healthcosts.net
Critical care each additional 30 minutes at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,152.00
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.
$1,920.00
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.
$70.93 with Highmark BCBS of PA vs $1,440.00 with Humana — 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 | $70.93 | ↓ -94% |
| UPMC Health Plan | Managed Medicaid | $81.84 | ↓ -93% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $85.41 | ↓ -93% |
| United Healthcare Community Plan for Families | PA Medicaid | $85.56 | ↓ -93% |
| Highmark Wholecare (prev Gateway) | Medicaid | $95.46 | ↓ -92% |
| Geisinger | Medicaid | $103.41 | ↓ -91% |
| UPMC Health Plan | Commercial | $127.22 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $168.81 | ↓ -85% |
| UPMC Health Plan | CHIP | $212.41 | ↓ -82% |
| Geisinger | Commercial | $756.10 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $768.00 | ↓ -33% |
| United Healthcare | Commercial | $827.52 | ↓ -28% |
| Highmark Wholecare (prev Gateway) | Medicare | $960.00 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $960.00 | ↓ -17% |
| Galaxy Health Plan | Commercial | $1,248.00 | ↑ +8% |
| Humana | Commercial | $1,440.00 | ↑ +25% |
Visitor-reported prices
Comments
Critical care each additional 30 minutes at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $627.60 | $71.66 – $941.40 |
| UPMC Muncy | Muncy | $504.00 | $81.84 – $672.00 |
| UPMC Northwest | Seneca | $478.80 | $81.84 – $678.30 |
| UPMC Passavant-McCandless | Pittsburgh | $570.60 | $72.34 – $808.35 |
| UPMC Presbyterian | Pittsburgh | $655.80 | $72.34 – $929.05 |
| UPMC St. Margaret | Pittsburgh | $519.00 | $72.34 – $735.25 |
| UPMC Wellsboro | Wellsboro | $609.60 | $12.06 – $168.81 |
| UPMC Williamsport | Williamsport | $504.00 | $81.84 – $672.00 |