healthcosts.net
Observation per hour at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$111.60
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.
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What you pay up front if you don't use insurance.
$186.00
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.
$27.31 with Highmark BCBS of PA vs $2,340.62 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 |
|---|---|---|---|
| Highmark BCBS of PA | Medicare Advantage | $27.31 | ↓ -76% |
| UPMC Health Plan | CHIP | $50.26 | ↓ -55% |
| Geisinger | Commercial | $73.25 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $74.40 | ↓ -33% |
| United Healthcare | Commercial | $80.17 | ↓ -28% |
| Highmark Wholecare (prev Gateway) | Medicare | $93.00 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $93.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $116.55 | ↑ +4% |
| Galaxy Health Plan | Commercial | $120.90 | ↑ +8% |
| Humana | Commercial | $139.50 | ↑ +25% |
| UNITED BEHAVIORAL HEALTH | COMMERCIAL | $375.00 | ↑ +236% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $1,025.00 | ↑ +818% |
| UPMC Health Plan | Managed Medicaid | $1,074.19 | ↑ +863% |
| Highmark Wholecare (prev Gateway) | Medicaid | $1,252.90 | ↑ +1023% |
| Geisinger | Medicaid | $2,207.16 | ↑ +1878% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $2,340.62 | ↑ +1997% |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
Visitor-reported prices
Comments
Observation per hour at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $925.80 | $26.56 – $1,123.02 |
| UPMC Muncy | Muncy | $176.40 | $44.10 – $264.60 |
| UPMC Northwest | Seneca | $443.40 | $25.00 – $1,074.19 |
| UPMC Passavant-McCandless | Pittsburgh | $793.20 | $27.85 – $1,074.19 |
| UPMC Presbyterian | Pittsburgh | $1,750.20 | $27.85 – $359.55 |
| UPMC St. Margaret | Pittsburgh | $838.80 | $27.85 – $1,074.19 |
| UPMC Wellsboro | Wellsboro | $213.60 | $48.06 – $240.30 |
| UPMC Williamsport | Williamsport | $176.40 | $79.38 – $1,372.04 |