healthcosts.net
Cystourethroscop/calib/dilat stric 52281 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,428.80
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.
$4,048.00
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.
$118.25 with UPMC Health Plan vs $3,666.19 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $118.25 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $123.41 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $137.92 | ↓ -94% |
| Geisinger | Medicaid | $149.41 | ↓ -94% |
| Geisinger | Commercial | $302.83 | ↓ -88% |
| Aetna of PA | TPA/Carrier | $307.60 | ↓ -87% |
| United Healthcare | Commercial | $331.44 | ↓ -86% |
| Multiplan | PPO (Includes PHCS as a Payer) | $384.50 | ↓ -84% |
| UPMC Work Partners | Workers Comp | $414.95 | ↓ -83% |
| Galaxy Health Plan | Commercial | $499.85 | ↓ -79% |
| Humana | Commercial | $576.75 | ↓ -76% |
| United Healthcare Community Plan for Families | PA Medicaid | $609.50 | ↓ -75% |
| Highmark BCBS of PA | Medicare Advantage | $722.42 | ↓ -70% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $1,933.48 | ↓ -20% |
| AmeriHealth Caritas | Medicare | $1,953.01 | ↓ -20% |
| UPMC Health Plan | Managed Medicare | $1,953.01 | ↓ -20% |
| United Healthcare | Medicare | $1,953.01 | ↓ -20% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,992.07 | ↓ -18% |
| Highmark Wholecare (prev Gateway) | Medicare | $2,109.06 | ↓ -13% |
| UPMC Health Plan | CHIP | $2,314.70 | ↓ -5% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,896.51 | ↑ +19% |
| UPMC Health Plan | Commercial | $2,937.00 | ↑ +21% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $3,666.19 | ↑ +51% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Cystourethroscop/calib/dilat stric 52281 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,442.20 | $118.25 – $4,876.45 |
| UPMC Presbyterian | Pittsburgh | $4,871.40 | $118.25 – $6,901.15 |
| UPMC St. Margaret | Pittsburgh | $3,770.40 | $118.25 – $5,341.40 |
| UPMC Williamsport | Williamsport | $4,732.80 | $118.25 – $6,310.40 |
| UPMC Mercy | Pittsburgh | not published | $118.25 – $2,148.31 |
| UPMC Northwest | Seneca | not published | $118.25 – $2,050.66 |
| UPMC Wellsboro | Wellsboro | not published | $118.25 – $678.40 |