Breast punct aspir cyst, bil at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$924.60
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.
$1,541.00
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.
$46.35 with Highmark Wholecare (prev Gateway) vs $2,103.41 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 | $46.35 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $46.35 | ↓ -95% |
| UPMC Health Plan | Managed Medicaid | $47.45 | ↓ -95% |
| United Healthcare Community Plan for Families | PA Medicaid | $47.81 | ↓ -95% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $49.71 | ↓ -95% |
| Geisinger | Medicaid/CHIP | $53.17 | ↓ -94% |
| PA Health & Wellness | PA Medicaid HMO | $62.20 | ↓ -93% |
| UPMC Work Partners | Workers Comp | $128.01 | ↓ -86% |
| Prime Net | Managed Medicare | $211.12 | ↓ -77% |
| Capital Blue Cross | Medicare Advantage | $308.20 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $308.20 | ↓ -67% |
| UPMC Health Plan | CHIP | $402.19 | ↓ -57% |
| Prime Net | Legacy Commercial | $600.99 | ↓ -35% |
| Prime Net | ACO | $605.61 | ↓ -35% |
| Aetna | ACO | $605.61 | ↓ -35% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $666.34 | ↓ -28% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $666.34 | ↓ -28% |
| Humana | Medicare | $673.07 | ↓ -27% |
| Aetna | Medicare | $702.01 | ↓ -24% |
| Geisinger | Medicare | $706.72 | ↓ -24% |
| Cigna | Medicare | $706.72 | ↓ -24% |
| Prime Net | NonGateKeeper | $716.57 | ↓ -22% |
| United Healthcare | Medicare | $720.18 | ↓ -22% |
| Prime Net | GateKeeper | $721.19 | ↓ -22% |
| Aetna | Commercial | $721.19 | ↓ -22% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $726.92 | ↓ -21% |
| Capital Blue Cross | Commercial | $842.93 | ↓ -9% |
| Keystone Health Plan | Commercial | $842.93 | ↓ -9% |
| Capital Blue Cross | CHIP | $842.93 | ↓ -9% |
| Wellspan Population Health | PPO | $1,001.65 | ↑ +8% |
| Geisinger | Commercial | $1,009.05 | ↑ +9% |
| Keystone Autism Services | ACAP | $1,076.91 | ↑ +16% |
| UPMC Health Plan | Commercial | $1,078.70 | ↑ +17% |
| Prime Net | FH-Medical Rental | $1,165.00 | ↑ +26% |
| Cigna | Commercial | $1,201.98 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,309.85 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $1,893.08 | ↑ +105% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,973.17 | ↑ +113% |
| Highmark BCBS of PA | Commercial | $2,103.41 | ↑ +127% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Breast punct aspir cyst, bil at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $489.00 | $36.50 – $652.00 |
| UPMC Bedford | Everett | $808.20 | $38.33 – $1,212.30 |
| UPMC Community Osteopathic | Harrisburg | $924.60 | $46.35 – $1,309.85 |
| UPMC Hamot | Erie | $543.00 | $40.15 – $975.61 |
| UPMC Northwest | Seneca | $777.00 | $40.15 – $704.33 |
| UPMC Hanover | Hanover | $924.60 | $46.35 – $1,075.42 |
| UPMC Horizon-Greenville | Greenville | $910.20 | $38.33 – $253.13 |
| UPMC Jameson | New Castle | $858.60 | $37.15 – $132.41 |