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Annual Physical, New Patient (age 40-64) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$154.80
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.
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What you pay up front if you don't use insurance.
$258.00
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.
$23.00 with United Healthcare Community Plan for Families vs $193.50 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $23.00 | ↓ -85% |
| Highmark BCBS of PA | Medicare Advantage | $57.43 | ↓ -63% |
| Geisinger | Commercial | $101.60 | ↓ -34% |
| UPMC Health Plan | Commercial | $102.30 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $103.20 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $129.00 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $129.00 | ↓ -17% |
| Geisinger | Medicaid | $141.90 | ↓ -8% |
| Galaxy Health Plan | Commercial | $167.70 | ↑ +8% |
| UPMC Health Plan | CHIP | $170.80 | ↑ +10% |
| Humana | Commercial | $193.50 | ↑ +25% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
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Annual Physical, New Patient (age 40-64) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $304.20 | $58.01 – $405.60 |
| UPMC Community Osteopathic | Harrisburg | $154.80 | $26.20 – $310.40 |
| UPMC Magee | Pittsburgh | $590.40 | $58.57 – $905.28 |
| UPMC Wellsboro | Wellsboro | $208.80 | $25.60 – $313.20 |
| UPMC Williamsport | Williamsport | $121.20 | $25.60 – $181.80 |