healthcosts.net
Athrectomy fem/pop/unilateral 37225 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$17,281.80
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.
$28,803.00
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.
$892.40 with United Healthcare Community Plan for Families vs $32,136.88 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↓ -95% |
| Geisinger | Commercial | $11,342.62 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $11,521.20 | ↓ -33% |
| UPMC Health Plan | Commercial | $12,252.02 | ↓ -29% |
| United Healthcare | Commercial | $12,414.09 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $14,401.50 | ↓ -17% |
| UPMC Work Partners | Workers Comp | $15,770.34 | ↓ -9% |
| Geisinger | Medicaid | $15,841.65 | ↓ -8% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $16,948.38 | ↓ -2% |
| AmeriHealth Caritas | Medicare | $17,119.58 | ↓ -1% |
| UPMC Health Plan | Managed Medicare | $17,119.58 | ↓ -1% |
| United Healthcare | Medicare | $17,119.58 | ↓ -1% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $17,461.97 | ↑ +1% |
| Highmark Wholecare (prev Gateway) | Medicare | $18,487.43 | ↑ +7% |
| Galaxy Health Plan | Commercial | $18,721.95 | ↑ +8% |
| Highmark BCBS of PA | Medicare Advantage | $19,016.09 | ↑ +10% |
| UPMC Health Plan | CHIP | $20,455.34 | ↑ +18% |
| Humana | Commercial | $21,602.25 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $25,390.05 | ↑ +47% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $32,136.88 | ↑ +86% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Athrectomy fem/pop/unilateral 37225 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $34,695.00 | $11,399.11 – $49,151.25 |
| UPMC Mercy | Pittsburgh | $34,849.20 | $571.49 – $52,273.80 |
| UPMC Northwest | Seneca | $120,934.20 | $14,741.00 – $171,323.45 |
| UPMC Presbyterian | Pittsburgh | $35,674.80 | $571.49 – $50,539.30 |
| UPMC St. Margaret | Pittsburgh | $35,730.60 | $11,817.71 – $50,618.35 |
| UPMC Williamsport | Williamsport | $11,535.60 | $993.28 – $18,487.43 |