Closure laceration vestibule mouth > 2.5 cm cmplx at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$1,663.80
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.
$2,773.00
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.
$60.33 with AmeriHealth Caritas vs $2,357.05 with Multiplan — 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $60.33 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $60.33 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $61.75 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $64.69 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $69.19 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $80.95 | ↓ -95% |
| Prime Net | Managed Medicare | $379.90 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $430.26 | ↓ -74% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $482.29 | ↓ -71% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $482.29 | ↓ -71% |
| Humana | Medicare | $487.16 | ↓ -71% |
| Aetna | Medicare | $508.11 | ↓ -69% |
| Cigna | Medicare | $511.52 | ↓ -69% |
| Geisinger | Medicare | $511.52 | ↓ -69% |
| United Healthcare | Medicare | $521.26 | ↓ -69% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $526.13 | ↓ -68% |
| Keystone Health Plan | Medicare Advantage | $554.60 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $554.60 | ↓ -67% |
| Keystone Autism Services | ACAP | $779.46 | ↓ -53% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -39% |
| Prime Net | Legacy Commercial | $1,081.47 | ↓ -35% |
| Prime Net | ACO | $1,089.79 | ↓ -34% |
| Aetna | ACO | $1,089.79 | ↓ -34% |
| Prime Net | NonGateKeeper | $1,289.44 | ↓ -23% |
| Aetna | Commercial | $1,297.76 | ↓ -22% |
| Prime Net | GateKeeper | $1,297.76 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $1,370.19 | ↓ -18% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,428.16 | ↓ -14% |
| Capital Blue Cross | Commercial | $1,516.83 | ↓ -9% |
| Capital Blue Cross | CHIP | $1,516.83 | ↓ -9% |
| Keystone Health Plan | Commercial | $1,516.83 | ↓ -9% |
| Highmark BCBS of PA | Commercial | $1,522.42 | ↓ -8% |
| UPMC Health Plan | CHIP | $1,714.55 | ↑ +3% |
| Wellspan Population Health | PPO | $1,802.45 | ↑ +8% |
| Geisinger | Commercial | $1,815.76 | ↑ +9% |
| UPMC Health Plan | Commercial | $1,941.10 | ↑ +17% |
| Prime Net | FH-Medical Rental | $2,096.39 | ↑ +26% |
| Cigna | Commercial | $2,162.94 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $2,357.05 | ↑ +42% |
| 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
Closure laceration vestibule mouth > 2.5 cm cmplx at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $1,663.80 | $60.33 – $2,357.05 |
| UPMC East | Monroeville | $3,021.60 | $52.25 – $4,028.80 |
| UPMC Hamot | Erie | $3,143.40 | $52.25 – $706.14 |
| UPMC Hanover | Hanover | $1,663.80 | $60.33 – $1,016.56 |
| UPMC Lititz | Lititz | $1,663.80 | $60.33 – $1,016.56 |
| UPMC Memorial | York | $1,663.80 | $60.33 – $1,016.56 |
| UPMC Mercy | Pittsburgh | $2,393.40 | $52.25 – $545.04 |
| UPMC Passavant-McCandless | Pittsburgh | $2,769.00 | $52.25 – $550.23 |