Bx breast 1st lesion strtctc at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$2,087.40
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.
$3,479.00
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.
$188.34 with Highmark Wholecare (prev Gateway) vs $6,413.00 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 | $188.34 | ↓ -91% |
| UPMC Health Plan | Managed Medicaid | $192.79 | ↓ -91% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $200.21 | ↓ -90% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $201.98 | ↓ -90% |
| Geisinger | Medicaid/CHIP | $216.01 | ↓ -90% |
| PA Health & Wellness | PA Medicaid HMO | $252.73 | ↓ -88% |
| Prime Net | Managed Medicare | $476.62 | ↓ -77% |
| Aetna | Medicare | $574.03 | ↓ -73% |
| Keystone Health Plan | Medicare Advantage | $695.80 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $695.80 | ↓ -67% |
| UPMC Work Partners | Workers Comp | $942.36 | ↓ -55% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -51% |
| Prime Net | Legacy Commercial | $1,356.81 | ↓ -35% |
| Aetna | ACO | $1,367.25 | ↓ -34% |
| Prime Net | ACO | $1,367.25 | ↓ -34% |
| Prime Net | NonGateKeeper | $1,617.73 | ↓ -23% |
| Aetna | Commercial | $1,628.17 | ↓ -22% |
| Prime Net | GateKeeper | $1,628.17 | ↓ -22% |
| Keystone Health Plan | Commercial | $1,903.01 | ↓ -9% |
| Capital Blue Cross | Commercial | $1,903.01 | ↓ -9% |
| Capital Blue Cross | CHIP | $1,903.01 | ↓ -9% |
| UPMC Health Plan | CHIP | $2,131.42 | ↑ +2% |
| Wellspan Population Health | PPO | $2,261.35 | ↑ +8% |
| Geisinger | Commercial | $2,278.05 | ↑ +9% |
| UPMC Health Plan | Commercial | $2,435.30 | ↑ +17% |
| Prime Net | FH-Medical Rental | $2,630.12 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $2,957.15 | ↑ +42% |
| Cigna | Commercial | $6,413.00 | ↑ +207% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
Visitor-reported prices
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Bx breast 1st lesion strtctc at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $2,923.20 | $148.30 – $3,897.60 |
| UPMC Cole | Coudersport | $421.80 | $155.72 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $2,087.40 | $200.21 – $2,957.15 |
| UPMC Hamot | Erie | $7,023.60 | $163.13 – $900.48 |
| UPMC Northwest | Seneca | $5,112.00 | $163.13 – $1,621.93 |
| UPMC Hanover | Hanover | $2,087.40 | $188.34 – $2,476.51 |
| UPMC Horizon-Greenville | Greenville | $4,273.80 | $155.72 – $919.85 |
| UPMC Jameson | New Castle | $4,273.80 | $143.14 – $900.48 |