healthcosts.net
Blind interatrial shunt ide at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$39,788.40
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.
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What you pay up front if you don't use insurance.
$66,314.00
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.
$6,926.94 with Highmark BCBS of PA vs $49,735.50 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $6,926.94 | ↓ -83% |
| United Healthcare Community Plan for Families | PA Medicaid | $12,276.61 | ↓ -69% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $16,517.78 | ↓ -58% |
| AmeriHealth Caritas | Medicare | $16,684.63 | ↓ -58% |
| UPMC Health Plan | Managed Medicare | $16,684.63 | ↓ -58% |
| United Healthcare | Medicare | $16,684.63 | ↓ -58% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $17,018.32 | ↓ -57% |
| Highmark Wholecare (prev Gateway) | Medicare | $18,017.73 | ↓ -55% |
| UPMC Health Plan | CHIP | $23,209.90 | ↓ -42% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $24,744.97 | ↓ -38% |
| Geisinger | Commercial | $26,114.45 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $26,525.60 | ↓ -33% |
| United Healthcare | Commercial | $28,581.33 | ↓ -28% |
| UPMC Health Plan | Commercial | $29,841.30 | ↓ -25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $31,320.39 | ↓ -21% |
| Multiplan | PPO (Includes PHCS as a Payer) | $33,157.00 | ↓ -17% |
| Geisinger | Medicaid | $36,472.70 | ↓ -8% |
| Galaxy Health Plan | Commercial | $43,104.10 | ↑ +8% |
| Humana | Commercial | $49,735.50 | ↑ +25% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |