healthcosts.net
Exc abd les sc 3 cm/> at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,144.80
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.
$1,908.00
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.
$418.59 with UPMC Health Plan vs $5,122.17 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 | Managed Medicare | $418.59 | ↓ -63% |
| Highmark Wholecare (prev Gateway) | Medicare | $452.04 | ↓ -61% |
| UPMC Work Partners | Workers Comp | $645.96 | ↓ -44% |
| Highmark BCBS of PA | Medicare Advantage | $767.37 | ↓ -33% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↓ -22% |
| UPMC Health Plan | Commercial | $2,187.91 | ↑ +91% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $2,701.33 | ↑ +136% |
| AmeriHealth Caritas | Medicare | $2,728.62 | ↑ +138% |
| United Healthcare | Medicare | $2,728.62 | ↑ +138% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $2,783.19 | ↑ +143% |
| UPMC Health Plan | CHIP | $3,652.82 | ↑ +219% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,046.82 | ↑ +253% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $5,122.17 | ↑ +347% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Exc abd les sc 3 cm/> at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | not published | $645.96 – $3,001.48 |
| UPMC Northwest | Seneca | not published | $645.96 – $2,946.91 |
| UPMC Presbyterian | Pittsburgh | not published | $724.44 – $3,001.48 |