Treatment of thigh fracture at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$759.00
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.
$1,265.00
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.
$226.41 with Highmark BCBS of PA vs $1,714.38 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 |
|---|---|---|---|
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $226.41 | ↓ -70% |
| AmeriHealth Caritas | Medicare | $228.70 | ↓ -70% |
| United Healthcare | Medicare | $228.70 | ↓ -70% |
| UPMC Health Plan | Managed Medicare | $228.70 | ↓ -70% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $233.27 | ↓ -69% |
| Highmark Wholecare (prev Gateway) | Medicare | $246.97 | ↓ -67% |
| UPMC Health Plan | Managed Medicaid | $268.95 | ↓ -65% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $280.69 | ↓ -63% |
| Highmark Wholecare (prev Gateway) | Medicaid | $313.69 | ↓ -59% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $339.18 | ↓ -55% |
| Geisinger | Medicaid | $339.83 | ↓ -55% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $429.32 | ↓ -43% |
| Geisinger | Commercial | $498.16 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $506.00 | ↓ -33% |
| Highmark BCBS of PA | Medicare Advantage | $539.52 | ↓ -29% |
| United Healthcare | Commercial | $545.22 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $632.50 | ↓ -17% |
| Galaxy Health Plan | Commercial | $822.25 | ↑ +8% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↑ +18% |
| Humana | Commercial | $948.75 | ↑ +25% |
| UPMC Health Plan | Commercial | $1,026.85 | ↑ +35% |
| UPMC Work Partners | Workers Comp | $1,098.00 | ↑ +45% |
| UPMC Health Plan | CHIP | $1,714.38 | ↑ +126% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Treatment of thigh fracture at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $759.00 | $173.31 – $1,149.07 |
| UPMC Cole | Coudersport | $1,671.60 | $126.96 – $1,098.00 |
| UPMC Community Osteopathic | Harrisburg | $759.00 | $233.61 – $1,714.38 |
| UPMC Hamot | Erie | $3,021.60 | $263.94 – $1,127.86 |
| UPMC Hanover | Hanover | $759.00 | $226.87 – $1,144.70 |
| UPMC Lititz | Lititz | $759.00 | $228.10 – $1,149.07 |
| UPMC Memorial | York | $759.00 | $239.91 – $1,144.70 |
| UPMC Muncy | Muncy | $825.60 | $268.95 – $1,206.55 |