Exc mal+marg tal 1.1-2 cm 11602 at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
not published by hospital
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.
not published by hospital
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.
$89.10 with UPMC Health Plan vs $1,730.01 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 Health Plan | Managed Medicaid | $89.10 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $92.99 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $103.92 | — |
| Geisinger | Medicaid | $112.58 | — |
| UPMC Work Partners | Workers Comp | $368.43 | — |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $377.09 | — |
| UPMC Health Plan | Managed Medicare | $380.90 | — |
| AmeriHealth Caritas | Medicare | $380.90 | — |
| United Healthcare | Medicare | $380.90 | — |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $388.52 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $411.33 | — |
| Highmark BCBS of PA | Medicare Advantage | $539.52 | — |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $564.91 | — |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $715.03 | — |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | — |
| UPMC Health Plan | Commercial | $1,036.21 | — |
| UPMC Health Plan | CHIP | $1,730.01 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Exc mal+marg tal 1.1-2 cm 11602 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Carlisle | Carlisle | $1,272.60 | $102.87 – $1,802.85 |
| UPMC Cole | Coudersport | $199.20 | $40.75 – $2,325.85 |
| UPMC Hanover | Hanover | $1,272.60 | $102.87 – $1,016.56 |
| UPMC Kane | Kane | $496.20 | $89.10 – $1,022.85 |
| UPMC Lititz | Lititz | $1,272.60 | $102.87 – $1,016.56 |
| UPMC Magee | Pittsburgh | $2,427.00 | $89.10 – $550.23 |
| UPMC Presbyterian | Pittsburgh | $2,961.60 | $89.10 – $931.20 |
| UPMC St. Margaret | Pittsburgh | $2,574.60 | $89.10 – $550.23 |