Breast reconstruction 19357 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
not published by hospital
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.
not published by hospital
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.
$1,016.56 with United Healthcare Community Plan for Families vs $52,012.95 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | — |
| UPMC Work Partners | Workers Comp | $2,955.68 | — |
| UPMC Health Plan | CHIP | $3,889.82 | — |
| Cigna | Commercial | $7,801.00 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $9,153.99 | — |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $16,477.17 | — |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $16,477.17 | — |
| Humana | Medicare | $16,643.61 | — |
| Aetna | Medicare | $17,359.29 | — |
| Geisinger | Medicare | $17,475.79 | — |
| Cigna | Medicare | $17,475.79 | — |
| United Healthcare | Medicare | $17,808.66 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $17,975.10 | — |
| Keystone Autism Services | ACAP | $26,629.78 | — |
| Highmark BCBS of PA | Community Blue PPO | $46,811.82 | — |
| Highmark BCBS of PA | CHIP - Managed Care | $48,792.41 | — |
| Highmark BCBS of PA | Commercial | $52,012.95 | — |
| 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
Breast reconstruction 19357 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| Uniontown Hospital | Uniontown | $9,526.00 | $205.80 – $27,743.09 |
| UPMC Altoona | Altoona | not published | $1,232.68 – $17,914.22 |
| UPMC Community Osteopathic | Harrisburg | not published | $1,016.56 – $18,483.56 |
| UPMC Hamot | Erie | not published | $1,232.68 – $24,124.95 |
| UPMC Lititz | Lititz | not published | $1,016.56 – $26,736.67 |
| UPMC Magee | Pittsburgh | not published | $1,244.42 – $18,245.96 |
| UPMC Memorial | York | not published | $1,004.69 – $26,693.25 |
| UPMC Presbyterian | Pittsburgh | not published | $931.20 – $18,245.96 |