Exploration of knee joint at UPMC Jameson
1211 Wilmington Avenue, New Castle, PA · UPMC · · NPI 111471575
$4,599.60
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.
$7,666.00
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.
$419.10 with UPMC Health Plan vs $6,746.08 with National Provider Network — 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 | $419.10 | ↓ -91% |
| Aetna | Medicaid | $430.53 | ↓ -91% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $495.34 | ↓ -89% |
| Geisinger | Medicaid/CHIP | $529.55 | ↓ -88% |
| PA Health & Wellness | PA Medicaid HMO | $649.30 | ↓ -86% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $1,029.25 | ↓ -78% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,049.16 | ↓ -77% |
| Cigna | Commercial | $1,339.68 | ↓ -71% |
| UPMC Work Partners | Workers Comp | $1,763.49 | ↓ -62% |
| United Healthcare | Medicare | $3,093.35 | ↓ -33% |
| Humana | Medicare | $3,093.35 | ↓ -33% |
| Aetna of PA | Medicare | $3,093.35 | ↓ -33% |
| UPMC Health Plan | Managed Medicare | $3,223.89 | ↓ -30% |
| UPMC Health Plan | EPO Partners/Partners/Select | $3,230.08 | ↓ -30% |
| UPMC Health Plan | CHIP | $3,251.70 | ↓ -29% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | ↓ -27% |
| Cigna | Medicare | $3,340.82 | ↓ -27% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,340.82 | ↓ -27% |
| AmeriHealth Caritas | Medicare | $3,340.82 | ↓ -27% |
| UPMC Health Plan | Commercial | $3,449.70 | ↓ -25% |
| Occunet | Commercial | $4,176.02 | ↓ -9% |
| United Healthcare | Commercial | $4,493.00 | ↓ -2% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $5,749.50 | ↑ +25% |
| Humana | Commercial | $6,132.80 | ↑ +33% |
| National Provider Network | PPO | $6,746.08 | ↑ +47% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Exploration of knee joint at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $1,357.80 | $400.05 – $1,813.00 |
| UPMC Hamot | Erie | $5,799.00 | $419.10 – $4,499.05 |
| UPMC Horizon-Greenville | Greenville | $4,599.60 | $419.10 – $3,340.82 |
| UPMC Magee | Pittsburgh | $5,046.00 | $419.10 – $3,340.82 |
| UPMC Passavant-McCandless | Pittsburgh | $5,776.80 | $419.10 – $3,402.68 |
| UPMC Presbyterian | Pittsburgh | $8,659.80 | $419.10 – $3,402.68 |
| UPMC St. Margaret | Pittsburgh | $5,891.40 | $419.10 – $3,402.68 |
| UPMC Williamsport | Williamsport | $6,400.80 | $419.10 – $3,309.88 |