Bx breast add lesion strtctc at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$1,135.20
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.
$1,892.00
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.
$89.38 with Highmark Wholecare (prev Gateway) vs $9,539.00 with Cigna — 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 | $89.38 | ↓ -92% |
| UPMC Health Plan | Managed Medicaid | $91.49 | ↓ -92% |
| United Healthcare Community Plan for Families | PA Medicaid | $92.20 | ↓ -92% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $95.01 | ↓ -92% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $95.86 | ↓ -92% |
| Geisinger | Medicaid/CHIP | $102.52 | ↓ -91% |
| PA Health & Wellness | PA Medicaid HMO | $119.94 | ↓ -89% |
| Prime Net | Managed Medicare | $259.20 | ↓ -77% |
| Aetna | Medicare | $312.18 | ↓ -73% |
| Keystone Health Plan | Medicare Advantage | $378.40 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $378.40 | ↓ -67% |
| Prime Net | Legacy Commercial | $737.88 | ↓ -35% |
| Prime Net | ACO | $743.56 | ↓ -34% |
| Aetna | ACO | $743.56 | ↓ -34% |
| UPMC Work Partners | Workers Comp | $754.53 | ↓ -34% |
| UPMC Health Plan | CHIP | $778.90 | ↓ -31% |
| Prime Net | NonGateKeeper | $879.78 | ↓ -23% |
| Aetna | Commercial | $885.46 | ↓ -22% |
| Prime Net | GateKeeper | $885.46 | ↓ -22% |
| Capital Blue Cross | CHIP | $1,034.92 | ↓ -9% |
| Keystone Health Plan | Commercial | $1,034.92 | ↓ -9% |
| Capital Blue Cross | Commercial | $1,034.92 | ↓ -9% |
| Wellspan Population Health | PPO | $1,229.80 | ↑ +8% |
| Geisinger | Commercial | $1,238.88 | ↑ +9% |
| UPMC Health Plan | Commercial | $1,324.40 | ↑ +17% |
| Prime Net | FH-Medical Rental | $1,430.35 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,608.20 | ↑ +42% |
| Cigna | Commercial | $9,539.00 | ↑ +740% |
| United Healthcare | Commercial | not published by hospital | — |
Visitor-reported prices
Comments
Bx breast add lesion strtctc at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $2,923.20 | $70.38 – $3,897.60 |
| UPMC Cole | Coudersport | $337.80 | $73.90 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $1,135.20 | $92.20 – $1,608.20 |
| UPMC Hamot | Erie | $7,023.60 | $77.42 – $721.00 |
| UPMC Northwest | Seneca | $5,112.00 | $77.42 – $982.57 |
| UPMC Hanover | Hanover | $1,135.20 | $89.38 – $754.53 |
| UPMC Horizon-Greenville | Greenville | $4,273.80 | $73.90 – $736.51 |
| UPMC Jameson | New Castle | $3,612.00 | $72.00 – $721.00 |