓ -96% |
| Aetna | Medicaid | $213.60 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $263.97 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $277.88 | ↓ -95% |
| PA Health & Wellness | PA Medicaid HMO | $303.35 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $653.16 | ↓ -89% |
| UPMC Health Plan | Commercial | $1,543.99 | ↓ -73% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,675.75 | ↓ -53% |
| UPMC Health Plan | Managed Medicare | $2,805.36 | ↓ -51% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $3,093.35 | ↓ -46% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,166.97 | ↓ -45% |
| Aetna | Medicare | $3,186.15 | ↓ -44% |
| United Healthcare | Unison Advantage Non Special Needs | $3,248.02 | ↓ -43% |
| Aetna of PA | Medicare | $3,248.02 | ↓ -43% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $3,296.72 | ↓ -43% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | ↓ -42% |
| AmeriHealth Caritas | Medicare | $3,340.82 | ↓ -42% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,340.82 | ↓ -42% |
| United Healthcare | Unison Advantage Special Needs | $3,402.68 | ↓ -41% |
| InterGroup | PPO | $3,704.00 | ↓ -35% |
| Cigna | Commercial | $3,823.20 | ↓ -33% |
| Aetna | EBR ASO | $3,823.20 | ↓ -33% |
| Aetna | EBR FI | $5,543.64 | ↓ -3% |
| Aetna | Neighborhood Network | $5,734.80 | ↑ +0% |
| Aetna | Home Depot Employer Group | $5,897.29 | ↑ +3% |
| Aetna | NBR ASO/FI | $6,021.54 | ↑ +5% |
| Cigna | New Business ASO | $6,021.54 | ↑ +5% |
| Coventry/First Health | Commercial | $6,690.60 | ↑ +17% |
| Health Coalition Partners | PPO | $6,881.76 | ↑ +20% |
| Private Health Care Systems | PPO | $7,646.40 | ↑ +33% |
| Humana | Commercial | $8,124.30 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Tx open dstl phlngl fx f/t internal fixation ea at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $5,728.20 | $195.80 – $8,114.95 |
| UPMC Mercy | Pittsburgh | $4,558.80 | $195.80 – $6,838.20 |
| UPMC Muncy | Muncy | $6,510.60 | $195.80 – $8,680.80 |
| UPMC Presbyterian | Pittsburgh | $7,773.00 | $195.80 – $11,011.75 |
| UPMC Somerset | Somerset | $4,150.20 | $195.80 – $5,187.75 |
| UPMC St. Margaret | Pittsburgh | $5,007.60 | $195.80 – $7,094.10 |
| UPMC Wellsboro | Wellsboro | $7,873.60 | $195.80 – $8,857.80 |
| UPMC Williamsport | Williamsport | $6,510.60 | $195.80 – $8,680.80 |