Exploration of knee joint at UPMC Magee
300 Halket Street, Pittsburgh, PA · UPMC · · NPI 1952311508
$5,046.00
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.
$8,410.00
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 $7,737.20 with Multiplan — 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 | ↓ -92% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $419.10 | ↓ -92% |
| Aetna | CHIP/Medicaid | $495.30 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $565.02 | ↓ -89% |
| Geisinger | Medicaid/CHIP | $593.10 | ↓ -88% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $602.89 | ↓ -88% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $649.30 | ↓ -87% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $1,040.78 | ↓ -79% |
| UPMC Work Partners | Workers Comp | $1,897.74 | ↓ -62% |
| UPMC Health Plan | Commercial | $2,013.26 | ↓ -60% |
| UPMC Health Plan | Managed Medicare | $2,895.07 | ↓ -43% |
| Highmark BCBS of PA | Managed Care - Social Mission | $3,011.09 | ↓ -40% |
| Aetna | Neighborhood Network | $3,027.60 | ↓ -40% |
| UPMC Health Plan | Partners/Select | $3,173.16 | ↓ -37% |
| Aetna of PA | Medicare | $3,248.02 | ↓ -36% |
| UPMC Health Plan | CHIP | $3,251.70 | ↓ -36% |
| Aetna | EBR FI | $3,279.90 | ↓ -35% |
| Aetna | Home Depot Employer Group | $3,296.72 | ↓ -35% |
| Highmark Wholecare (prev Gateway) | Medicare | $3,340.51 | ↓ -34% |
| AmeriHealth Caritas | Medicare | $3,340.82 | ↓ -34% |
| United Healthcare | Medicare | $3,340.82 | ↓ -34% |
| Cigna | New Business ASO | $3,364.00 | ↓ -33% |
| Aetna | EBR ASO | $3,364.00 | ↓ -33% |
| Aetna | NBR ASO/FI | $3,364.00 | ↓ -33% |
| Cigna | Commercial | $3,364.00 | ↓ -33% |
| Aetna | Medicare | $3,402.68 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $3,491.13 | ↓ -31% |
| Highmark BCBS of PA | Managed Care | $4,032.40 | ↓ -20% |
| InterGroup | PPO | $4,205.00 | ↓ -17% |
| Highmark BCBS of PA | Commercial - Indemnity | $4,675.39 | ↓ -7% |
| Coventry/First Health | Commercial | $5,887.00 | ↑ +17% |
| Highmark BCBS of PA | UPMC Emergent | $6,048.63 | ↑ +20% |
| Preferred Healthcare System | PPO | $6,728.00 | ↑ +33% |
| Private Health Care Systems | PPO | $7,148.50 | ↑ +42% |
| Humana | Commercial | $7,148.50 | ↑ +42% |
| Multiplan | PPO | $7,737.20 | ↑ +53% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Exploration of knee joint at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| 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 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 Jameson | New Castle | $4,599.60 | $419.10 – $4,176.02 |
| UPMC Williamsport | Williamsport | $6,400.80 | $419.10 – $3,309.88 |