healthcosts.net
Exchange nephrostomy cath at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,685.60
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.
?
What you pay up front if you don't use insurance.
$4,476.00
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.
$312.43 with Highmark BCBS of PA vs $3,666.19 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $312.43 | ↓ -88% |
| UPMC Work Partners | Workers Comp | $604.53 | ↓ -77% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↓ -67% |
| UPMC Health Plan | Commercial | $1,432.24 | ↓ -47% |
| Geisinger | Commercial | $1,762.65 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,790.40 | ↓ -33% |
| United Healthcare | Commercial | $1,929.16 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $1,933.48 | ↓ -28% |
| AmeriHealth Caritas | Medicare | $1,953.01 | ↓ -27% |
| UPMC Health Plan | Managed Medicare | $1,953.01 | ↓ -27% |
| United Healthcare | Medicare | $1,953.01 | ↓ -27% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,992.07 | ↓ -26% |
| Highmark Wholecare (prev Gateway) | Medicare | $2,109.06 | ↓ -21% |
| Multiplan | PPO (Includes PHCS as a Payer) | $2,238.00 | ↓ -17% |
| UPMC Health Plan | CHIP | $2,391.20 | ↓ -11% |
| Geisinger | Medicaid | $2,461.80 | ↓ -8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $2,896.51 | ↑ +8% |
| Galaxy Health Plan | Commercial | $2,909.40 | ↑ +8% |
| Humana | Commercial | $3,357.00 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $3,666.19 | ↑ +37% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Exchange nephrostomy cath at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $8,884.20 | $318.63 – $12,585.95 |
| UPMC Mercy | Pittsburgh | $1,941.60 | $315.62 – $2,912.40 |
| UPMC Northwest | Seneca | $2,643.00 | $604.53 – $3,744.25 |
| UPMC Presbyterian | Pittsburgh | $8,699.40 | $318.63 – $12,324.15 |
| UPMC St. Margaret | Pittsburgh | $2,572.20 | $318.63 – $3,643.95 |
| UPMC Williamsport | Williamsport | $5,026.20 | $604.53 – $6,701.60 |