healthcosts.net
Bld prd mix at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$201.60
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.
?
What you pay up front if you don't use insurance.
$336.00
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.
$47.27 with Highmark BCBS of PA vs $306.68 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $47.27 | ↓ -77% |
| UPMC Health Plan | Commercial | $89.97 | ↓ -55% |
| United Healthcare Community Plan for Families | PA Medicaid | $110.31 | ↓ -45% |
| UPMC Health Plan | CHIP | $130.42 | ↓ -35% |
| Geisinger | Commercial | $132.32 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $134.40 | ↓ -33% |
| United Healthcare | Commercial | $144.82 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $161.74 | ↓ -20% |
| AmeriHealth Caritas | Medicare | $163.37 | ↓ -19% |
| UPMC Health Plan | Managed Medicare | $163.37 | ↓ -19% |
| United Healthcare | Medicare | $163.37 | ↓ -19% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $166.64 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $168.00 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $176.42 | ↓ -12% |
| Geisinger | Medicaid | $184.80 | ↓ -8% |
| Galaxy Health Plan | Commercial | $218.40 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $242.29 | ↑ +20% |
| Humana | Commercial | $252.00 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $306.68 | ↑ +52% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Bld prd mix at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $106.80 | $36.19 – $179.71 |
| UPMC Mercy | Pittsburgh | $81.60 | $35.98 – $176.44 |
| UPMC Presbyterian | Pittsburgh | $498.00 | $38.19 – $705.50 |
| UPMC St. Margaret | Pittsburgh | $237.00 | $36.28 – $335.75 |
| UPMC Williamsport | Williamsport | $29.40 | $14.99 – $176.42 |