Biopsy abdominal mass at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$2,461.20
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.
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What you pay up front if you don't use insurance.
$4,102.00
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.
$102.83 with AmeriHealth Caritas vs $4,843.75 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $102.83 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $102.83 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $105.26 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $110.28 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $117.94 | ↓ -95% |
| PA Health & Wellness | PA Medicaid HMO | $137.99 | ↓ -94% |
| Prime Net | Managed Medicare | $561.97 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $681.20 | ↓ -72% |
| Keystone Health Plan | Medicare Advantage | $820.40 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $820.40 | ↓ -67% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -59% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,534.45 | ↓ -38% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $1,534.45 | ↓ -38% |
| Humana | Medicare | $1,549.95 | ↓ -37% |
| Prime Net | Legacy Commercial | $1,599.78 | ↓ -35% |
| Prime Net | ACO | $1,612.09 | ↓ -34% |
| Aetna | ACO | $1,612.09 | ↓ -34% |
| Aetna | Medicare | $1,616.60 | ↓ -34% |
| Cigna | Medicare | $1,627.45 | ↓ -34% |
| Geisinger | Medicare | $1,627.45 | ↓ -34% |
| United Healthcare | Medicare | $1,658.45 | ↓ -33% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,673.95 | ↓ -32% |
| UPMC Health Plan | CHIP | $1,714.50 | ↓ -30% |
| Prime Net | NonGateKeeper | $1,907.43 | ↓ -23% |
| Aetna | Commercial | $1,919.74 | ↓ -22% |
| Prime Net | GateKeeper | $1,919.74 | ↓ -22% |
| United Healthcare | Commercial | $2,128.94 | ↓ -13% |
| Capital Blue Cross | CHIP | $2,243.79 | ↓ -9% |
| Keystone Health Plan | Commercial | $2,243.79 | ↓ -9% |
| Capital Blue Cross | Commercial | $2,243.79 | ↓ -9% |
| Keystone Autism Services | ACAP | $2,479.92 | ↑ +1% |
| Wellspan Population Health | PPO | $2,666.30 | ↑ +8% |
| Geisinger | Commercial | $2,685.99 | ↑ +9% |
| UPMC Health Plan | Commercial | $2,871.40 | ↑ +17% |
| Prime Net | FH-Medical Rental | $3,101.11 | ↑ +26% |
| Cigna | Commercial | $3,199.56 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $3,486.70 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $4,359.39 | ↑ +77% |
| Highmark BCBS of PA | CHIP - Managed Care | $4,543.83 | ↑ +85% |
| Highmark BCBS of PA | Commercial | $4,843.75 | ↑ +97% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
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Biopsy abdominal mass at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,224.60 | $80.97 – $1,632.80 |
| UPMC Community Osteopathic | Harrisburg | $2,461.20 | $102.83 – $3,486.70 |
| UPMC East | Monroeville | $1,689.60 | $89.07 – $2,252.80 |
| UPMC Hamot | Erie | $2,312.40 | $89.07 – $2,246.66 |
| UPMC Northwest | Seneca | $2,419.20 | $89.07 – $1,621.93 |
| UPMC Hanover | Hanover | $2,461.20 | $102.83 – $2,476.51 |
| UPMC Horizon-Greenville | Greenville | $2,304.60 | $89.07 – $1,668.28 |
| UPMC Jameson | New Castle | $2,304.60 | $89.07 – $2,085.34 |