healthcosts.net
Lead capillary at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$62.40
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.
$104.00
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.
$10.00 with CBHNP vs $78.00 with Humana — 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 |
|---|---|---|---|
| CBHNP | Commercial | $10.00 | ↓ -84% |
| UPMC Health Plan | Managed Medicaid | $11.00 | ↓ -82% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $11.48 | ↓ -82% |
| United Healthcare Community Plan for Families | PA Medicaid | $11.50 | ↓ -82% |
| UPMC Work Partners | Workers Comp | $11.96 | ↓ -81% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $11.99 | ↓ -81% |
| AmeriHealth Caritas | Medicare | $12.11 | ↓ -81% |
| UPMC Health Plan | Managed Medicare | $12.11 | ↓ -81% |
| United Healthcare | Medicare | $12.11 | ↓ -81% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $12.35 | ↓ -80% |
| Highmark Wholecare (prev Gateway) | Medicaid | $12.83 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicare | $13.08 | ↓ -79% |
| Geisinger | Medicaid | $13.90 | ↓ -78% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $17.96 | ↓ -71% |
| CCBHN | Commercial | $20.00 | ↓ -68% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $22.73 | ↓ -64% |
| Highmark BCBS of PA | Medicare Advantage | $23.15 | ↓ -63% |
| United Healthcare | Commercial | $36.30 | ↓ -42% |
| Geisinger | Commercial | $40.96 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $41.60 | ↓ -33% |
| Multiplan | PPO (Includes PHCS as a Payer) | $52.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $52.65 | ↓ -16% |
| Galaxy Health Plan | Commercial | $67.60 | ↑ +8% |
| UPMC Health Plan | CHIP | $76.33 | ↑ +22% |
| Humana | Commercial | $78.00 | ↑ +25% |
Visitor-reported prices
Comments
Lead capillary at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $67.20 | $11.00 – $95.20 |
| UPMC Mercy | Pittsburgh | $90.60 | $10.09 – $127.80 |
| UPMC Muncy | Muncy | $165.60 | $11.00 – $220.80 |
| UPMC Northwest | Seneca | $85.20 | $10.98 – $120.70 |
| UPMC Presbyterian | Pittsburgh | $571.80 | $10.00 – $184.45 |
| UPMC St. Margaret | Pittsburgh | $146.40 | $10.46 – $207.40 |
| UPMC Wellsboro | Wellsboro | $404.80 | $10.00 – $56.70 |
| UPMC Williamsport | Williamsport | $165.60 | $11.00 – $220.80 |