Biliary endo perq dx w/speci at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$9,768.60
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.
$16,281.00
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.
$294.75 with United Healthcare Community Plan for Families vs $18,653.94 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $294.75 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $755.07 | ↓ -92% |
| Prime Net | Managed Medicare | $2,230.50 | ↓ -77% |
| UPMC Health Plan | CHIP | $2,299.08 | ↓ -76% |
| Keystone Health Plan | Medicare Advantage | $3,256.20 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $3,256.20 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $3,282.99 | ↓ -66% |
| Cigna | Commercial | $5,035.00 | ↓ -48% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $5,909.38 | ↓ -40% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $5,909.38 | ↓ -40% |
| Humana | Medicare | $5,969.07 | ↓ -39% |
| Aetna | Medicare | $6,225.74 | ↓ -36% |
| Geisinger | Medicare | $6,267.52 | ↓ -36% |
| Cigna | Medicare | $6,267.52 | ↓ -36% |
| Prime Net | Legacy Commercial | $6,349.59 | ↓ -35% |
| United Healthcare | Medicare | $6,386.90 | ↓ -35% |
| Prime Net | ACO | $6,398.43 | ↓ -35% |
| Aetna | ACO | $6,398.43 | ↓ -35% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $6,446.60 | ↓ -34% |
| Prime Net | NonGateKeeper | $7,570.66 | ↓ -23% |
| Prime Net | GateKeeper | $7,619.51 | ↓ -22% |
| Aetna | Commercial | $7,619.51 | ↓ -22% |
| Keystone Health Plan | Commercial | $8,905.71 | ↓ -9% |
| Capital Blue Cross | CHIP | $8,905.71 | ↓ -9% |
| Capital Blue Cross | Commercial | $8,905.71 | ↓ -9% |
| Geisinger | Medicaid/CHIP | $8,954.55 | ↓ -8% |
| PA Health & Wellness | PA Medicaid HMO | $8,954.55 | ↓ -8% |
| Keystone Autism Services | ACAP | $9,550.51 | ↓ -2% |
| Wellspan Population Health | PPO | $10,582.65 | ↑ +8% |
| Geisinger | Commercial | $10,660.80 | ↑ +9% |
| UPMC Health Plan | Commercial | $11,396.70 | ↑ +17% |
| Prime Net | FH-Medical Rental | $12,308.44 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $13,838.85 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $16,788.61 | ↑ +72% |
| Highmark BCBS of PA | CHIP - Managed Care | $17,498.93 | ↑ +79% |
| Highmark BCBS of PA | Commercial | $18,653.94 | ↑ +91% |
| Tricare | East Region | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Biliary endo perq dx w/speci at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $9,768.60 | $294.75 – $13,838.85 |
| UPMC Hamot | Erie | $4,193.40 | $729.80 – $7,414.98 |
| UPMC Hanover | Hanover | $9,768.60 | $294.75 – $9,537.33 |
| UPMC Lititz | Lititz | $9,768.60 | $294.75 – $9,588.85 |
| UPMC Memorial | York | $9,768.60 | $294.75 – $9,573.28 |
| UPMC Mercy | Pittsburgh | $4,037.40 | $596.00 – $6,543.73 |
| UPMC Somerset | Somerset | $9,768.60 | $258.75 – $6,424.16 |