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Lower Back (Lumbar Spine) MRI (without contrast) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,656.00
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.
$2,760.00
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.
$215.28 with United Healthcare Community Plan for Families vs $2,070.00 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $215.28 | ↓ -87% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $228.15 | ↓ -86% |
| AmeriHealth Caritas | Medicare | $230.45 | ↓ -86% |
| UPMC Health Plan | Managed Medicare | $230.45 | ↓ -86% |
| United Healthcare | Medicare | $230.45 | ↓ -86% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $235.06 | ↓ -86% |
| Highmark Wholecare (prev Gateway) | Medicare | $248.86 | ↓ -85% |
| UPMC Health Plan | Managed Medicaid | $281.76 | ↓ -83% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $294.06 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicaid | $328.64 | ↓ -80% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $341.78 | ↓ -79% |
| Geisinger | Medicaid | $356.02 | ↓ -79% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $432.60 | ↓ -74% |
| Highmark BCBS of PA | Medicare Advantage | $613.22 | ↓ -63% |
| Geisinger | Commercial | $1,086.89 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,104.00 | ↓ -33% |
| United Healthcare | Commercial | $1,189.56 | ↓ -28% |
| UPMC Work Partners | Workers Comp | $1,227.91 | ↓ -26% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,380.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $1,465.85 | ↓ -11% |
| Galaxy Health Plan | Commercial | $1,794.00 | ↑ +8% |
| UPMC Health Plan | CHIP | $1,948.86 | ↑ +18% |
| Humana | Commercial | $2,070.00 | ↑ +25% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Lower Back (Lumbar Spine) MRI (without contrast) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $3,801.60 | $214.16 – $5,385.60 |
| UPMC East | Monroeville | $3,940.80 | $231.07 – $5,254.40 |
| UPMC Hamot | Erie | $1,623.00 | $183.52 – $1,893.50 |
| UPMC Horizon-Greenville | Greenville | $4,861.20 | $206.32 – $6,886.70 |
| UPMC Jameson | New Castle | $1,519.80 | $197.92 – $2,229.04 |
| UPMC Kane | Kane | $2,338.80 | $93.80 – $1,227.91 |
| UPMC McKeesport | Mckeesport | $3,834.60 | $213.60 – $5,432.35 |
| UPMC Carlisle | Carlisle | $1,656.00 | $228.92 – $2,346.00 |