healthcosts.net
Prp i/hern init block >5 yr at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,536.60
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.
$2,561.00
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.
$225.65 with Geisinger vs $6,315.91 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| Geisinger | Commercial | $225.65 | ↓ -85% |
| Aetna of PA | TPA/Carrier | $229.20 | ↓ -85% |
| United Healthcare | Commercial | $246.96 | ↓ -84% |
| Multiplan | PPO (Includes PHCS as a Payer) | $286.50 | ↓ -81% |
| Geisinger | Medicaid | $315.15 | ↓ -79% |
| Galaxy Health Plan | Commercial | $372.45 | ↓ -76% |
| Humana | Commercial | $429.75 | ↓ -72% |
| UPMC Health Plan | Managed Medicare | $557.75 | ↓ -64% |
| Highmark Wholecare (prev Gateway) | Medicare | $602.31 | ↓ -61% |
| United Healthcare Community Plan for Families | PA Medicaid | $892.40 | ↓ -42% |
| UPMC Work Partners | Workers Comp | $1,222.76 | ↓ -20% |
| Highmark BCBS of PA | Medicare Advantage | $1,614.93 | ↑ +5% |
| UPMC Health Plan | Commercial | $3,085.43 | ↑ +101% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $3,330.89 | ↑ +117% |
| AmeriHealth Caritas | Medicare | $3,364.54 | ↑ +119% |
| United Healthcare | Medicare | $3,364.54 | ↑ +119% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $3,431.83 | ↑ +123% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $4,989.95 | ↑ +225% |
| UPMC Health Plan | CHIP | $5,151.27 | ↑ +235% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $6,315.91 | ↑ +311% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Prp i/hern init block >5 yr at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $9,925.80 | $1,326.21 – $14,061.55 |
| UPMC Mercy | Pittsburgh | $8,917.80 | $1,348.02 – $13,376.70 |
| UPMC Presbyterian | Pittsburgh | $12,411.60 | $931.20 – $17,583.10 |
| UPMC Northwest | Seneca | not published | $1,236.70 – $3,633.70 |
| UPMC St. Margaret | Pittsburgh | not published | $1,326.21 – $3,700.99 |
| UPMC Wellsboro | Wellsboro | not published | $993.28 – $1,222.76 |
| UPMC Williamsport | Williamsport | not published | $993.28 – $3,633.70 |