Dch validity tests at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$25.20
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.
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What you pay up front if you don't use insurance.
$42.00
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.
$3.45 with Highmark BCBS of PA vs $35.70 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 |
|---|---|---|---|
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $3.45 | ↓ -86% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $3.45 | ↓ -86% |
| Humana | Medicare | $3.48 | ↓ -86% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $3.57 | ↓ -86% |
| UPMC Work Partners | Workers Comp | $3.60 | ↓ -86% |
| Aetna | Medicare | $3.63 | ↓ -86% |
| Geisinger | Medicare | $3.65 | ↓ -86% |
| Cigna | Medicare | $3.65 | ↓ -86% |
| United Healthcare | Medicare | $3.72 | ↓ -85% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3.76 | ↓ -85% |
| Highmark Wholecare (prev Gateway) | Medicaid | $4.53 | ↓ -82% |
| UPMC Health Plan | Managed Medicaid | $4.64 | ↓ -82% |
| United Healthcare Community Plan for Families | PA Medicaid | $4.68 | ↓ -81% |
| United Healthcare | Commercial | $4.70 | ↓ -81% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $4.86 | ↓ -81% |
| Geisinger | Medicaid/CHIP | $5.20 | ↓ -79% |
| Keystone Autism Services | ACAP | $5.57 | ↓ -78% |
| Prime Net | Managed Medicare | $5.75 | ↓ -77% |
| PA Health & Wellness | PA Medicaid HMO | $6.08 | ↓ -76% |
| Keystone Health Plan | Medicare Advantage | $8.40 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $8.40 | ↓ -67% |
| Cigna | Commercial | $9.04 | ↓ -64% |
| Highmark BCBS of PA | Community Blue PPO | $9.79 | ↓ -61% |
| Highmark BCBS of PA | CHIP - Managed Care | $10.20 | ↓ -60% |
| Highmark BCBS of PA | Commercial | $10.88 | ↓ -57% |
| Prime Net | Legacy Commercial | $16.38 | ↓ -35% |
| Prime Net | ACO | $16.51 | ↓ -34% |
| Aetna | ACO | $16.51 | ↓ -34% |
| Prime Net | NonGateKeeper | $19.53 | ↓ -23% |
| Aetna | Commercial | $19.66 | ↓ -22% |
| Prime Net | GateKeeper | $19.66 | ↓ -22% |
| Capital Blue Cross | CHIP | $22.97 | ↓ -9% |
| Keystone Health Plan | Commercial | $22.97 | ↓ -9% |
| Capital Blue Cross | Commercial | $22.97 | ↓ -9% |
| UPMC Health Plan | CHIP | $26.26 | ↑ +4% |
| Wellspan Population Health | PPO | $27.30 | ↑ +8% |
| Geisinger | Commercial | $27.50 | ↑ +9% |
| UPMC Health Plan | Commercial | $29.40 | ↑ +17% |
| Prime Net | FH-Medical Rental | $31.75 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $35.70 | ↑ +42% |
Visitor-reported prices
Comments
Dch validity tests at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $18.60 | $3.44 – $24.80 |
| UPMC Bedford | Everett | $37.20 | $1.26 – $55.80 |
| UPMC Cole | Coudersport | $19.80 | $2.26 – $26.40 |
| UPMC Community Osteopathic | Harrisburg | $25.20 | $2.40 – $26.26 |
| UPMC East | Monroeville | $53.40 | $3.44 – $71.20 |
| UPMC Hamot | Erie | $19.80 | $3.44 – $6.95 |
| UPMC Northwest | Seneca | $18.60 | $3.16 – $4.11 |
| UPMC Hanover | Hanover | $25.20 | $3.45 – $5.57 |