Biopsy, bone open deep at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$8,070.00
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.
$13,450.00
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.
$286.38 with Highmark Wholecare (prev Gateway) vs $11,432.50 with Multiplan — 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $286.38 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $286.38 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $293.15 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $307.13 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $328.46 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $384.30 | ↓ -95% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -87% |
| UPMC Work Partners | Workers Comp | $1,089.74 | ↓ -86% |
| Prime Net | Managed Medicare | $1,842.65 | ↓ -77% |
| UPMC Health Plan | CHIP | $2,637.66 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $2,690.00 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $2,690.00 | ↓ -67% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $2,710.51 | ↓ -66% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $2,710.51 | ↓ -66% |
| Humana | Medicare | $2,737.89 | ↓ -66% |
| Aetna | Medicare | $2,855.62 | ↓ -65% |
| Geisinger | Medicare | $2,874.78 | ↓ -64% |
| Cigna | Medicare | $2,874.78 | ↓ -64% |
| United Healthcare | Medicare | $2,929.54 | ↓ -64% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2,956.92 | ↓ -63% |
| Keystone Autism Services | ACAP | $4,380.62 | ↓ -46% |
| Prime Net | Legacy Commercial | $5,245.50 | ↓ -35% |
| Aetna | ACO | $5,285.85 | ↓ -35% |
| Prime Net | ACO | $5,285.85 | ↓ -35% |
| Prime Net | NonGateKeeper | $6,254.25 | ↓ -23% |
| Aetna | Commercial | $6,294.60 | ↓ -22% |
| Prime Net | GateKeeper | $6,294.60 | ↓ -22% |
| Keystone Health Plan | Commercial | $7,357.15 | ↓ -9% |
| Capital Blue Cross | CHIP | $7,357.15 | ↓ -9% |
| Capital Blue Cross | Commercial | $7,357.15 | ↓ -9% |
| Highmark BCBS of PA | Community Blue PPO | $7,700.59 | ↓ -5% |
| Highmark BCBS of PA | CHIP - Managed Care | $8,026.40 | ↓ -1% |
| Highmark BCBS of PA | Commercial | $8,556.18 | ↑ +6% |
| Wellspan Population Health | PPO | $8,742.50 | ↑ +8% |
| Geisinger | Commercial | $8,807.06 | ↑ +9% |
| UPMC Health Plan | Commercial | $9,415.00 | ↑ +17% |
| Prime Net | FH-Medical Rental | $10,168.20 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $11,432.50 | ↑ +42% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy, bone open deep at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $5,397.60 | $225.50 – $7,196.80 |
| UPMC Cole | Coudersport | $1,188.60 | $236.78 – $1,533.60 |
| UPMC Hamot | Erie | $4,663.20 | $248.05 – $3,968.58 |
| UPMC Hanover | Hanover | $8,070.00 | $286.38 – $4,374.59 |
| UPMC Magee | Pittsburgh | $3,961.20 | $248.05 – $2,946.91 |
| UPMC Mercy | Pittsburgh | $3,819.60 | $248.05 – $3,001.48 |
| UPMC Passavant-McCandless | Pittsburgh | $4,321.20 | $248.05 – $3,001.48 |
| UPMC Community Osteopathic | Harrisburg | not published | $304.43 – $5,805.45 |