healthcosts.net
Upper Endoscopy (EGD, diagnostic) at UPMC Northwest
100 Fairfield Drive, Seneca, PA · UPMC · · NPI 1619069440
$1,558.20
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.
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What you pay up front if you don't use insurance.
$2,597.00
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.
$137.74 with UPMC Health Plan vs $2,207.45 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 | $137.74 | ↓ -91% |
| United Healthcare Community Plan for Families | Unison Kids | $144.00 | ↓ -91% |
| Aetna | Medicaid | $150.26 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $185.70 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $195.48 | ↓ -87% |
| PA Health & Wellness | PA Medicaid HMO | $213.40 | ↓ -86% |
| UPMC Work Partners | Workers Comp | $615.84 | ↓ -60% |
| UPMC Health Plan | Commercial | $809.41 | ↓ -48% |
| UPMC Health Plan | Managed Medicare | $810.63 | ↓ -48% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $893.85 | ↓ -43% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $915.12 | ↓ -41% |
| Aetna | Medicare | $920.67 | ↓ -41% |
| United Healthcare | Unison Advantage Non Special Needs | $938.54 | ↓ -40% |
| Aetna of PA | Medicare | $938.54 | ↓ -40% |
| Highmark Wholecare (prev Gateway) | Medicare | $965.27 | ↓ -38% |
| AmeriHealth Caritas | Medicare | $965.36 | ↓ -38% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $965.36 | ↓ -38% |
| United Healthcare | Unison Advantage Special Needs | $983.24 | ↓ -37% |
| Cigna | Commercial | $1,038.80 | ↓ -33% |
| Aetna | EBR ASO | $1,038.80 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,414.58 | ↓ -9% |
| Aetna | EBR FI | $1,506.26 | ↓ -3% |
| Aetna | Neighborhood Network | $1,558.20 | ↑ +0% |
| Aetna | Home Depot Employer Group | $1,602.35 | ↑ +3% |
| Aetna | NBR ASO/FI | $1,636.11 | ↑ +5% |
| Cigna | New Business ASO | $1,636.11 | ↑ +5% |
| InterGroup | PPO | $1,688.05 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,742.87 | ↑ +12% |
| Coventry/First Health | Commercial | $1,817.90 | ↑ +17% |
| Health Coalition Partners | PPO | $1,869.84 | ↑ +20% |
| Private Health Care Systems | PPO | $2,077.60 | ↑ +33% |
| Humana | Commercial | $2,207.45 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Upper Endoscopy (EGD, diagnostic) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,895.40 | $137.74 – $2,685.15 |
| UPMC East | Monroeville | $2,281.20 | $137.74 – $3,041.60 |
| UPMC Hamot | Erie | $2,310.60 | $137.74 – $2,695.70 |
| UPMC Carlisle | Carlisle | $1,509.00 | $159.03 – $2,137.75 |
| UPMC Altoona | Altoona | $1,675.80 | $125.22 – $2,234.40 |
| UPMC Bedford | Everett | $1,214.40 | $131.48 – $1,821.60 |
| UPMC Cole | Coudersport | $878.40 | $131.48 – $1,171.20 |
| UPMC Community Osteopathic | Harrisburg | $1,909.80 | $159.03 – $2,137.75 |