healthcosts.net
Appendectomy at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$869.40
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.
$1,449.00
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.
$246.52 with Geisinger vs $11,167.18 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| Geisinger | Commercial | $246.52 | ↓ -72% |
| Aetna of PA | TPA/Carrier | $250.40 | ↓ -71% |
| United Healthcare | Commercial | $269.81 | ↓ -69% |
| Multiplan | PPO (Includes PHCS as a Payer) | $313.00 | ↓ -64% |
| Geisinger | Medicaid | $344.30 | ↓ -60% |
| Galaxy Health Plan | Commercial | $406.90 | ↓ -53% |
| Humana | Commercial | $469.50 | ↓ -46% |
| UPMC Health Plan | Managed Medicare | $607.18 | ↓ -30% |
| Highmark Wholecare (prev Gateway) | Medicare | $655.69 | ↓ -25% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↑ +3% |
| UPMC Work Partners | Workers Comp | $1,104.20 | ↑ +27% |
| Highmark BCBS of PA | Medicare Advantage | $1,614.93 | ↑ +86% |
| UPMC Health Plan | Commercial | $3,085.16 | ↑ +255% |
| UPMC Health Plan | CHIP | $5,150.82 | ↑ +492% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $5,889.36 | ↑ +577% |
| AmeriHealth Caritas | Medicare | $5,948.85 | ↑ +584% |
| United Healthcare | Medicare | $5,948.85 | ↑ +584% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $6,067.83 | ↑ +598% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $8,822.74 | ↑ +915% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $11,167.18 | ↑ +1184% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Appendectomy at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | not published | $1,210.25 – $6,543.73 |
| UPMC Presbyterian | Pittsburgh | not published | $931.20 – $6,543.73 |