healthcosts.net
Antibody bacterium, not elsewhere specified at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$138.00
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.
$230.00
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.
$11.12 with UPMC Health Plan vs $195.50 with Humana — 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 Medicare | $11.12 | ↓ -92% |
| UPMC Work Partners | Workers Comp | $12.73 | ↓ -91% |
| Aetna of PA | Medicare | $13.52 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicare | $13.91 | ↓ -90% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $13.91 | ↓ -90% |
| Aetna | Medicare | $14.17 | ↓ -90% |
| UPMC Health Plan | Commercial | $30.63 | ↓ -78% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $35.37 | ↓ -74% |
| Aetna | Neighborhood Network | $57.96 | ↓ -58% |
| Highmark BCBS of PA | Managed Care - Social Mission | $61.49 | ↓ -55% |
| Aetna | Home Depot Employer Group | $63.02 | ↓ -54% |
| Aetna | NBR ASO/FI | $64.40 | ↓ -53% |
| Cigna | New Business ASO | $64.40 | ↓ -53% |
| Highmark BCBS of PA | Managed Care | $82.35 | ↓ -40% |
| Aetna | EBR FI | $87.40 | ↓ -37% |
| Aetna | EBR ASO | $92.00 | ↓ -33% |
| Cigna | Commercial | $92.00 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $102.38 | ↓ -26% |
| PA Health & Wellness | PA Medicaid HMO | $126.50 | ↓ -8% |
| Highmark BCBS of PA | Commercial - Indemnity | $137.11 | ↓ -1% |
| Coventry/First Health | Commercial | $161.00 | ↑ +17% |
| Highmark BCBS of PA | UPMC Emergent | $164.70 | ↑ +19% |
| Private Health Care Systems | PPO | $184.00 | ↑ +33% |
| SelectCare | Commercial | $184.00 | ↑ +33% |
| Humana | Commercial | $195.50 | ↑ +42% |
Visitor-reported prices
Comments
Antibody bacterium, not elsewhere specified at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $76.80 | $11.97 – $108.80 |
| UPMC Mercy | Pittsburgh | $136.20 | $10.74 – $204.30 |
| UPMC Presbyterian | Pittsburgh | $285.00 | $9.43 – $403.75 |
| UPMC Muncy | Muncy | $36.60 | $9.15 – $48.80 |
| UPMC Northwest | Seneca | $119.40 | $11.68 – $169.15 |
| UPMC Somerset | Somerset | $72.00 | $9.04 – $90.00 |
| UPMC Wellsboro | Wellsboro | $44.20 | $9.95 – $49.73 |
| UPMC Williamsport | Williamsport | $36.60 | $10.06 – $48.80 |