healthcosts.net
New Patient Office Visit (level 5) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$814.80
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.
$1,358.00
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.
$28.87 with Highmark BCBS of PA vs $999.75 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $28.87 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $129.29 | ↓ -84% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $134.94 | ↓ -83% |
| United Healthcare Community Plan for Families | PA Medicaid | $135.17 | ↓ -83% |
| Highmark Wholecare (prev Gateway) | Medicaid | $150.80 | ↓ -81% |
| Geisinger | Medicaid | $163.37 | ↓ -80% |
| UPMC Health Plan | Managed Medicare | $171.06 | ↓ -79% |
| Highmark Wholecare (prev Gateway) | Medicare | $184.73 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $236.04 | ↓ -71% |
| UPMC Health Plan | Commercial | $271.15 | ↓ -67% |
| UPMC Health Plan | CHIP | $452.70 | ↓ -44% |
| Geisinger | Commercial | $524.94 | ↓ -36% |
| Aetna of PA | TPA/Carrier | $533.20 | ↓ -35% |
| Multiplan | PPO (Includes PHCS as a Payer) | $666.50 | ↓ -18% |
| Galaxy Health Plan | Commercial | $866.45 | ↑ +6% |
| Humana | Commercial | $999.75 | ↑ +23% |
Visitor-reported prices
Comments
New Patient Office Visit (level 5) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $663.60 | $129.29 – $940.10 |
| UPMC East | Monroeville | $516.00 | $36.08 – $688.00 |
| UPMC Hamot | Erie | $360.60 | $90.15 – $527.06 |
| UPMC Altoona | Altoona | $343.80 | $30.00 – $458.40 |
| UPMC Bedford | Everett | $355.80 | $36.08 – $533.70 |
| UPMC Cole | Coudersport | $526.20 | $65.78 – $385.60 |
| UPMC Community Osteopathic | Harrisburg | $814.80 | $149.28 – $1,133.05 |
| UPMC Horizon-Greenville | Greenville | $526.20 | $123.42 – $745.45 |