Reconstruction knee at UPMC Cole
1001 East Second Street, Coudersport, PA · UPMC · · NPI 110485184
$1,380.60
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.
$2,301.00
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.
$637.84 with Highmark BCBS of PA vs $3,855.74 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 |
|---|---|---|---|
| Highmark BCBS of PA | Community Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $637.84 | ↓ -54% |
| UPMC Health Plan | Managed Medicare | $644.28 | ↓ -53% |
| AmeriHealth Caritas | Medicare | $644.28 | ↓ -53% |
| Humana | Medicare | $650.72 | ↓ -53% |
| AmeriHealth Caritas | Community HealthChoices (CHC) | $660.39 | ↓ -52% |
| AmeriHealth Caritas | Medicaid | $660.39 | ↓ -52% |
| Aetna | CHIP/Medicaid | $666.88 | ↓ -52% |
| UPMC Health Plan | Managed Medicaid | $667.29 | ↓ -52% |
| Cigna | Medicare | $676.49 | ↓ -51% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP | $695.82 | ↓ -50% |
| PA Health & Wellness | Medicare Advantage (Allwell by Wellcare) | $695.82 | ↓ -50% |
| Aetna | Medicare | $701.80 | ↓ -49% |
| Geisinger | Medicaid | $882.75 | ↓ -36% |
| Highmark Wholecare (prev Gateway) | Medicaid | $920.40 | ↓ -33% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $957.76 | ↓ -31% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $1,082.37 | ↓ -22% |
| BCBS of Western NY | Medicare Advantage | $1,192.92 | ↓ -14% |
| UPMC Health Plan | Commercial | $1,610.70 | ↑ +17% |
| Geisinger | Commercial | $1,725.75 | ↑ +25% |
| InterGroup | PPO | $1,840.80 | ↑ +33% |
| Humana | Commercial | $1,840.80 | ↑ +33% |
| Galaxy Health Plan | Commercial | $1,840.80 | ↑ +33% |
| Multiplan | Worker's Compensation | $1,840.80 | ↑ +33% |
| Multiplan | PPO/Auto | $1,840.80 | ↑ +33% |
| Aetna | Commercial | $1,886.82 | ↑ +37% |
| UPMC Work Partners | Workers Comp | $2,124.78 | ↑ +54% |
| UPMC Health Plan | CHIP | $2,637.26 | ↑ +91% |
| Highmark BCBS of PA | Managed Care - Social Mission | $3,166.33 | ↑ +129% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,166.33 | ↑ +129% |
| Highmark BCBS of PA | Managed Care | $3,855.74 | ↑ +179% |
| Highmark BCBS of PA | Commercial - Indemnity | $3,855.74 | ↑ +179% |
Visitor-reported prices
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Reconstruction knee at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Uniontown Hospital | Uniontown | $7,222.25 | $7,033.14 – $16,387.22 |
| UPMC Altoona | Altoona | not published | $635.12 – $7,355.55 |
| UPMC Carlisle | Carlisle | not published | $806.60 – $10,934.13 |
| UPMC Community Osteopathic | Harrisburg | not published | $857.41 – $11,127.90 |
| UPMC East | Monroeville | not published | $698.63 – $7,491.76 |
| UPMC Hamot | Erie | not published | $698.63 – $9,905.66 |
| UPMC Mercy | Pittsburgh | not published | $681.00 – $7,491.76 |
| UPMC Presbyterian | Pittsburgh | not published | $698.63 – $7,491.76 |