healthcosts.net
Susceptibility enzyme detection per enzyme at UPMC St. Margaret
815 Freeport Road, Pittsburgh, PA · UPMC · · NPI 1790795359
$55.80
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.
$93.00
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.
$4.10 with UPMC Health Plan vs $79.05 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 | $4.10 | ↓ -93% |
| UPMC Work Partners | Workers Comp | $4.70 | ↓ -92% |
| Aetna of PA | Medicare | $4.99 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicare | $5.13 | ↓ -91% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $5.13 | ↓ -91% |
| Aetna | Medicare | $5.22 | ↓ -91% |
| UPMC Health Plan | Managed Medicaid | $5.78 | ↓ -90% |
| United Healthcare Community Plan for Families | PA CHIP/PA Medicaid | $5.78 | ↓ -90% |
| UPMC Health Plan | Commercial | $6.48 | ↓ -88% |
| Highmark Wholecare (prev Gateway) | Medicaid | $7.79 | ↓ -86% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $8.20 | ↓ -85% |
| PA Health & Wellness | PA Medicaid HMO | $8.95 | ↓ -84% |
| Highmark BCBS of PA | Complete Blue Medicare Advantage/Freedom Blue Medicare Advantage/Security Blue Medicare Advantage | $12.72 | ↓ -77% |
| Highmark BCBS of PA | Managed Care - Social Mission | $22.12 | ↓ -60% |
| Aetna | Neighborhood Network | $23.44 | ↓ -58% |
| Aetna | Home Depot Employer Group | $25.48 | ↓ -54% |
| Aetna | NBR ASO/FI | $26.04 | ↓ -53% |
| Cigna | New Business ASO | $26.04 | ↓ -53% |
| Highmark BCBS of PA | Managed Care | $29.62 | ↓ -47% |
| Aetna | EBR FI | $35.34 | ↓ -37% |
| Highmark BCBS of PA | Commercial - Social Mission Indemnity | $36.82 | ↓ -34% |
| Aetna | EBR ASO | $37.20 | ↓ -33% |
| Cigna | Commercial | $37.20 | ↓ -33% |
| Highmark BCBS of PA | Commercial - Indemnity | $49.32 | ↓ -12% |
| Highmark BCBS of PA | UPMC Emergent | $59.24 | ↑ +6% |
| Coventry/First Health | Commercial | $65.10 | ↑ +17% |
| Private Health Care Systems | PPO | $74.40 | ↑ +33% |
| SelectCare | Commercial | $74.40 | ↑ +33% |
| Humana | Commercial | $79.05 | ↑ +42% |
Visitor-reported prices
Comments
Susceptibility enzyme detection per enzyme at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Passavant-McCandless | Pittsburgh | $68.40 | $4.41 – $96.90 |
| UPMC Mercy | Pittsburgh | $47.40 | $3.96 – $71.10 |
| UPMC Presbyterian | Pittsburgh | $64.80 | $4.70 – $91.80 |
| UPMC Muncy | Muncy | $16.80 | $4.20 – $22.40 |
| UPMC Northwest | Seneca | $78.60 | $4.31 – $111.35 |
| UPMC Somerset | Somerset | $25.80 | $4.70 – $32.25 |
| UPMC Wellsboro | Wellsboro | $20.40 | $4.59 – $22.95 |
| UPMC Williamsport | Williamsport | $16.80 | $4.70 – $22.40 |