Benign lesion paring 4+ at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$435.60
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.
$726.00
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.
$49.45 with AmeriHealth Caritas vs $1,016.56 with United Healthcare Community Plan for Families — 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $49.45 | ↓ -89% |
| Highmark Wholecare (prev Gateway) | Medicaid | $49.45 | ↓ -89% |
| UPMC Health Plan | Managed Medicaid | $50.62 | ↓ -88% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $53.04 | ↓ -88% |
| Geisinger | Medicaid/CHIP | $56.72 | ↓ -87% |
| UPMC Work Partners | Workers Comp | $65.19 | ↓ -85% |
| PA Health & Wellness | PA Medicaid HMO | $66.36 | ↓ -85% |
| Prime Net | Managed Medicare | $99.46 | ↓ -77% |
| Capital Blue Cross | Medicare Advantage | $145.20 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $145.20 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $188.18 | ↓ -57% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $188.18 | ↓ -57% |
| Humana | Medicare | $190.08 | ↓ -56% |
| Aetna | Medicare | $198.25 | ↓ -54% |
| Geisinger | Medicare | $199.58 | ↓ -54% |
| Cigna | Medicare | $199.58 | ↓ -54% |
| United Healthcare | Medicare | $203.39 | ↓ -53% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $205.29 | ↓ -53% |
| Prime Net | Legacy Commercial | $283.14 | ↓ -35% |
| Aetna | ACO | $285.32 | ↓ -34% |
| Prime Net | ACO | $285.32 | ↓ -34% |
| Keystone Autism Services | ACAP | $304.13 | ↓ -30% |
| Prime Net | NonGateKeeper | $337.59 | ↓ -23% |
| Prime Net | GateKeeper | $339.77 | ↓ -22% |
| Aetna | Commercial | $339.77 | ↓ -22% |
| Capital Blue Cross | Commercial | $397.12 | ↓ -9% |
| Capital Blue Cross | CHIP | $397.12 | ↓ -9% |
| Keystone Health Plan | Commercial | $397.12 | ↓ -9% |
| UPMC Health Plan | CHIP | $420.50 | ↓ -3% |
| Wellspan Population Health | PPO | $471.90 | ↑ +8% |
| Geisinger | Commercial | $475.38 | ↑ +9% |
| UPMC Health Plan | Commercial | $508.20 | ↑ +17% |
| Highmark BCBS of PA | Community Blue PPO | $534.62 | ↑ +23% |
| Prime Net | FH-Medical Rental | $548.86 | ↑ +26% |
| Highmark BCBS of PA | CHIP - Managed Care | $557.24 | ↑ +28% |
| Cigna | Commercial | $566.28 | ↑ +30% |
| Highmark BCBS of PA | Commercial | $594.02 | ↑ +36% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $617.10 | ↑ +42% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↑ +133% |
| United Healthcare | Commercial | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Benign lesion paring 4+ at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $671.40 | $38.94 – $895.20 |
| UPMC Cole | Coudersport | $210.60 | $13.58 – $2,094.25 |
| UPMC Community Osteopathic | Harrisburg | $435.60 | $49.45 – $1,016.56 |
| UPMC Hanover | Hanover | $435.60 | $49.45 – $1,016.56 |
| UPMC Jameson | New Castle | $479.40 | $42.83 – $892.40 |
| UPMC Kane | Kane | $141.00 | $42.83 – $373.29 |
| UPMC Lititz | Lititz | $435.60 | $49.45 – $1,016.56 |
| UPMC McKeesport | Mckeesport | $436.20 | $42.83 – $208.38 |