Consultation pathology during surgery at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$78.60
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.
$131.00
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.
$9.91 with UPMC Health Plan vs $177.57 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 |
|---|---|---|---|
| UPMC Health Plan | CHIP | $9.91 | ↓ -87% |
| Prime Net | Managed Medicare | $17.95 | ↓ -77% |
| Keystone Health Plan | Medicare Advantage | $26.20 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $26.20 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $29.77 | ↓ -62% |
| Highmark Wholecare (prev Gateway) | Medicaid | $37.81 | ↓ -52% |
| UPMC Health Plan | Managed Medicaid | $38.70 | ↓ -51% |
| United Healthcare Community Plan for Families | PA Medicaid | $39.00 | ↓ -50% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $40.55 | ↓ -48% |
| Geisinger | Medicaid/CHIP | $43.36 | ↓ -45% |
| PA Health & Wellness | PA Medicaid HMO | $50.73 | ↓ -35% |
| Prime Net | Legacy Commercial | $51.09 | ↓ -35% |
| Prime Net | ACO | $51.48 | ↓ -35% |
| Aetna | ACO | $51.48 | ↓ -35% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $56.25 | ↓ -28% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $56.25 | ↓ -28% |
| Humana | Medicare | $56.82 | ↓ -28% |
| Aetna | Medicare | $59.26 | ↓ -25% |
| Geisinger | Medicare | $59.66 | ↓ -24% |
| Cigna | Medicare | $59.66 | ↓ -24% |
| United Healthcare | Medicare | $60.80 | ↓ -23% |
| Prime Net | NonGateKeeper | $60.91 | ↓ -23% |
| Prime Net | GateKeeper | $61.31 | ↓ -22% |
| Aetna | Commercial | $61.31 | ↓ -22% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $61.37 | ↓ -22% |
| Capital Blue Cross | Commercial | $71.66 | ↓ -9% |
| Keystone Health Plan | Commercial | $71.66 | ↓ -9% |
| Capital Blue Cross | CHIP | $71.66 | ↓ -9% |
| Wellspan Population Health | PPO | $85.15 | ↑ +8% |
| Geisinger | Commercial | $85.78 | ↑ +9% |
| Keystone Autism Services | ACAP | $90.91 | ↑ +16% |
| UPMC Health Plan | Commercial | $91.70 | ↑ +17% |
| UPMC Work Partners | Workers Comp | $94.72 | ↑ +21% |
| Cigna | Commercial | $98.52 | ↑ +25% |
| Prime Net | FH-Medical Rental | $99.04 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $111.35 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $159.81 | ↑ +103% |
| Highmark BCBS of PA | CHIP - Managed Care | $166.57 | ↑ +112% |
| Highmark BCBS of PA | Commercial | $177.57 | ↑ +126% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Consultation pathology during surgery at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $78.60 | $9.91 – $111.35 |
| UPMC East | Monroeville | $159.60 | $2.73 – $212.80 |
| UPMC Hamot | Erie | $133.80 | $4.95 – $95.98 |
| UPMC Northwest | Seneca | $63.60 | $2.75 – $89.17 |
| UPMC Hanover | Hanover | $78.60 | $9.91 – $93.32 |
| UPMC Jameson | New Castle | $55.80 | $6.11 – $89.17 |
| UPMC Lititz | Lititz | $78.60 | $9.91 – $94.72 |
| UPMC Magee | Pittsburgh | $118.20 | $2.89 – $95.98 |