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Flexible Sigmoidoscopy at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$1,158.00
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.
$1,930.00
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.
$58.47 with UPMC Health Plan vs $1,631.68 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 |
|---|---|---|---|
| UPMC Health Plan | Managed Medicaid | $58.47 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $61.02 | ↓ -95% |
| Highmark Wholecare (prev Gateway) | Medicaid | $68.19 | ↓ -94% |
| Geisinger | Medicaid | $73.87 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $193.56 | ↓ -83% |
| Highmark BCBS of PA | Medicare Advantage | $331.20 | ↓ -71% |
| United Healthcare Community Plan for Families | PA Medicaid | $387.55 | ↓ -67% |
| UPMC Health Plan | Commercial | $627.24 | ↓ -46% |
| Geisinger | Commercial | $760.03 | ↓ -34% |
| Aetna of PA | TPA/Carrier | $772.00 | ↓ -33% |
| United Healthcare | Commercial | $831.83 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $860.52 | ↓ -26% |
| AmeriHealth Caritas | Medicare | $869.21 | ↓ -25% |
| UPMC Health Plan | Managed Medicare | $869.21 | ↓ -25% |
| United Healthcare | Medicare | $869.21 | ↓ -25% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $886.59 | ↓ -23% |
| Highmark Wholecare (prev Gateway) | Medicare | $938.66 | ↓ -19% |
| Multiplan | PPO (Includes PHCS as a Payer) | $965.00 | ↓ -17% |
| UPMC Health Plan | CHIP | $1,047.20 | ↓ -10% |
| Galaxy Health Plan | Commercial | $1,254.50 | ↑ +8% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,289.13 | ↑ +11% |
| Humana | Commercial | $1,447.50 | ↑ +25% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,631.68 | ↑ +41% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Flexible Sigmoidoscopy at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $598.20 | $58.47 – $956.13 |
| UPMC East | Monroeville | $598.20 | $58.47 – $912.67 |
| UPMC Hamot | Erie | $598.20 | $58.47 – $1,264.19 |
| UPMC Carlisle | Carlisle | $1,158.00 | $67.50 – $1,640.50 |
| UPMC Altoona | Altoona | $598.20 | $53.15 – $797.60 |
| UPMC Bedford | Everett | $598.20 | $55.81 – $897.30 |
| UPMC Cole | Coudersport | $176.40 | $55.81 – $2,325.85 |
| UPMC Community Osteopathic | Harrisburg | $1,158.00 | $67.50 – $1,640.50 |