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Hla class i high defin qual at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,800.60
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.
$3,001.00
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.
$140.47 with Highmark BCBS of PA vs $2,290.85 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 | $140.47 | ↓ -92% |
| UPMC Health Plan | Managed Medicaid | $146.45 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $152.84 | ↓ -92% |
| United Healthcare Community Plan for Families | PA Medicaid | $153.11 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicaid | $170.82 | ↓ -91% |
| Geisinger | Medicaid | $185.05 | ↓ -90% |
| UPMC Work Partners | Workers Comp | $319.97 | ↓ -82% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $320.51 | ↓ -82% |
| AmeriHealth Caritas | Medicare | $323.75 | ↓ -82% |
| UPMC Health Plan | Managed Medicare | $323.75 | ↓ -82% |
| United Healthcare | Medicare | $323.75 | ↓ -82% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $330.23 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicare | $349.62 | ↓ -81% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $480.15 | ↓ -73% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $607.74 | ↓ -66% |
| United Healthcare | Commercial | $1,047.35 | ↓ -42% |
| Geisinger | Commercial | $1,181.79 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,200.40 | ↓ -33% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,500.50 | ↓ -17% |
| UPMC Health Plan | Commercial | $1,580.24 | ↓ -12% |
| Galaxy Health Plan | Commercial | $1,950.65 | ↑ +8% |
| Humana | Commercial | $2,250.75 | ↑ +25% |
| UPMC Health Plan | CHIP | $2,290.85 | ↑ +27% |
Visitor-reported prices
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Hla class i high defin qual at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $435.60 | $143.25 – $582.25 |
| UPMC Mercy | Pittsburgh | $411.60 | $141.90 – $617.40 |
| UPMC Northwest | Seneca | $409.20 | $146.45 – $579.70 |
| UPMC Presbyterian | Pittsburgh | $585.00 | $133.14 – $828.75 |
| UPMC St. Margaret | Pittsburgh | $411.60 | $143.25 – $583.10 |
| UPMC Williamsport | Williamsport | $556.80 | $146.45 – $742.40 |