healthcosts.net
Dch validity tests at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$25.20
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.
$42.00
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.
$3.44 with UPMC Work Partners vs $26.26 with UPMC Health Plan — 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 | $3.44 | ↓ -86% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $3.45 | ↓ -86% |
| AmeriHealth Caritas | Medicare | $3.48 | ↓ -86% |
| UPMC Health Plan | Managed Medicare | $3.48 | ↓ -86% |
| United Healthcare | Medicare | $3.48 | ↓ -86% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3.55 | ↓ -86% |
| Highmark Wholecare (prev Gateway) | Medicare | $3.76 | ↓ -85% |
| UPMC Health Plan | Managed Medicaid | $3.93 | ↓ -84% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $4.10 | ↓ -84% |
| United Healthcare Community Plan for Families | PA Medicaid | $4.11 | ↓ -84% |
| United Healthcare | Commercial | $4.19 | ↓ -83% |
| Highmark Wholecare (prev Gateway) | Medicaid | $4.58 | ↓ -82% |
| Geisinger | Commercial | $4.73 | ↓ -81% |
| Aetna of PA | TPA/Carrier | $4.80 | ↓ -81% |
| Geisinger | Medicaid | $4.96 | ↓ -80% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $5.16 | ↓ -80% |
| Multiplan | PPO (Includes PHCS as a Payer) | $6.00 | ↓ -76% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $6.53 | ↓ -74% |
| Highmark BCBS of PA | Medicare Advantage | $6.88 | ↓ -73% |
| Galaxy Health Plan | Commercial | $7.80 | ↓ -69% |
| Humana | Commercial | $9.00 | ↓ -64% |
| UPMC Health Plan | Commercial | $18.12 | ↓ -28% |
| UPMC Health Plan | CHIP | $26.26 | ↑ +4% |
Visitor-reported prices
Comments
Dch validity tests at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $27.00 | $3.23 – $38.25 |
| UPMC Mercy | Pittsburgh | $33.60 | $2.90 – $50.40 |
| UPMC Muncy | Muncy | $51.00 | $3.44 – $68.00 |
| UPMC Northwest | Seneca | $18.60 | $3.16 – $26.35 |
| UPMC Presbyterian | Pittsburgh | $21.60 | $3.44 – $30.60 |
| UPMC St. Margaret | Pittsburgh | $70.80 | $3.00 – $100.30 |
| UPMC Wellsboro | Wellsboro | $62.20 | $2.65 – $13.28 |
| UPMC Williamsport | Williamsport | $51.00 | $3.44 – $9.60 |