Analysis tumor at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$337.20
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.
?
What you pay up front if you don't use insurance.
$562.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$27.03 with United Healthcare Community Plan for Families vs $512.30 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $27.03 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $62.49 | ↓ -81% |
| Prime Net | Managed Medicare | $76.99 | ↓ -77% |
| Highmark Wholecare (prev Gateway) | Medicaid | $79.36 | ↓ -76% |
| UPMC Health Plan | Managed Medicaid | $81.24 | ↓ -76% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $85.11 | ↓ -75% |
| Geisinger | Medicaid/CHIP | $91.02 | ↓ -73% |
| PA Health & Wellness | PA Medicaid HMO | $106.50 | ↓ -68% |
| Keystone Health Plan | Medicare Advantage | $112.40 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $112.40 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $162.29 | ↓ -52% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $162.29 | ↓ -52% |
| Humana | Medicare | $163.93 | ↓ -51% |
| Aetna | Medicare | $170.98 | ↓ -49% |
| Geisinger | Medicare | $172.13 | ↓ -49% |
| Cigna | Medicare | $172.13 | ↓ -49% |
| United Healthcare | Medicare | $175.41 | ↓ -48% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $177.04 | ↓ -47% |
| Cigna | Commercial | $217.68 | ↓ -35% |
| Prime Net | Legacy Commercial | $219.18 | ↓ -35% |
| Aetna | ACO | $220.87 | ↓ -34% |
| Prime Net | ACO | $220.87 | ↓ -34% |
| UPMC Health Plan | CHIP | $246.23 | ↓ -27% |
| Prime Net | NonGateKeeper | $261.33 | ↓ -23% |
| Keystone Autism Services | ACAP | $262.29 | ↓ -22% |
| Prime Net | GateKeeper | $263.02 | ↓ -22% |
| Aetna | Commercial | $263.02 | ↓ -22% |
| Keystone Health Plan | Commercial | $307.41 | ↓ -9% |
| Capital Blue Cross | Commercial | $307.41 | ↓ -9% |
| Capital Blue Cross | CHIP | $307.41 | ↓ -9% |
| Wellspan Population Health | PPO | $365.30 | ↑ +8% |
| Geisinger | Commercial | $368.00 | ↑ +9% |
| UPMC Health Plan | Commercial | $393.40 | ↑ +17% |
| Prime Net | FH-Medical Rental | $424.87 | ↑ +26% |
| Highmark BCBS of PA | Community Blue PPO | $461.07 | ↑ +37% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $477.70 | ↑ +42% |
| Highmark BCBS of PA | CHIP - Managed Care | $480.58 | ↑ +43% |
| Highmark BCBS of PA | Commercial | $512.30 | ↑ +52% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Analysis tumor at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $337.20 | $27.03 – $477.70 |
| UPMC Lititz | Lititz | $337.20 | $27.03 – $263.33 |
| UPMC Somerset | Somerset | $337.20 | $23.72 – $163.37 |