healthcosts.net
Hdr rdncl ntrstl/icav brchtx at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,553.60
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.
$4,256.00
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.
$411.57 with Highmark BCBS of PA vs $3,566.75 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 | $411.57 | ↓ -84% |
| United Healthcare Community Plan for Families | PA Medicaid | $547.38 | ↓ -79% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $654.85 | ↓ -74% |
| AmeriHealth Caritas | Medicare | $661.46 | ↓ -74% |
| UPMC Health Plan | Managed Medicare | $661.46 | ↓ -74% |
| United Healthcare | Medicare | $661.46 | ↓ -74% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $674.69 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicare | $714.31 | ↓ -72% |
| UPMC Health Plan | Managed Medicaid | $766.73 | ↓ -70% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $800.19 | ↓ -69% |
| Highmark Wholecare (prev Gateway) | Medicaid | $894.29 | ↓ -65% |
| Geisinger | Medicaid | $968.80 | ↓ -62% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $981.01 | ↓ -62% |
| UPMC Work Partners | Workers Comp | $1,166.16 | ↓ -54% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,241.69 | ↓ -51% |
| Geisinger | Commercial | $1,676.01 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,702.40 | ↓ -33% |
| United Healthcare | Commercial | $1,834.34 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $2,128.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $2,682.77 | ↑ +5% |
| Galaxy Health Plan | Commercial | $2,766.40 | ↑ +8% |
| Humana | Commercial | $3,192.00 | ↑ +25% |
| UPMC Health Plan | CHIP | $3,566.75 | ↑ +40% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |