Fusion of ankle joint open at UPMC Hamot
201 State Street, Erie, PA · UPMC · · NPI 1487647590
not published by hospital
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.
not published by hospital
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.
$638.55 with UPMC Health Plan vs $22,326.53 with Independent Health — 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 | $638.55 | — |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $667.58 | — |
| Aetna | Medicaid | $696.60 | — |
| Geisinger | Medicaid/CHIP | $806.84 | — |
| Highmark Wholecare (prev Gateway) | Medicaid | $860.88 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $875.39 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $906.22 | — |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $989.29 | — |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,030.96 | — |
| UPMC Work Partners | Workers Comp | $2,666.77 | — |
| United Healthcare | Commercial | $2,849.00 | — |
| Highmark BCBS of PA | Commercial - Indemnity/Commercial - Social Mission Indemnity/Managed Care/Managed Care - Social Mission | $3,115.30 | — |
| BCBS of Western NY | Commercial | $3,547.20 | — |
| UPMC Health Plan | Commercial | $4,059.28 | — |
| Highmark BCBS of PA | UPMC Emergent | $4,984.44 | — |
| Fidelis | Medicare | $14,157.62 | — |
| Aetna | Medicare | $14,440.77 | — |
| UPMC Health Plan | Partners/Select | $14,452.10 | — |
| Wellcare | Medicare Advantage | $14,582.35 | — |
| BCBS of Western NY | Medicare Advantage | $14,865.50 | — |
| United Healthcare | Medicare | $15,148.65 | — |
| Highmark Wholecare (prev Gateway) | Medicare | $15,288.81 | — |
| AmeriHealth Caritas | Medicare | $15,290.23 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $15,290.23 | — |
| Cigna | Medicare | $15,290.23 | — |
| Independent Health | Medicare Advantage | $17,841.43 | — |
| Independent Health | Commercial | $22,326.53 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Fusion of ankle joint open at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $1,972.20 | $609.52 – $2,629.60 |
| Uniontown Hospital | Uniontown | $3,712.67 | $12,443.98 – $28,994.47 |
| UPMC Altoona | Altoona | not published | $580.50 – $13,248.33 |
| UPMC Community Osteopathic | Harrisburg | not published | $783.67 – $23,763.60 |
| UPMC East | Monroeville | not published | $638.55 – $13,493.67 |
| UPMC Memorial | York | not published | $737.24 – $19,740.78 |
| UPMC Passavant-McCandless | Pittsburgh | not published | $638.55 – $13,493.67 |
| UPMC Presbyterian | Pittsburgh | not published | $638.55 – $13,493.67 |