Control oropharyngeal hemorr/simp 42960 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$1,349.40
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.
$2,249.00
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.
$100.97 with AmeriHealth Caritas vs $1,911.65 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 | $100.97 | ↓ -93% |
| Highmark Wholecare (prev Gateway) | Medicaid | $100.97 | ↓ -93% |
| UPMC Health Plan | Managed Medicaid | $103.35 | ↓ -92% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $108.28 | ↓ -92% |
| Geisinger | Medicaid/CHIP | $115.80 | ↓ -91% |
| PA Health & Wellness | PA Medicaid HMO | $135.48 | ↓ -90% |
| Prime Net | Managed Medicare | $308.11 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $330.29 | ↓ -76% |
| Capital Blue Cross | Medicare Advantage | $449.80 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $449.80 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $482.29 | ↓ -64% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $482.29 | ↓ -64% |
| Humana | Medicare | $487.16 | ↓ -64% |
| Aetna | Medicare | $508.11 | ↓ -62% |
| Cigna | Medicare | $511.52 | ↓ -62% |
| Geisinger | Medicare | $511.52 | ↓ -62% |
| United Healthcare | Medicare | $521.26 | ↓ -61% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $526.13 | ↓ -61% |
| Keystone Autism Services | ACAP | $779.46 | ↓ -42% |
| Prime Net | Legacy Commercial | $877.11 | ↓ -35% |
| Aetna | ACO | $883.86 | ↓ -34% |
| Prime Net | ACO | $883.86 | ↓ -34% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -25% |
| Prime Net | NonGateKeeper | $1,045.79 | ↓ -22% |
| Prime Net | GateKeeper | $1,052.53 | ↓ -22% |
| Aetna | Commercial | $1,052.53 | ↓ -22% |
| Keystone Health Plan | Commercial | $1,230.20 | ↓ -9% |
| Capital Blue Cross | Commercial | $1,230.20 | ↓ -9% |
| Capital Blue Cross | CHIP | $1,230.20 | ↓ -9% |
| Highmark BCBS of PA | Community Blue PPO | $1,370.19 | ↑ +2% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,428.16 | ↑ +6% |
| Wellspan Population Health | PPO | $1,461.85 | ↑ +8% |
| Geisinger | Commercial | $1,472.65 | ↑ +9% |
| Highmark BCBS of PA | Commercial | $1,522.42 | ↑ +13% |
| UPMC Health Plan | Commercial | $1,574.30 | ↑ +17% |
| Prime Net | FH-Medical Rental | $1,700.24 | ↑ +26% |
| UPMC Health Plan | CHIP | $1,732.81 | ↑ +28% |
| Cigna | Commercial | $1,754.22 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,911.65 | ↑ +42% |
| United Healthcare | Commercial | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Control oropharyngeal hemorr/simp 42960 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $3,378.00 | $79.50 – $4,504.00 |
| UPMC Cole | Coudersport | $1,266.00 | $83.47 – $771.51 |
| UPMC Community Osteopathic | Harrisburg | $1,349.40 | $100.97 – $1,911.65 |
| UPMC East | Monroeville | $2,857.80 | $87.45 – $3,810.40 |
| UPMC Hamot | Erie | $3,191.40 | $87.45 – $706.14 |
| UPMC Hanover | Hanover | $1,349.40 | $100.97 – $1,016.56 |
| UPMC Lititz | Lititz | $1,349.40 | $100.97 – $1,016.56 |
| UPMC Magee | Pittsburgh | $3,502.20 | $87.45 – $550.23 |