healthcosts.net
Complx repair sal addl 5 cm/> 13122 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$828.60
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.
$1,381.00
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.
$83.78 with United Healthcare Community Plan for Families vs $1,308.89 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $83.78 | ↓ -90% |
| UPMC Work Partners | Workers Comp | $176.83 | ↓ -79% |
| Highmark BCBS of PA | Medicare Advantage | $205.29 | ↓ -75% |
| Geisinger | Commercial | $543.84 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $552.40 | ↓ -33% |
| United Healthcare | Commercial | $595.21 | ↓ -28% |
| Highmark Wholecare (prev Gateway) | Medicare | $690.50 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $690.50 | ↓ -17% |
| Geisinger | Medicaid | $759.55 | ↓ -8% |
| UPMC Health Plan | Commercial | $783.98 | ↓ -5% |
| Galaxy Health Plan | Commercial | $897.65 | ↑ +8% |
| Humana | Commercial | $1,035.75 | ↑ +25% |
| UPMC Health Plan | CHIP | $1,308.89 | ↑ +58% |
Visitor-reported prices
Comments
Complx repair sal addl 5 cm/> 13122 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $478.20 | $176.83 – $677.45 |
| UPMC Mercy | Pittsburgh | $378.00 | $157.50 – $822.33 |
| UPMC Muncy | Muncy | $825.60 | $93.25 – $1,100.80 |
| UPMC Northwest | Seneca | $1,128.00 | $176.83 – $1,598.00 |
| UPMC Presbyterian | Pittsburgh | $1,247.40 | $87.42 – $1,767.15 |
| UPMC St. Margaret | Pittsburgh | $595.80 | $176.83 – $844.05 |
| UPMC Wellsboro | Wellsboro | $998.40 | $93.25 – $1,123.20 |
| UPMC Williamsport | Williamsport | $825.60 | $93.25 – $1,100.80 |