Biopsy of prostate at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$3,295.80
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.
?
What you pay up front if you don't use insurance.
$5,493.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$113.67 with Highmark Wholecare (prev Gateway) vs $6,124.10 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $113.67 | ↓ -97% |
| UPMC Health Plan | Managed Medicaid | $116.35 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $120.83 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $121.90 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $130.37 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $152.53 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $364.29 | ↓ -89% |
| Prime Net | Managed Medicare | $752.54 | ↓ -77% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -69% |
| Capital Blue Cross | Medicare Advantage | $1,098.60 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $1,098.60 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,940.05 | ↓ -41% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $1,940.05 | ↓ -41% |
| Humana | Medicare | $1,959.65 | ↓ -41% |
| Aetna | Medicare | $2,043.91 | ↓ -38% |
| Cigna | Medicare | $2,057.63 | ↓ -38% |
| Geisinger | Medicare | $2,057.63 | ↓ -38% |
| United Healthcare | Medicare | $2,096.83 | ↓ -36% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2,116.42 | ↓ -36% |
| Prime Net | Legacy Commercial | $2,142.27 | ↓ -35% |
| Prime Net | ACO | $2,158.75 | ↓ -34% |
| Aetna | ACO | $2,158.75 | ↓ -34% |
| UPMC Health Plan | CHIP | $2,316.78 | ↓ -30% |
| Prime Net | NonGateKeeper | $2,554.24 | ↓ -23% |
| Aetna | Commercial | $2,570.72 | ↓ -22% |
| Prime Net | GateKeeper | $2,570.72 | ↓ -22% |
| Keystone Health Plan | Commercial | $3,004.67 | ↓ -9% |
| Capital Blue Cross | Commercial | $3,004.67 | ↓ -9% |
| Capital Blue Cross | CHIP | $3,004.67 | ↓ -9% |
| Keystone Autism Services | ACAP | $3,135.44 | ↓ -5% |
| Wellspan Population Health | PPO | $3,570.45 | ↑ +8% |
| Geisinger | Commercial | $3,596.82 | ↑ +9% |
| UPMC Health Plan | Commercial | $3,845.10 | ↑ +17% |
| Prime Net | FH-Medical Rental | $4,152.71 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $4,669.05 | ↑ +42% |
| Cigna | Commercial | $5,035.00 | ↑ +53% |
| Highmark BCBS of PA | Community Blue PPO | $5,511.71 | ↑ +67% |
| Highmark BCBS of PA | CHIP - Managed Care | $5,744.91 | ↑ +74% |
| Highmark BCBS of PA | Commercial | $6,124.10 | ↑ +86% |
| 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
Biopsy of prostate at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $427.80 | $93.97 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $3,295.80 | $113.67 – $2,316.78 |
| UPMC Hamot | Erie | $3,124.80 | $98.45 – $2,840.52 |
| UPMC Hanover | Hanover | $3,295.80 | $113.67 – $3,131.10 |
| UPMC Jameson | New Castle | $2,635.80 | $98.45 – $2,636.56 |
| UPMC Kane | Kane | $1,848.60 | $98.45 – $1,007.18 |
| UPMC Lititz | Lititz | $3,295.80 | $113.67 – $3,148.02 |
| UPMC Memorial | York | $3,295.80 | $113.67 – $3,142.91 |