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Drainage of kidney lesion at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$2,461.20
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.
$4,102.00
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.
$116.27 with Highmark Wholecare (prev Gateway) vs $3,486.70 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 Wholecare (prev Gateway) | Medicaid | $116.27 | ↓ -95% |
| UPMC Health Plan | Managed Medicaid | $119.02 | ↓ -95% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $123.59 | ↓ -95% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $124.69 | ↓ -95% |
| Geisinger | Medicaid/CHIP | $133.35 | ↓ -95% |
| PA Health & Wellness | PA Medicaid HMO | $156.02 | ↓ -94% |
| UPMC Work Partners | Workers Comp | $481.71 | ↓ -80% |
| Prime Net | Managed Medicare | $561.97 | ↓ -77% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $666.34 | ↓ -73% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $666.34 | ↓ -73% |
| Humana | Medicare | $673.07 | ↓ -73% |
| Aetna | Medicare | $702.01 | ↓ -71% |
| Cigna | Medicare | $706.72 | ↓ -71% |
| Geisinger | Medicare | $706.72 | ↓ -71% |
| United Healthcare | Medicare | $720.18 | ↓ -71% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $726.92 | ↓ -70% |
| Capital Blue Cross | Medicare Advantage | $820.40 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $820.40 | ↓ -67% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -59% |
| Keystone Autism Services | ACAP | $1,076.91 | ↓ -56% |
| Prime Net | Legacy Commercial | $1,599.78 | ↓ -35% |
| Aetna | ACO | $1,612.09 | ↓ -34% |
| Prime Net | ACO | $1,612.09 | ↓ -34% |
| UPMC Health Plan | CHIP | $1,712.54 | ↓ -30% |
| Highmark BCBS of PA | Community Blue PPO | $1,893.08 | ↓ -23% |
| Prime Net | NonGateKeeper | $1,907.43 | ↓ -23% |
| Aetna | Commercial | $1,919.74 | ↓ -22% |
| Prime Net | GateKeeper | $1,919.74 | ↓ -22% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,973.17 | ↓ -20% |
| Highmark BCBS of PA | Commercial | $2,103.41 | ↓ -15% |
| Capital Blue Cross | CHIP | $2,243.79 | ↓ -9% |
| Keystone Health Plan | Commercial | $2,243.79 | ↓ -9% |
| Capital Blue Cross | Commercial | $2,243.79 | ↓ -9% |
| Wellspan Population Health | PPO | $2,666.30 | ↑ +8% |
| Geisinger | Commercial | $2,685.99 | ↑ +9% |
| UPMC Health Plan | Commercial | $2,871.40 | ↑ +17% |
| Prime Net | FH-Medical Rental | $3,101.11 | ↑ +26% |
| Cigna | Commercial | $3,397.00 | ↑ +38% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $3,486.70 | ↑ +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
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Drainage of kidney lesion at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,225.20 | $91.55 – $1,633.60 |
| UPMC Northwest | Seneca | $2,056.80 | $100.70 – $2,913.80 |
| UPMC Mercy | Pittsburgh | $2,552.40 | $100.70 – $3,828.60 |
| UPMC Muncy | Muncy | $1,119.00 | $100.70 – $1,492.00 |
| UPMC Presbyterian | Pittsburgh | $3,367.20 | $100.70 – $4,770.20 |
| UPMC Somerset | Somerset | $2,461.20 | $100.70 – $3,076.50 |
| UPMC St. Margaret | Pittsburgh | $2,583.00 | $100.70 – $3,659.25 |
| UPMC Wellsboro | Wellsboro | $1,352.80 | $100.70 – $1,521.90 |