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Upper Endoscopy (EGD, with biopsy) at UPMC Somerset
225 South Center Avenue, Somerset, PA · UPMC · · NPI 1912900168
$2,083.20
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.
$3,472.00
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.
$163.44 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 | $163.44 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $170.57 | ↓ -92% |
| Highmark Wholecare (prev Gateway) | Medicaid | $190.63 | ↓ -91% |
| Geisinger | Medicaid | $206.51 | ↓ -90% |
| United Healthcare Community Plan for Families | PA Medicaid | $323.15 | ↓ -84% |
| Highmark BCBS of PA | Medicare Advantage | $722.42 | ↓ -65% |
| UPMC Work Partners | Workers Comp | $730.25 | ↓ -65% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Together Blue Medicare Advantage | $884.91 | ↓ -58% |
| AmeriHealth Caritas | Medicare | $893.85 | ↓ -57% |
| UPMC Health Plan | Managed Medicare | $893.85 | ↓ -57% |
| United Healthcare | Medicare | $893.85 | ↓ -57% |
| UPMC Health Plan | EPO Partners/EPO Select Plan/HMO | $911.73 | ↓ -56% |
| Highmark Wholecare (prev Gateway) | Medicare | $965.27 | ↓ -54% |
| Geisinger | Commercial | $1,325.53 | ↓ -36% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity/Managed Care - Social Mission | $1,325.67 | ↓ -36% |
| Aetna of PA | TPA/Carrier | $1,346.40 | ↓ -35% |
| United Healthcare | Commercial | $1,450.75 | ↓ -30% |
| Highmark BCBS of PA | Commercial - Indemnity/Managed Care | $1,677.94 | ↓ -19% |
| Multiplan | PPO (Includes PHCS as a Payer) | $1,683.00 | ↓ -19% |
| Galaxy Health Plan | Commercial | $2,187.90 | ↑ +5% |
| UPMC Health Plan | CHIP | $2,316.50 | ↑ +11% |
| Humana | Commercial | $2,524.50 | ↑ +21% |
| UPMC Health Plan | Commercial | $2,937.00 | ↑ +41% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Upper Endoscopy (EGD, with biopsy) at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $2,214.00 | $163.44 – $3,136.50 |
| UPMC East | Monroeville | $3,055.20 | $163.44 – $4,073.60 |
| UPMC Hamot | Erie | $3,124.20 | $163.44 – $3,644.90 |
| UPMC Carlisle | Carlisle | $2,019.60 | $188.70 – $2,861.10 |
| UPMC Altoona | Altoona | $1,675.80 | $148.58 – $2,234.40 |
| UPMC Bedford | Everett | $1,656.60 | $156.01 – $2,484.90 |
| UPMC Cole | Coudersport | $637.20 | $156.01 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $2,083.20 | $188.70 – $2,861.10 |