Whfo nontorsion joint prefab at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$349.80
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.
$583.00
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.
$116.60 with Highmark Wholecare (prev Gateway) vs $2,082.35 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 Wholecare (prev Gateway) | Medicaid | $116.60 | ↓ -67% |
| Aetna | Medicare | $145.75 | ↓ -58% |
| Aetna | Neighborhood Network | $146.92 | ↓ -58% |
| Aetna | Home Depot Employer Group | $159.74 | ↓ -54% |
| Aetna | NBR ASO/FI | $163.24 | ↓ -53% |
| Cigna | New Business ASO | $163.24 | ↓ -53% |
| Aetna | EBR FI | $221.54 | ↓ -37% |
| Aetna | EBR ASO | $233.20 | ↓ -33% |
| Cigna | Commercial | $233.20 | ↓ -33% |
| UPMC Work Partners | Workers Comp | $233.39 | ↓ -33% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $269.99 | ↓ -23% |
| Highmark Wholecare (prev Gateway) | Medicare | $291.50 | ↓ -17% |
| PA Health & Wellness | PA Medicaid HMO | $320.65 | ↓ -8% |
| Coventry/First Health | Commercial | $408.10 | ↑ +17% |
| Private Health Care Systems | PPO | $466.40 | ↑ +33% |
| SelectCare | Commercial | $466.40 | ↑ +33% |
| Humana | Commercial | $495.55 | ↑ +42% |
| Highmark BCBS of PA | Managed Care - Social Mission | $777.46 | ↑ +122% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $781.44 | ↑ +123% |
| UPMC Health Plan | Commercial | $987.59 | ↑ +182% |
| Highmark BCBS of PA | Managed Care | $1,041.17 | ↑ +198% |
| Highmark BCBS of PA | Commercial - Indemnity | $1,046.57 | ↑ +199% |
| Highmark BCBS of PA | UPMC Emergent | $2,082.35 | ↑ +495% |
Visitor-reported prices
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Whfo nontorsion joint prefab at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Magee | Pittsburgh | $165.60 | $106.49 – $804.83 |
| UPMC Mercy | Pittsburgh | $176.40 | $233.39 – $635.53 |
| UPMC Passavant-McCandless | Pittsburgh | $381.60 | $233.39 – $1,167.91 |
| UPMC Presbyterian | Pittsburgh | $354.00 | $138.12 – $1,301.27 |
| 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 |