healthcosts.net
#flow interp 9 - 15 markers at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$55.20
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.
$92.00
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.
$32.11 with United Healthcare vs $166.71 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 |
|---|---|---|---|
| United Healthcare | Commercial | $32.11 | ↓ -42% |
| Geisinger | Commercial | $36.23 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $36.80 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $46.00 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $46.00 | ↓ -17% |
| Galaxy Health Plan | Commercial | $59.80 | ↑ +8% |
| Humana | Commercial | $69.00 | ↑ +25% |
| UPMC Health Plan | Managed Medicaid | $74.04 | ↑ +34% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $77.27 | ↑ +40% |
| United Healthcare Community Plan for Families | PA Medicaid | $77.41 | ↑ +40% |
| Highmark Wholecare (prev Gateway) | Medicaid | $86.36 | ↑ +56% |
| Geisinger | Medicaid | $93.55 | ↑ +69% |
| UPMC Health Plan | Commercial | $115.00 | ↑ +108% |
| UPMC Work Partners | Workers Comp | $153.90 | ↑ +179% |
| Highmark BCBS of PA | Medicare Advantage | $154.82 | ↑ +180% |
| UPMC Health Plan | CHIP | $166.71 | ↑ +202% |
Visitor-reported prices
Comments
#flow interp 9 - 15 markers at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $777.00 | $45.99 – $1,165.50 |
| UPMC Muncy | Muncy | $288.00 | $72.00 – $384.00 |
| UPMC Northwest | Seneca | $303.00 | $46.29 – $429.25 |
| UPMC Passavant-McCandless | Pittsburgh | $627.60 | $46.27 – $333.20 |
| UPMC Presbyterian | Pittsburgh | $303.00 | $48.82 – $429.25 |
| UPMC St. Margaret | Pittsburgh | $575.40 | $46.38 – $815.15 |
| UPMC Wellsboro | Wellsboro | $348.00 | $67.31 – $390.60 |
| UPMC Williamsport | Williamsport | $287.40 | $74.04 – $383.20 |