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Drainage of mouth lesion at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$3,971.40
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.
$6,619.00
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.
$25.85 with UPMC Health Plan vs $5,804.08 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 | $25.85 | ↓ -99% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $26.98 | ↓ -99% |
| Highmark Wholecare (prev Gateway) | Medicaid | $30.15 | ↓ -99% |
| Geisinger | Medicaid | $32.66 | ↓ -99% |
| UPMC Work Partners | Workers Comp | $393.99 | ↓ -90% |
| Highmark BCBS of PA | Medicare Advantage | $539.52 | ↓ -86% |
| United Healthcare Community Plan for Families | PA Medicaid | $711.85 | ↓ -82% |
| UPMC Health Plan | CHIP | $1,731.86 | ↓ -56% |
| UPMC Health Plan | Commercial | $2,220.00 | ↓ -44% |
| Geisinger | Commercial | $2,606.56 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $2,647.60 | ↓ -33% |
| United Healthcare | Commercial | $2,852.79 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $3,060.96 | ↓ -23% |
| AmeriHealth Caritas | Medicare | $3,091.88 | ↓ -22% |
| UPMC Health Plan | Managed Medicare | $3,091.88 | ↓ -22% |
| United Healthcare | Medicare | $3,091.88 | ↓ -22% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,153.72 | ↓ -21% |
| Multiplan | PPO (Includes PHCS as a Payer) | $3,309.50 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,338.92 | ↓ -16% |
| Galaxy Health Plan | Commercial | $4,302.35 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,585.57 | ↑ +15% |
| Humana | Commercial | $4,964.25 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $5,804.08 | ↑ +46% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Drainage of mouth lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,202.80 | $25.85 – $4,537.30 |
| UPMC Mercy | Pittsburgh | $2,552.40 | $25.85 – $3,828.60 |
| UPMC Muncy | Muncy | $3,435.60 | $25.85 – $4,580.80 |
| UPMC Northwest | Seneca | $3,430.80 | $25.85 – $4,860.30 |
| UPMC Presbyterian | Pittsburgh | $4,240.80 | $25.85 – $6,007.80 |
| UPMC Williamsport | Williamsport | $3,435.60 | $25.85 – $4,580.80 |
| UPMC St. Margaret | Pittsburgh | not published | $25.85 – $3,401.07 |