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Pt evaluation high complexity patient/family at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$363.00
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.
$605.00
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.
$51.04 with Highmark BCBS of PA vs $453.75 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 | $51.04 | ↓ -86% |
| United Healthcare Community Plan for Families | PA Medicaid | $73.15 | ↓ -80% |
| UPMC Work Partners | Workers Comp | $127.65 | ↓ -65% |
| UPMC Health Plan | Commercial | $133.30 | ↓ -63% |
| Premier Comp Solutions | Worker's Comp | $148.43 | ↓ -59% |
| UPMC Health Plan | CHIP | $222.54 | ↓ -39% |
| Geisinger | Commercial | $238.25 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $242.00 | ↓ -33% |
| United Healthcare | Commercial | $260.75 | ↓ -28% |
| Highmark Wholecare (prev Gateway) | Medicare | $302.50 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $302.50 | ↓ -17% |
| Geisinger | Medicaid | $332.75 | ↓ -8% |
| Galaxy Health Plan | Commercial | $393.25 | ↑ +8% |
| Humana | Commercial | $453.75 | ↑ +25% |
Visitor-reported prices
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Pt evaluation high complexity patient/family at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $382.20 | $51.56 – $573.30 |
| UPMC Muncy | Muncy | $197.40 | $49.35 – $263.20 |
| UPMC Northwest | Seneca | $320.40 | $127.65 – $453.90 |
| UPMC Passavant-McCandless | Pittsburgh | $345.00 | $52.05 – $488.75 |
| UPMC Presbyterian | Pittsburgh | $692.40 | $52.05 – $980.90 |
| UPMC St. Margaret | Pittsburgh | $303.00 | $52.05 – $429.25 |
| UPMC Wellsboro | Wellsboro | $238.40 | $53.64 – $268.20 |
| UPMC Williamsport | Williamsport | $197.40 | $81.42 – $263.20 |