healthcosts.net
Ins/rpl pm gen exist dual lead at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$15,540.60
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.
?
What you pay up front if you don't use insurance.
$25,901.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$892.40 with United Healthcare Community Plan for Families vs $19,425.75 with Humana — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 Community Plan for Families | PA Medicaid | $892.40 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $1,140.25 | ↓ -93% |
| Highmark BCBS of PA | Medicare Advantage | $1,614.93 | ↓ -90% |
| UPMC Health Plan | Commercial | $3,406.00 | ↓ -78% |
| UPMC Health Plan | CHIP | $5,149.48 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $9,877.67 | ↓ -36% |
| AmeriHealth Caritas | Medicare | $9,977.44 | ↓ -36% |
| UPMC Health Plan | Managed Medicare | $9,977.44 | ↓ -36% |
| United Healthcare | Medicare | $9,977.44 | ↓ -36% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $10,176.99 | ↓ -35% |
| Geisinger | Commercial | $10,199.81 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $10,360.40 | ↓ -33% |
| Highmark Wholecare (prev Gateway) | Medicare | $10,774.64 | ↓ -31% |
| United Healthcare | Commercial | $11,163.33 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $12,950.50 | ↓ -17% |
| Geisinger | Medicaid | $14,245.55 | ↓ -8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $14,797.54 | ↓ -5% |
| Galaxy Health Plan | Commercial | $16,835.65 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $18,729.65 | ↑ +21% |
| Humana | Commercial | $19,425.75 | ↑ +25% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Ins/rpl pm gen exist dual lead at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $10,852.20 | $681.00 – $16,278.30 |
| UPMC Presbyterian | Pittsburgh | $18,634.20 | $931.20 – $26,398.45 |
| UPMC Williamsport | Williamsport | $3,922.80 | $993.28 – $10,774.64 |