healthcosts.net
Established Patient Office Visit (level 4) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$271.80
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.
$453.00
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.
$22.63 with Highmark BCBS of PA vs $185.08 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $22.63 | ↓ -92% |
| UPMC Health Plan | Managed Medicaid | $59.86 | ↓ -78% |
| Geisinger | Commercial | $61.04 | ↓ -78% |
| Aetna of PA | TPA/Carrier | $62.00 | ↓ -77% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $62.47 | ↓ -77% |
| United Healthcare Community Plan for Families | PA Medicaid | $62.58 | ↓ -77% |
| Highmark Wholecare (prev Gateway) | Medicaid | $69.82 | ↓ -74% |
| Geisinger | Medicaid | $75.64 | ↓ -72% |
| Highmark Wholecare (prev Gateway) | Medicare | $77.50 | ↓ -71% |
| Multiplan | PPO (Includes PHCS as a Payer) | $77.50 | ↓ -71% |
| UPMC Health Plan | Managed Medicare | $91.48 | ↓ -66% |
| Galaxy Health Plan | Commercial | $100.75 | ↓ -63% |
| UPMC Health Plan | Commercial | $110.86 | ↓ -59% |
| Humana | Commercial | $116.25 | ↓ -57% |
| UPMC Work Partners | Workers Comp | $122.27 | ↓ -55% |
| UPMC Health Plan | CHIP | $185.08 | ↓ -32% |
Visitor-reported prices
Comments
Established Patient Office Visit (level 4) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $250.80 | $59.86 – $355.30 |
| UPMC East | Monroeville | $216.00 | $36.08 – $288.00 |
| UPMC Altoona | Altoona | $274.20 | $20.00 – $365.60 |
| UPMC Bedford | Everett | $142.20 | $36.08 – $213.30 |
| UPMC Cole | Coudersport | $273.00 | $51.57 – $190.40 |
| UPMC Hamot | Erie | $178.20 | $44.55 – $247.66 |
| UPMC Community Osteopathic | Harrisburg | $271.80 | $31.00 – $337.75 |
| UPMC Hanover | Hanover | $93.00 | $29.45 – $134.85 |