healthcosts.net
Quant diff pulm perf w/imaging at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,228.80
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.
$2,048.00
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.
$136.50 with United Healthcare Community Plan for Families vs $1,536.00 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $136.50 | ↓ -89% |
| UPMC Health Plan | Managed Medicaid | $160.27 | ↓ -87% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $167.26 | ↓ -86% |
| Highmark Wholecare (prev Gateway) | Medicaid | $186.93 | ↓ -85% |
| Highmark BCBS of PA | Medicare Advantage | $187.07 | ↓ -85% |
| Geisinger | Medicaid | $202.51 | ↓ -84% |
| UPMC Work Partners | Workers Comp | $268.52 | ↓ -78% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $379.27 | ↓ -69% |
| AmeriHealth Caritas | Medicare | $383.10 | ↓ -69% |
| UPMC Health Plan | Managed Medicare | $383.10 | ↓ -69% |
| United Healthcare | Medicare | $383.10 | ↓ -69% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $390.76 | ↓ -68% |
| Highmark Wholecare (prev Gateway) | Medicare | $413.71 | ↓ -66% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $568.18 | ↓ -54% |
| UPMC Health Plan | Commercial | $597.11 | ↓ -51% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $719.16 | ↓ -41% |
| UPMC Health Plan | CHIP | $793.86 | ↓ -35% |
| Geisinger | Commercial | $806.50 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $819.20 | ↓ -33% |
| United Healthcare | Commercial | $882.69 | ↓ -28% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,024.00 | ↓ -17% |
| Galaxy Health Plan | Commercial | $1,331.20 | ↑ +8% |
| Humana | Commercial | $1,536.00 | ↑ +25% |
| 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 w/imaging at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $1,798.20 | $160.27 – $2,547.45 |
| UPMC Mercy | Pittsburgh | $1,830.00 | $160.27 – $2,745.00 |
| UPMC Muncy | Muncy | $1,126.20 | $151.94 – $1,501.60 |
| UPMC Presbyterian | Pittsburgh | $1,653.60 | $142.44 – $2,342.60 |
| UPMC St. Margaret | Pittsburgh | $2,236.80 | $160.27 – $3,168.80 |
| UPMC Wellsboro | Wellsboro | $1,362.40 | $151.94 – $1,532.70 |
| UPMC Williamsport | Williamsport | $1,126.20 | $151.94 – $1,501.60 |