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Cap trach decann 15mm at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,737.00
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.
$2,895.00
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.
$51.80 with Highmark Wholecare (prev Gateway) vs $3,673.43 with UPMC Health Plan — 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 Wholecare (prev Gateway) | Medicaid | $51.80 | ↓ -97% |
| Geisinger | Medicaid | $85.47 | ↓ -95% |
| Geisinger | Commercial | $101.99 | ↓ -94% |
| Aetna of PA | TPA/Carrier | $103.60 | ↓ -94% |
| Highmark Wholecare (prev Gateway) | Medicare | $129.50 | ↓ -93% |
| Multiplan | PPO (Includes PHCS as a Payer) | $129.50 | ↓ -93% |
| Galaxy Health Plan | Commercial | $168.35 | ↓ -90% |
| Humana | Commercial | $194.25 | ↓ -89% |
| Highmark BCBS of PA | Medicare Advantage | $332.93 | ↓ -81% |
| UPMC Health Plan | Commercial | $2,200.25 | ↑ +27% |
| UPMC Health Plan | CHIP | $3,673.43 | ↑ +111% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
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Cap trach decann 15mm at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $1,833.60 | $190.80 – $2,900.70 |
| UPMC Muncy | Muncy | $931.80 | $99.90 – $599.40 |
| UPMC Northwest | Seneca | $1,444.80 | $179.00 – $4,445.18 |
| UPMC Passavant-McCandless | Pittsburgh | $1,708.20 | $131.25 – $5,330.61 |
| UPMC Presbyterian | Pittsburgh | $9,624.00 | $50.88 – $5,939.28 |
| UPMC St. Margaret | Pittsburgh | $1,363.20 | $159.00 – $4,507.56 |
| UPMC Wellsboro | Wellsboro | $1,127.20 | $83.16 – $415.80 |
| UPMC Williamsport | Williamsport | $1,842.60 | $141.80 – $600.30 |