healthcosts.net
Consultation pathology during surgery at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$78.60
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.
$131.00
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.
$6.84 with UPMC Health Plan vs $106.31 with Highmark BCBS of PA — 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 Health Plan | Commercial | $6.84 | ↓ -91% |
| UPMC Health Plan | CHIP | $9.91 | ↓ -87% |
| UPMC Health Plan | Managed Medicaid | $32.75 | ↓ -58% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $34.18 | ↓ -57% |
| United Healthcare Community Plan for Families | PA Medicaid | $34.24 | ↓ -56% |
| Highmark Wholecare (prev Gateway) | Medicaid | $38.19 | ↓ -51% |
| Geisinger | Medicaid | $41.38 | ↓ -47% |
| United Healthcare | Commercial | $45.72 | ↓ -42% |
| Geisinger | Commercial | $51.59 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $52.40 | ↓ -33% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $56.06 | ↓ -29% |
| AmeriHealth Caritas | Medicare | $56.63 | ↓ -28% |
| UPMC Health Plan | Managed Medicare | $56.63 | ↓ -28% |
| United Healthcare | Medicare | $56.63 | ↓ -28% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $57.76 | ↓ -27% |
| Highmark Wholecare (prev Gateway) | Medicare | $61.15 | ↓ -22% |
| Multiplan | PPO (Includes PHCS as a Payer) | $65.50 | ↓ -17% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $83.99 | ↑ +7% |
| Galaxy Health Plan | Commercial | $85.15 | ↑ +8% |
| UPMC Work Partners | Workers Comp | $90.51 | ↑ +15% |
| Humana | Commercial | $98.25 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $106.31 | ↑ +35% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Consultation pathology during surgery at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $94.80 | $2.73 – $142.20 |
| UPMC Muncy | Muncy | $159.00 | $32.75 – $212.00 |
| UPMC Northwest | Seneca | $63.60 | $2.75 – $90.10 |
| UPMC Passavant-McCandless | Pittsburgh | $144.60 | $2.75 – $204.85 |
| UPMC Presbyterian | Pittsburgh | $231.60 | $2.90 – $328.10 |
| UPMC St. Margaret | Pittsburgh | $163.80 | $2.76 – $232.05 |
| UPMC Wellsboro | Wellsboro | $192.00 | $29.77 – $216.00 |
| UPMC Williamsport | Williamsport | $159.00 | $32.75 – $212.00 |