healthcosts.net
Clsd tx fx radius/ulna w/manip 25565 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,055.00
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.
?
What you pay up front if you don't use insurance.
$3,425.00
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.
$220.55 with UPMC Health Plan vs $2,864.23 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $220.55 | ↓ -89% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $230.17 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicaid | $257.24 | ↓ -87% |
| Geisinger | Medicaid | $278.67 | ↓ -86% |
| Highmark BCBS of PA | Medicare Advantage | $722.42 | ↓ -65% |
| United Healthcare Community Plan for Families | PA Medicaid | $791.20 | ↓ -61% |
| UPMC Work Partners | Workers Comp | $1,062.25 | ↓ -48% |
| Geisinger | Commercial | $1,348.77 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,370.00 | ↓ -33% |
| UPMC Health Plan | Commercial | $1,377.34 | ↓ -33% |
| United Healthcare | Commercial | $1,476.17 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $1,510.54 | ↓ -26% |
| AmeriHealth Caritas | Medicare | $1,525.80 | ↓ -26% |
| UPMC Health Plan | Managed Medicare | $1,525.80 | ↓ -26% |
| United Healthcare | Medicare | $1,525.80 | ↓ -26% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,556.32 | ↓ -24% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,647.71 | ↓ -20% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,712.50 | ↓ -17% |
| Galaxy Health Plan | Commercial | $2,226.25 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,262.91 | ↑ +10% |
| UPMC Health Plan | CHIP | $2,299.53 | ↑ +12% |
| Humana | Commercial | $2,568.75 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,864.23 | ↑ +39% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Clsd tx fx radius/ulna w/manip 25565 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,928.80 | $220.55 – $5,565.80 |
| UPMC Mercy | Pittsburgh | $2,993.40 | $220.55 – $4,490.10 |
| UPMC Muncy | Muncy | $825.60 | $206.40 – $1,179.75 |
| UPMC Northwest | Seneca | $2,186.40 | $220.55 – $3,097.40 |
| UPMC Presbyterian | Pittsburgh | $4,765.20 | $220.55 – $6,750.70 |
| UPMC St. Margaret | Pittsburgh | $2,681.40 | $220.55 – $3,798.65 |
| UPMC Wellsboro | Wellsboro | $995.20 | $220.55 – $1,119.60 |
| UPMC Williamsport | Williamsport | $825.60 | $220.55 – $1,179.75 |