healthcosts.net
Quant diff pulm perf and vent w/imaging at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,574.40
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.
?
What you pay up front if you don't use insurance.
$2,624.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$221.19 with United Healthcare Community Plan for Families vs $2,247.34 with UPMC Health Plan — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $221.19 | ↓ -86% |
| UPMC Health Plan | Managed Medicaid | $245.43 | ↓ -84% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $256.14 | ↓ -84% |
| Highmark Wholecare (prev Gateway) | Medicaid | $286.26 | ↓ -82% |
| Highmark BCBS of PA | Medicare Advantage | $303.14 | ↓ -81% |
| Geisinger | Medicaid | $310.11 | ↓ -80% |
| UPMC Work Partners | Workers Comp | $411.18 | ↓ -74% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $508.05 | ↓ -68% |
| AmeriHealth Caritas | Medicare | $513.18 | ↓ -67% |
| UPMC Health Plan | Managed Medicare | $513.18 | ↓ -67% |
| United Healthcare | Medicare | $513.18 | ↓ -67% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $523.44 | ↓ -67% |
| Highmark Wholecare (prev Gateway) | Medicare | $554.18 | ↓ -65% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $761.10 | ↓ -52% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $963.34 | ↓ -39% |
| Geisinger | Commercial | $1,033.33 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,049.60 | ↓ -33% |
| United Healthcare | Commercial | $1,130.94 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,312.00 | ↓ -17% |
| UPMC Health Plan | Commercial | $1,690.36 | ↑ +7% |
| Galaxy Health Plan | Commercial | $1,705.60 | ↑ +8% |
| Humana | Commercial | $1,968.00 | ↑ +25% |
| UPMC Health Plan | CHIP | $2,247.34 | ↑ +43% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Quant diff pulm perf and vent w/imaging at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $2,655.60 | $245.43 – $3,762.10 |
| UPMC Muncy | Muncy | $3,089.40 | $245.43 – $4,119.20 |
| UPMC Northwest | Seneca | $2,878.80 | $245.43 – $4,078.30 |
| UPMC Presbyterian | Pittsburgh | $3,618.00 | $230.81 – $5,125.50 |
| UPMC St. Margaret | Pittsburgh | $2,908.80 | $245.43 – $4,120.80 |
| UPMC Wellsboro | Wellsboro | $3,736.00 | $245.43 – $4,203.00 |
| UPMC Williamsport | Williamsport | $3,089.40 | $245.43 – $4,119.20 |