healthcosts.net
ER Visit (level 4) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,320.00
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.
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What you pay up front if you don't use insurance.
$2,200.00
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.
$51.25 with AmeriHealth Caritas vs $948.20 with United Healthcare — 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $51.25 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $104.86 | ↓ -92% |
| Highmark Wholecare (prev Gateway) | Medicaid | $106.29 | ↓ -92% |
| United Healthcare Community Plan for Families | PA Medicaid | $109.63 | ↓ -92% |
| UPMC Health Plan | Managed Medicare | $114.40 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicare | $123.54 | ↓ -91% |
| Geisinger | Medicaid | $132.50 | ↓ -90% |
| Highmark BCBS of PA | Medicare Advantage | $140.54 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $168.00 | ↓ -87% |
| Geisinger | Commercial | $180.75 | ↓ -86% |
| Aetna of PA | TPA/Carrier | $183.60 | ↓ -86% |
| Multiplan | PPO (Includes PHCS as a Payer) | $229.50 | ↓ -83% |
| UPMC Health Plan | Commercial | $268.64 | ↓ -80% |
| Galaxy Health Plan | Commercial | $298.35 | ↓ -77% |
| Humana | Commercial | $344.25 | ↓ -74% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $401.91 | ↓ -70% |
| AmeriHealth Caritas | Medicare | $405.97 | ↓ -69% |
| United Healthcare | Medicare | $405.97 | ↓ -69% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $414.09 | ↓ -69% |
| UPMC Health Plan | CHIP | $448.50 | ↓ -66% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $602.09 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $762.09 | ↓ -42% |
| United Healthcare | Commercial | $948.20 | ↓ -28% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
ER Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,146.00 | $104.86 – $1,623.50 |
| UPMC Cole | Coudersport | $357.00 | $56.38 – $432.27 |
| UPMC East | Monroeville | $1,120.20 | $104.86 – $1,493.60 |
| UPMC Hamot | Erie | $1,581.00 | $104.86 – $1,844.50 |
| UPMC Altoona | Altoona | $1,012.20 | $123.00 – $1,349.60 |
| UPMC Carlisle | Carlisle | $1,320.00 | $65.00 – $1,870.00 |
| UPMC Bedford | Everett | $645.60 | $100.10 – $968.40 |
| UPMC Community Osteopathic | Harrisburg | $1,320.00 | $65.00 – $448.50 |