healthcosts.net
Removal duct glbldr calculi at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,132.80
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.
?
What you pay up front if you don't use insurance.
$1,888.00
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.
$193.54 with UPMC Health Plan vs $1,416.00 with Humana — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $193.54 | ↓ -83% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $201.99 | ↓ -82% |
| United Healthcare Community Plan for Families | PA Medicaid | $202.34 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicaid | $225.74 | ↓ -80% |
| Geisinger | Medicaid | $244.55 | ↓ -78% |
| Highmark BCBS of PA | Medicare Advantage | $542.36 | ↓ -52% |
| UPMC Health Plan | CHIP | $660.80 | ↓ -42% |
| Geisinger | Commercial | $743.49 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $755.20 | ↓ -33% |
| United Healthcare | Commercial | $813.73 | ↓ -28% |
| UPMC Health Plan | Commercial | $849.60 | ↓ -25% |
| Highmark Wholecare (prev Gateway) | Medicare | $944.00 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $944.00 | ↓ -17% |
| UPMC Work Partners | Workers Comp | $1,049.40 | ↓ -7% |
| Galaxy Health Plan | Commercial | $1,227.20 | ↑ +8% |
| Humana | Commercial | $1,416.00 | ↑ +25% |
Visitor-reported prices
Comments
Removal duct glbldr calculi at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $5,320.20 | $193.54 – $7,536.95 |
| UPMC Mercy | Pittsburgh | $2,987.40 | $193.54 – $4,481.10 |
| UPMC Presbyterian | Pittsburgh | $6,650.40 | $193.54 – $9,421.40 |