Biopsy lower leg soft tissue at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$3,040.80
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.
$5,068.00
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.
$43.81 with Highmark Wholecare (prev Gateway) 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $43.81 | ↓ -99% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $43.81 | ↓ -99% |
| UPMC Health Plan | Managed Medicaid | $44.85 | ↓ -99% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $46.99 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $50.25 | ↓ -98% |
| PA Health & Wellness | PA Medicaid HMO | $58.79 | ↓ -98% |
| UPMC Work Partners | Workers Comp | $247.98 | ↓ -92% |
| Prime Net | Managed Medicare | $694.32 | ↓ -77% |
| Keystone Health Plan | Medicare Advantage | $1,013.60 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $1,013.60 | ↓ -67% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -67% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $1,534.45 | ↓ -50% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,534.45 | ↓ -50% |
| Humana | Medicare | $1,549.95 | ↓ -49% |
| Aetna | Medicare | $1,616.60 | ↓ -47% |
| Cigna | Medicare | $1,627.45 | ↓ -46% |
| Geisinger | Medicare | $1,627.45 | ↓ -46% |
| United Healthcare | Medicare | $1,658.45 | ↓ -45% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,673.95 | ↓ -45% |
| UPMC Health Plan | CHIP | $1,732.02 | ↓ -43% |
| Prime Net | Legacy Commercial | $1,976.52 | ↓ -35% |
| Aetna | ACO | $1,991.72 | ↓ -35% |
| Prime Net | ACO | $1,991.72 | ↓ -35% |
| Prime Net | NonGateKeeper | $2,356.62 | ↓ -23% |
| Aetna | Commercial | $2,371.82 | ↓ -22% |
| Prime Net | GateKeeper | $2,371.82 | ↓ -22% |
| Keystone Autism Services | ACAP | $2,479.92 | ↓ -18% |
| Capital Blue Cross | CHIP | $2,772.20 | ↓ -9% |
| Keystone Health Plan | Commercial | $2,772.20 | ↓ -9% |
| Capital Blue Cross | Commercial | $2,772.20 | ↓ -9% |
| Wellspan Population Health | PPO | $3,294.20 | ↑ +8% |
| Geisinger | Commercial | $3,318.53 | ↑ +9% |
| UPMC Health Plan | Commercial | $3,547.60 | ↑ +17% |
| Prime Net | FH-Medical Rental | $3,831.41 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $4,307.80 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $4,359.39 | ↑ +43% |
| Highmark BCBS of PA | CHIP - Managed Care | $4,543.83 | ↑ +49% |
| Highmark BCBS of PA | Commercial | $4,843.75 | ↑ +59% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy lower leg soft tissue at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Presbyterian | Pittsburgh | $4,485.00 | $37.95 – $1,699.17 |
| UPMC St. Margaret | Pittsburgh | $3,128.40 | $37.95 – $550.23 |
| Uniontown Hospital | Uniontown | $2,392.00 | $37.95 – $3,324.90 |
| UPMC Cole | Coudersport | not published | $36.23 – $1,732.02 |