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Colonoscopy (with polyp removal) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,666.80
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.
$2,778.00
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.
$294.89 with UPMC Health Plan vs $2,937.00 with UPMC Health Plan — 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $294.89 | ↓ -82% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $307.76 | ↓ -82% |
| Highmark Wholecare (prev Gateway) | Medicaid | $343.95 | ↓ -79% |
| Geisinger | Medicaid | $372.60 | ↓ -78% |
| United Healthcare Community Plan for Families | PA Medicaid | $437.00 | ↓ -74% |
| Geisinger | Commercial | $649.77 | ↓ -61% |
| Aetna of PA | TPA/Carrier | $660.00 | ↓ -60% |
| Highmark BCBS of PA | Medicare Advantage | $722.42 | ↓ -57% |
| Multiplan | PPO (Includes PHCS as a Payer) | $825.00 | ↓ -51% |
| Galaxy Health Plan | Commercial | $1,072.50 | ↓ -36% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $1,112.87 | ↓ -33% |
| AmeriHealth Caritas | Medicare | $1,124.11 | ↓ -33% |
| UPMC Health Plan | Managed Medicare | $1,124.11 | ↓ -33% |
| United Healthcare | Medicare | $1,124.11 | ↓ -33% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $1,146.59 | ↓ -31% |
| UPMC Work Partners | Workers Comp | $1,152.55 | ↓ -31% |
| Highmark Wholecare (prev Gateway) | Medicare | $1,213.93 | ↓ -27% |
| Humana | Commercial | $1,237.50 | ↓ -26% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,667.17 | ↑ +0% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $2,110.18 | ↑ +27% |
| UPMC Health Plan | CHIP | $2,297.51 | ↑ +38% |
| UPMC Health Plan | Commercial | $2,937.00 | ↑ +76% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Colonoscopy (with polyp removal) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $4,705.20 | $294.89 – $6,665.70 |
| UPMC East | Monroeville | $3,055.20 | $294.89 – $4,073.60 |
| UPMC Hamot | Erie | $3,098.40 | $294.89 – $3,614.80 |
| UPMC Altoona | Altoona | $1,764.60 | $268.08 – $2,352.80 |
| UPMC Bedford | Everett | $1,581.00 | $281.48 – $2,371.50 |
| UPMC Cole | Coudersport | $862.80 | $281.48 – $1,152.55 |
| UPMC Community Osteopathic | Harrisburg | $1,666.80 | $330.00 – $2,297.51 |
| UPMC Horizon-Greenville | Greenville | $2,476.20 | $294.89 – $3,507.95 |