healthcosts.net
Drainage of nose lesion sept 30020 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,624.20
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.
$2,707.00
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.
$80.85 with UPMC Health Plan vs $5,168.52 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $80.85 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $84.38 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $94.30 | ↓ -94% |
| Geisinger | Medicaid | $102.16 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $233.46 | ↓ -86% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $480.65 | ↓ -70% |
| AmeriHealth Caritas | Medicare | $485.51 | ↓ -70% |
| UPMC Health Plan | Managed Medicare | $485.51 | ↓ -70% |
| United Healthcare | Medicare | $485.51 | ↓ -70% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $495.22 | ↓ -70% |
| Highmark Wholecare (prev Gateway) | Medicare | $524.30 | ↓ -68% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $720.06 | ↓ -56% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $911.40 | ↓ -44% |
| United Healthcare Community Plan for Families | PA Medicaid | $916.55 | ↓ -44% |
| Geisinger | Commercial | $1,066.02 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,082.80 | ↓ -33% |
| United Healthcare | Commercial | $1,166.72 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,353.50 | ↓ -17% |
| Highmark BCBS of PA | Medicare Advantage | $1,614.93 | ↓ -1% |
| Galaxy Health Plan | Commercial | $1,759.55 | ↑ +8% |
| Humana | Commercial | $2,030.25 | ↑ +25% |
| UPMC Health Plan | Commercial | $3,095.76 | ↑ +91% |
| UPMC Health Plan | CHIP | $5,168.52 | ↑ +218% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Drainage of nose lesion sept 30020 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $3,688.80 | $80.85 – $5,533.20 |
| UPMC Presbyterian | Pittsburgh | $4,920.00 | $80.85 – $6,970.00 |
| UPMC St. Margaret | Pittsburgh | not published | $80.85 – $1,646.97 |