Aco cont gluc mnt phys/qhp eqp 95250aco at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$390.00
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.
$650.00
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.
$89.05 with Prime Net vs $558.00 with United Healthcare — 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 |
|---|---|---|---|
| Prime Net | Managed Medicare | $89.05 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $100.89 | ↓ -74% |
| Highmark Wholecare (prev Gateway) | Medicaid | $112.09 | ↓ -71% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $112.09 | ↓ -71% |
| UPMC Health Plan | Managed Medicaid | $114.74 | ↓ -71% |
| United Healthcare Community Plan for Families | PA Medicaid | $115.62 | ↓ -70% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $120.21 | ↓ -69% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $122.05 | ↓ -69% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $122.05 | ↓ -69% |
| Humana | Medicare | $123.28 | ↓ -68% |
| Geisinger | Medicaid/CHIP | $128.56 | ↓ -67% |
| Aetna | Medicare | $128.58 | ↓ -67% |
| Geisinger | Medicare | $129.44 | ↓ -67% |
| Cigna | Medicare | $129.44 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $130.00 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $130.00 | ↓ -67% |
| United Healthcare | Medicare | $131.91 | ↓ -66% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $133.14 | ↓ -66% |
| PA Health & Wellness | PA Medicaid HMO | $150.41 | ↓ -61% |
| Keystone Autism Services | ACAP | $197.25 | ↓ -49% |
| Prime Net | Legacy Commercial | $253.50 | ↓ -35% |
| UPMC Health Plan | CHIP | $255.25 | ↓ -35% |
| Prime Net | ACO | $255.45 | ↓ -35% |
| Aetna | ACO | $255.45 | ↓ -35% |
| Prime Net | NonGateKeeper | $302.25 | ↓ -23% |
| Aetna | Commercial | $304.20 | ↓ -22% |
| Prime Net | GateKeeper | $304.20 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $346.74 | ↓ -11% |
| Capital Blue Cross | Commercial | $355.55 | ↓ -9% |
| Capital Blue Cross | CHIP | $355.55 | ↓ -9% |
| Keystone Health Plan | Commercial | $355.55 | ↓ -9% |
| Highmark BCBS of PA | CHIP - Managed Care | $361.41 | ↓ -7% |
| Highmark BCBS of PA | Commercial | $385.26 | ↓ -1% |
| Wellspan Population Health | PPO | $422.50 | ↑ +8% |
| Geisinger | Commercial | $425.62 | ↑ +9% |
| UPMC Health Plan | Commercial | $455.00 | ↑ +17% |
| Prime Net | FH-Medical Rental | $491.40 | ↑ +26% |
| Cigna | Commercial | $507.00 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $552.50 | ↑ +42% |
| United Healthcare | Commercial | $558.00 | ↑ +43% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Aco cont gluc mnt phys/qhp eqp 95250aco at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $805.20 | $88.26 – $1,073.60 |
| UPMC Cole | Coudersport | $467.40 | $92.67 – $623.20 |
| UPMC Community Osteopathic | Harrisburg | $390.00 | $100.89 – $552.50 |
| UPMC Hamot | Erie | $611.40 | $96.41 – $333.90 |
| UPMC Hanover | Hanover | $390.00 | $100.89 – $196.98 |
| UPMC Lititz | Lititz | $390.00 | $100.89 – $198.03 |
| UPMC Magee | Pittsburgh | $658.80 | $96.41 – $150.41 |
| UPMC Memorial | York | $390.00 | $90.75 – $197.71 |