Biopsy of salivary gland 42400 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$2,198.40
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.
$3,664.00
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.
$44.45 with Highmark Wholecare (prev Gateway) vs $3,397.00 with Cigna — 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 | $44.45 | ↓ -98% |
| UPMC Health Plan | Managed Medicaid | $45.50 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $47.25 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $47.67 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $50.98 | ↓ -98% |
| PA Health & Wellness | PA Medicaid HMO | $59.65 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $160.57 | ↓ -93% |
| UPMC Health Plan | CHIP | $400.74 | ↓ -82% |
| Prime Net | Managed Medicare | $501.97 | ↓ -77% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $666.34 | ↓ -70% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $666.34 | ↓ -70% |
| Humana | Medicare | $673.07 | ↓ -69% |
| Aetna | Medicare | $702.01 | ↓ -68% |
| Cigna | Medicare | $706.72 | ↓ -68% |
| Geisinger | Medicare | $706.72 | ↓ -68% |
| United Healthcare | Medicare | $720.18 | ↓ -67% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $726.92 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $732.80 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $732.80 | ↓ -67% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -54% |
| Keystone Autism Services | ACAP | $1,076.91 | ↓ -51% |
| Prime Net | Legacy Commercial | $1,428.96 | ↓ -35% |
| Prime Net | ACO | $1,439.95 | ↓ -35% |
| Aetna | ACO | $1,439.95 | ↓ -35% |
| Prime Net | NonGateKeeper | $1,703.76 | ↓ -23% |
| Prime Net | GateKeeper | $1,714.75 | ↓ -22% |
| Aetna | Commercial | $1,714.75 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $1,893.08 | ↓ -14% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,973.17 | ↓ -10% |
| Capital Blue Cross | Commercial | $2,004.21 | ↓ -9% |
| Capital Blue Cross | CHIP | $2,004.21 | ↓ -9% |
| Keystone Health Plan | Commercial | $2,004.21 | ↓ -9% |
| Highmark BCBS of PA | Commercial | $2,103.41 | ↓ -4% |
| Wellspan Population Health | PPO | $2,381.60 | ↑ +8% |
| Geisinger | Commercial | $2,399.19 | ↑ +9% |
| UPMC Health Plan | Commercial | $2,564.80 | ↑ +17% |
| Prime Net | FH-Medical Rental | $2,769.98 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $3,114.40 | ↑ +42% |
| Cigna | Commercial | $3,397.00 | ↑ +55% |
| United Healthcare | Commercial | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Biopsy of salivary gland 42400 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $730.20 | $35.00 – $973.60 |
| UPMC Cole | Coudersport | $117.00 | $36.75 – $2,325.85 |
| UPMC Community Osteopathic | Harrisburg | $2,198.40 | $47.25 – $3,114.40 |
| UPMC Hanover | Hanover | $2,198.40 | $44.45 – $1,075.42 |
| UPMC Jameson | New Castle | $738.00 | $38.50 – $905.57 |
| UPMC Lititz | Lititz | $2,198.40 | $44.45 – $1,081.23 |
| UPMC Memorial | York | $2,198.40 | $44.45 – $1,079.47 |
| UPMC Muncy | Muncy | $971.40 | $38.50 – $993.28 |