Whfo nontorsion joint prefab at UPMC Mercy
1400 Locust Street, Pittsburgh, PA · UPMC · · NPI 163914308
$176.40
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.
$294.00
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.
$70.56 with Highmark Wholecare (prev Gateway) vs $804.83 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $70.56 | ↓ -60% |
| Aetna | Medicare | $73.50 | ↓ -58% |
| Aetna | Neighborhood Network | $82.03 | ↓ -53% |
| Aetna | Home Depot Employer Group | $89.52 | ↓ -49% |
| Aetna | NBR ASO/FI | $91.14 | ↓ -48% |
| Cigna | New Business ASO | $99.96 | ↓ -43% |
| Aetna | EBR FI | $111.72 | ↓ -37% |
| Aetna | EBR ASO | $117.60 | ↓ -33% |
| Cigna | Commercial | $117.60 | ↓ -33% |
| Coventry/First Health | Commercial | $129.36 | ↓ -27% |
| InterGroup | PPO | $147.00 | ↓ -17% |
| Highmark Wholecare (prev Gateway) | Medicare | $147.00 | ↓ -17% |
| PA Health & Wellness | Community Health Choices/PA Medicaid HMO | $161.70 | ↓ -8% |
| Cigna Behavioral Health | Commercial | $176.40 | ↑ +0% |
| Private Health Care Systems | PPO | $220.50 | ↑ +25% |
| UPMC Work Partners | Workers Comp | $233.39 | ↑ +32% |
| InterGroup | Approved National Affiliated PPO Business | $235.20 | ↑ +33% |
| American Healthcare Group | Commercial | $235.20 | ↑ +33% |
| National Provider Network | PPO | $241.08 | ↑ +37% |
| Multiplan | PPO (inc. Auto and Worker's Compensation) | $264.60 | ↑ +50% |
| Health Payors Organization | Commercial | $264.60 | ↑ +50% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $267.44 | ↑ +52% |
| Highmark BCBS of PA | Managed Care - Social Mission | $403.90 | ↑ +129% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $411.24 | ↑ +133% |
| Highmark BCBS of PA | Managed Care | $540.87 | ↑ +207% |
| Highmark BCBS of PA | Commercial - Indemnity | $550.69 | ↑ +212% |
| UPMC Health Plan | Commercial | $635.53 | ↑ +260% |
| UPMC Health Plan | CHIP | $804.83 | ↑ +356% |
| Bravo | Medicare | not published by hospital | — |
Visitor-reported prices
Comments
Whfo nontorsion joint prefab at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | $165.60 | $106.49 – $804.83 |
| UPMC Passavant-McCandless | Pittsburgh | $381.60 | $233.39 – $1,167.91 |
| UPMC Presbyterian | Pittsburgh | $354.00 | $138.12 – $1,301.27 |
| UPMC St. Margaret | Pittsburgh | $349.80 | $233.39 – $987.59 |
| UPMC Altoona | Altoona | $159.00 | $50.35 – $804.83 |
| UPMC Bedford | Everett | $585.60 | $180.12 – $853.20 |
| UPMC Cole | Coudersport | $670.80 | $212.42 – $894.40 |
| UPMC East | Monroeville | $201.60 | $16.72 – $804.83 |