healthcosts.net
Tx open dstl phlngl fx f/t internal fixation ea at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$4,150.20
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.
?
What you pay up front if you don't use insurance.
$6,917.00
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.
$195.80 with UPMC Health Plan vs $5,806.84 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $195.80 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $204.34 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $228.37 | ↓ -94% |
| Geisinger | Medicaid | $247.40 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $749.75 | ↓ -82% |
| United Healthcare Community Plan for Families | PA Medicaid | $956.80 | ↓ -77% |
| Highmark BCBS of PA | Medicare Advantage | $1,020.54 | ↓ -75% |
| Geisinger | Commercial | $2,723.91 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $2,766.80 | ↓ -33% |
| United Healthcare | Commercial | $2,981.23 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $3,062.42 | ↓ -26% |
| AmeriHealth Caritas | Medicare | $3,093.35 | ↓ -25% |
| UPMC Health Plan | Managed Medicare | $3,093.35 | ↓ -25% |
| United Healthcare | Medicare | $3,093.35 | ↓ -25% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,155.22 | ↓ -24% |
| UPMC Health Plan | CHIP | $3,268.44 | ↓ -21% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | ↓ -20% |
| Multiplan | PPO (Includes PHCS as a Payer) | $3,458.50 | ↓ -17% |
| UPMC Health Plan | Commercial | $4,228.00 | ↑ +2% |
| Galaxy Health Plan | Commercial | $4,496.05 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,587.75 | ↑ +11% |
| Humana | Commercial | $5,187.75 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $5,806.84 | ↑ +40% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Tx open dstl phlngl fx f/t internal fixation ea at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $5,728.20 | $195.80 – $8,114.95 |
| UPMC Mercy | Pittsburgh | $4,558.80 | $195.80 – $6,838.20 |
| UPMC Muncy | Muncy | $6,510.60 | $195.80 – $8,680.80 |
| UPMC Northwest | Seneca | $5,734.80 | $195.80 – $8,124.30 |
| UPMC Presbyterian | Pittsburgh | $7,773.00 | $195.80 – $11,011.75 |
| UPMC St. Margaret | Pittsburgh | $5,007.60 | $195.80 – $7,094.10 |
| UPMC Wellsboro | Wellsboro | $7,873.60 | $195.80 – $8,857.80 |
| UPMC Williamsport | Williamsport | $6,510.60 | $195.80 – $8,680.80 |