healthcosts.net
Surgical pathology level 5 gross & microscopic examination at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$664.80
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.
$1,108.00
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.
$13.22 with United Healthcare Community Plan for Families vs $643.79 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $13.22 | ↓ -98% |
| Highmark BCBS of PA | Medicare Advantage | $48.56 | ↓ -93% |
| UPMC Health Plan | Managed Medicaid | $50.05 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $52.23 | ↓ -92% |
| Highmark Wholecare (prev Gateway) | Medicaid | $58.38 | ↓ -91% |
| Geisinger | Medicaid | $63.24 | ↓ -90% |
| United Healthcare | Commercial | $82.36 | ↓ -88% |
| UPMC Health Plan | Commercial | $90.08 | ↓ -86% |
| Geisinger | Commercial | $92.94 | ↓ -86% |
| Aetna of PA | TPA/Carrier | $94.40 | ↓ -86% |
| Multiplan | PPO (Includes PHCS as a Payer) | $118.00 | ↓ -82% |
| UPMC Health Plan | CHIP | $130.59 | ↓ -80% |
| Galaxy Health Plan | Commercial | $153.40 | ↓ -77% |
| Humana | Commercial | $177.00 | ↓ -73% |
| UPMC Work Partners | Workers Comp | $251.07 | ↓ -62% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $339.52 | ↓ -49% |
| AmeriHealth Caritas | Medicare | $342.95 | ↓ -48% |
| UPMC Health Plan | Managed Medicare | $342.95 | ↓ -48% |
| United Healthcare | Medicare | $342.95 | ↓ -48% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $349.81 | ↓ -47% |
| Highmark Wholecare (prev Gateway) | Medicare | $370.35 | ↓ -44% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $508.63 | ↓ -23% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $643.79 | ↓ -3% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Surgical pathology level 5 gross & microscopic examination at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Mercy | Pittsburgh | $505.20 | $36.03 – $757.80 |
| UPMC Muncy | Muncy | $408.00 | $14.72 – $544.00 |
| UPMC Northwest | Seneca | $360.60 | $36.26 – $510.85 |
| UPMC Passavant-McCandless | Pittsburgh | $440.40 | $36.24 – $623.90 |
| UPMC Presbyterian | Pittsburgh | $1,323.60 | $13.80 – $1,875.10 |
| UPMC St. Margaret | Pittsburgh | $888.00 | $36.33 – $1,258.00 |
| UPMC Wellsboro | Wellsboro | $493.60 | $14.72 – $555.30 |
| UPMC Williamsport | Williamsport | $408.00 | $14.72 – $544.00 |