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_afb org id by sequencing rflx ast-sendout at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$642.60
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.
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What you pay up front if you don't use insurance.
$1,071.00
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.
$114.02 with UPMC Work Partners vs $803.25 with Humana — 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 Work Partners | Workers Comp | $114.02 | ↓ -82% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $114.21 | ↓ -82% |
| AmeriHealth Caritas | Medicare | $115.36 | ↓ -82% |
| UPMC Health Plan | Managed Medicare | $115.36 | ↓ -82% |
| United Healthcare | Medicare | $115.36 | ↓ -82% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $117.67 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicare | $124.58 | ↓ -81% |
| UPMC Health Plan | Commercial | $127.59 | ↓ -80% |
| UPMC Health Plan | Managed Medicaid | $145.40 | ↓ -77% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $151.74 | ↓ -76% |
| United Healthcare Community Plan for Families | PA Medicaid | $152.01 | ↓ -76% |
| Highmark Wholecare (prev Gateway) | Medicaid | $169.59 | ↓ -74% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $171.09 | ↓ -73% |
| Geisinger | Medicaid | $183.72 | ↓ -71% |
| UPMC Health Plan | CHIP | $184.97 | ↓ -71% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $216.55 | ↓ -66% |
| Highmark BCBS of PA | Medicare Advantage | $304.00 | ↓ -53% |
| United Healthcare | Commercial | $373.78 | ↓ -42% |
| Geisinger | Commercial | $421.76 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $428.40 | ↓ -33% |
| Multiplan | PPO (Includes PHCS as a Payer) | $535.50 | ↓ -17% |
| Galaxy Health Plan | Commercial | $696.15 | ↑ +8% |
| Humana | Commercial | $803.25 | ↑ +25% |
Visitor-reported prices
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_afb org id by sequencing rflx ast-sendout at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,327.80 | $51.33 – $1,881.05 |
| UPMC Mercy | Pittsburgh | $1,062.00 | $51.03 – $1,593.00 |
| UPMC Muncy | Muncy | $1,507.80 | $114.02 – $2,010.40 |
| UPMC Northwest | Seneca | $1,823.40 | $51.36 – $2,583.15 |
| UPMC Presbyterian | Pittsburgh | $574.80 | $54.16 – $814.30 |
| UPMC St. Margaret | Pittsburgh | $1,266.00 | $51.46 – $1,793.50 |
| UPMC Wellsboro | Wellsboro | $1,823.20 | $114.02 – $2,051.10 |
| UPMC Williamsport | Williamsport | $1,507.80 | $114.02 – $2,010.40 |