healthcosts.net
Ins picad w subq port 5yr> at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$4,201.80
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.
$7,003.00
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.
$885.98 with Highmark BCBS of PA vs $5,633.03 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $885.98 | ↓ -79% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↓ -79% |
| UPMC Health Plan | CHIP | $1,113.73 | ↓ -73% |
| UPMC Work Partners | Workers Comp | $2,755.22 | ↓ -34% |
| Geisinger | Commercial | $2,757.78 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $2,801.20 | ↓ -33% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $2,970.75 | ↓ -29% |
| AmeriHealth Caritas | Medicare | $3,000.76 | ↓ -29% |
| UPMC Health Plan | Managed Medicare | $3,000.76 | ↓ -29% |
| United Healthcare | Medicare | $3,000.76 | ↓ -29% |
| United Healthcare | Commercial | $3,018.29 | ↓ -28% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,060.78 | ↓ -27% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,240.52 | ↓ -23% |
| UPMC Health Plan | Commercial | $3,406.00 | ↓ -19% |
| Multiplan | PPO (Includes PHCS as a Payer) | $3,501.50 | ↓ -17% |
| Geisinger | Medicaid | $3,851.65 | ↓ -8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,450.43 | ↑ +6% |
| Galaxy Health Plan | Commercial | $4,551.95 | ↑ +8% |
| Humana | Commercial | $5,252.25 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $5,633.03 | ↑ +34% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Ins picad w subq port 5yr> at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $2,961.00 | $503.41 – $4,194.75 |
| UPMC Mercy | Pittsburgh | $5,418.00 | $681.00 – $8,127.00 |
| UPMC Muncy | Muncy | $1,705.80 | $426.45 – $2,755.22 |
| UPMC Presbyterian | Pittsburgh | $5,529.60 | $423.71 – $7,833.60 |
| UPMC St. Margaret | Pittsburgh | $4,228.20 | $499.85 – $5,989.95 |
| UPMC Wellsboro | Wellsboro | $2,063.20 | $464.22 – $2,755.22 |
| UPMC Williamsport | Williamsport | $1,624.80 | $993.28 – $3,240.52 |
| UPMC Northwest | Seneca | not published | $526.12 – $3,240.82 |