Adh-sendout at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$123.00
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.
$205.00
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.
$28.09 with Prime Net vs $275.69 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 |
|---|---|---|---|
| Prime Net | Managed Medicare | $28.09 | ↓ -77% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $33.60 | ↓ -73% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $33.60 | ↓ -73% |
| Humana | Medicare | $33.94 | ↓ -72% |
| UPMC Work Partners | Workers Comp | $35.10 | ↓ -71% |
| Aetna | Medicare | $35.40 | ↓ -71% |
| Geisinger | Medicare | $35.64 | ↓ -71% |
| Cigna | Medicare | $35.64 | ↓ -71% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $36.00 | ↓ -71% |
| United Healthcare | Medicare | $36.32 | ↓ -70% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $36.66 | ↓ -70% |
| Capital Blue Cross | Medicare Advantage | $41.00 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $41.00 | ↓ -67% |
| Highmark Wholecare (prev Gateway) | Medicaid | $45.72 | ↓ -63% |
| UPMC Health Plan | Managed Medicaid | $46.80 | ↓ -62% |
| United Healthcare Community Plan for Families | PA Medicaid | $47.16 | ↓ -62% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $49.03 | ↓ -60% |
| United Healthcare | Commercial | $52.34 | ↓ -57% |
| Geisinger | Medicaid/CHIP | $52.44 | ↓ -57% |
| Keystone Autism Services | ACAP | $54.30 | ↓ -56% |
| PA Health & Wellness | PA Medicaid HMO | $61.35 | ↓ -50% |
| Prime Net | Legacy Commercial | $79.95 | ↓ -35% |
| Aetna | ACO | $80.56 | ↓ -35% |
| Prime Net | ACO | $80.56 | ↓ -35% |
| Cigna | Commercial | $88.24 | ↓ -28% |
| Prime Net | NonGateKeeper | $95.33 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $95.46 | ↓ -22% |
| Aetna | Commercial | $95.94 | ↓ -22% |
| Prime Net | GateKeeper | $95.94 | ↓ -22% |
| Highmark BCBS of PA | CHIP - Managed Care | $99.50 | ↓ -19% |
| Highmark BCBS of PA | Commercial | $106.07 | ↓ -14% |
| Capital Blue Cross | CHIP | $112.14 | ↓ -9% |
| Capital Blue Cross | Commercial | $112.14 | ↓ -9% |
| Keystone Health Plan | Commercial | $112.14 | ↓ -9% |
| Wellspan Population Health | PPO | $133.25 | ↑ +8% |
| Geisinger | Commercial | $134.23 | ↑ +9% |
| UPMC Health Plan | Commercial | $143.50 | ↑ +17% |
| Prime Net | FH-Medical Rental | $154.98 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $174.25 | ↑ +42% |
| UPMC Health Plan | CHIP | $275.69 | ↑ +124% |
Visitor-reported prices
Comments
Adh-sendout at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $123.00 | $33.60 – $275.69 |
| UPMC Hamot | Erie | $430.80 | $33.54 – $92.25 |
| UPMC Northwest | Seneca | $236.40 | $30.78 – $41.40 |
| UPMC Hanover | Hanover | $123.00 | $33.60 – $54.30 |
| UPMC Horizon-Greenville | Greenville | $322.80 | $30.39 – $63.69 |
| UPMC Kane | Kane | $201.60 | $33.54 – $146.49 |
| UPMC Lititz | Lititz | $123.00 | $33.60 – $54.30 |
| UPMC Magee | Pittsburgh | $321.00 | $31.76 – $93.13 |