healthcosts.net
Shoulder MRI (with and without contrast) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,713.80
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.
$4,523.00
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.
$543.29 with United Healthcare Community Plan for Families vs $3,392.25 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 | $543.29 | ↓ -80% |
| UPMC Health Plan | Managed Medicaid | $630.19 | ↓ -77% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $657.69 | ↓ -76% |
| Highmark Wholecare (prev Gateway) | Medicaid | $735.03 | ↓ -73% |
| Geisinger | Medicaid | $796.27 | ↓ -71% |
| Highmark BCBS of PA | Medicare Advantage | $988.80 | ↓ -64% |
| UPMC Health Plan | Commercial | $1,705.35 | ↓ -37% |
| Geisinger | Commercial | $1,781.16 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $1,809.20 | ↓ -33% |
| United Healthcare | Commercial | $1,949.41 | ↓ -28% |
| UPMC Work Partners | Workers Comp | $1,992.24 | ↓ -27% |
| Highmark Wholecare (prev Gateway) | Medicare | $2,261.50 | ↓ -17% |
| Multiplan | PPO (Includes PHCS as a Payer) | $2,261.50 | ↓ -17% |
| UPMC Health Plan | CHIP | $2,267.27 | ↓ -16% |
| Galaxy Health Plan | Commercial | $2,939.95 | ↑ +8% |
| Humana | Commercial | $3,392.25 | ↑ +25% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Shoulder MRI (with and without contrast) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $5,999.40 | $316.41 – $8,499.15 |
| UPMC East | Monroeville | $6,218.40 | $341.40 – $8,291.20 |
| UPMC Hamot | Erie | $2,415.00 | $265.23 – $2,817.50 |
| UPMC Jameson | New Castle | $3,830.40 | $340.48 – $5,617.92 |
| UPMC Altoona | Altoona | $2,604.00 | $425.00 – $3,472.00 |
| UPMC Carlisle | Carlisle | $2,713.80 | $618.88 – $3,844.55 |
| UPMC Bedford | Everett | $2,563.20 | $122.85 – $3,844.80 |
| UPMC Cole | Coudersport | $1,855.20 | $467.77 – $2,473.60 |