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Mayo avwpr vw factor activity at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$156.00
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.
$260.00
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.
$28.93 with UPMC Health Plan vs $148.46 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $28.93 | ↓ -81% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $30.19 | ↓ -81% |
| United Healthcare Community Plan for Families | PA Medicaid | $30.25 | ↓ -81% |
| UPMC Work Partners | Workers Comp | $30.50 | ↓ -80% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $30.55 | ↓ -80% |
| AmeriHealth Caritas | Medicare | $30.86 | ↓ -80% |
| UPMC Health Plan | Managed Medicare | $30.86 | ↓ -80% |
| United Healthcare | Medicare | $30.86 | ↓ -80% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $31.48 | ↓ -80% |
| Highmark Wholecare (prev Gateway) | Medicare | $33.33 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicaid | $33.74 | ↓ -78% |
| Geisinger | Medicaid | $36.55 | ↓ -77% |
| United Healthcare | Commercial | $39.09 | ↓ -75% |
| Geisinger | Commercial | $44.11 | ↓ -72% |
| Aetna of PA | TPA/Carrier | $44.80 | ↓ -71% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $45.77 | ↓ -71% |
| Multiplan | PPO (Includes PHCS as a Payer) | $56.00 | ↓ -64% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $57.93 | ↓ -63% |
| Highmark BCBS of PA | Medicare Advantage | $61.66 | ↓ -60% |
| Galaxy Health Plan | Commercial | $72.80 | ↓ -53% |
| Humana | Commercial | $84.00 | ↓ -46% |
| UPMC Health Plan | Commercial | $102.41 | ↓ -34% |
| UPMC Health Plan | CHIP | $148.46 | ↓ -5% |
Visitor-reported prices
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Mayo avwpr vw factor activity at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $229.80 | $28.68 – $306.00 |
| UPMC Mercy | Pittsburgh | $317.40 | $25.72 – $476.10 |
| UPMC Northwest | Seneca | $415.80 | $27.99 – $589.05 |
| UPMC Presbyterian | Pittsburgh | $766.20 | $26.30 – $1,085.45 |
| UPMC St. Margaret | Pittsburgh | $286.80 | $26.64 – $406.30 |
| UPMC Williamsport | Williamsport | $322.80 | $28.93 – $430.40 |