Exc/pilonidal cyst/sinus/simple 11770 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$5,229.00
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.
?
What you pay up front if you don't use insurance.
$8,715.00
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.
?
The hospital's undiscounted list price — almost no one pays this.
$192.37 with AmeriHealth Caritas vs $8,556.18 with Highmark BCBS of PA — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 | $192.37 | ↓ -96% |
| Highmark Wholecare (prev Gateway) | Medicaid | $192.37 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $196.91 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $206.30 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $220.63 | ↓ -96% |
| PA Health & Wellness | PA Medicaid HMO | $258.14 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $736.35 | ↓ -86% |
| United Healthcare Community Plan for Families | PA Medicaid | $903.90 | ↓ -83% |
| Prime Net | Managed Medicare | $1,193.95 | ↓ -77% |
| Keystone Health Plan | Medicare Advantage | $1,743.00 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $1,743.00 | ↓ -67% |
| UPMC Health Plan | CHIP | $2,636.14 | ↓ -50% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $2,710.51 | ↓ -48% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $2,710.51 | ↓ -48% |
| Humana | Medicare | $2,737.89 | ↓ -48% |
| Aetna | Medicare | $2,855.62 | ↓ -45% |
| Cigna | Medicare | $2,874.78 | ↓ -45% |
| Geisinger | Medicare | $2,874.78 | ↓ -45% |
| United Healthcare | Medicare | $2,929.54 | ↓ -44% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $2,956.92 | ↓ -43% |
| Prime Net | Legacy Commercial | $3,398.85 | ↓ -35% |
| Prime Net | ACO | $3,424.99 | ↓ -35% |
| Aetna | ACO | $3,424.99 | ↓ -35% |
| Prime Net | NonGateKeeper | $4,052.47 | ↓ -23% |
| Aetna | Commercial | $4,078.62 | ↓ -22% |
| Prime Net | GateKeeper | $4,078.62 | ↓ -22% |
| Keystone Autism Services | ACAP | $4,380.62 | ↓ -16% |
| Keystone Health Plan | Commercial | $4,767.10 | ↓ -9% |
| Capital Blue Cross | Commercial | $4,767.10 | ↓ -9% |
| Capital Blue Cross | CHIP | $4,767.10 | ↓ -9% |
| Wellspan Population Health | PPO | $5,664.75 | ↑ +8% |
| Geisinger | Commercial | $5,706.58 | ↑ +9% |
| UPMC Health Plan | Commercial | $6,100.50 | ↑ +17% |
| Cigna | Commercial | $6,413.00 | ↑ +23% |
| United Healthcare | Commercial | $6,414.24 | ↑ +23% |
| Prime Net | FH-Medical Rental | $6,588.54 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $7,407.75 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $7,700.59 | ↑ +47% |
| Highmark BCBS of PA | CHIP - Managed Care | $8,026.40 | ↑ +53% |
| Highmark BCBS of PA | Commercial | $8,556.18 | ↑ +64% |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Exc/pilonidal cyst/sinus/simple 11770 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Community Osteopathic | Harrisburg | $480.60 | $204.48 – $5,805.45 |
| UPMC Northwest | Seneca | $5,481.60 | $166.62 – $2,865.05 |
| UPMC Hanover | Hanover | $5,229.00 | $192.37 – $4,374.59 |
| UPMC Lititz | Lititz | $5,229.00 | $192.37 – $4,398.21 |
| UPMC Magee | Pittsburgh | $3,669.60 | $166.62 – $2,946.91 |
| UPMC Muncy | Muncy | $7,126.80 | $166.62 – $883.20 |
| UPMC Passavant-McCandless | Pittsburgh | $4,251.00 | $166.62 – $3,001.48 |
| UPMC Presbyterian | Pittsburgh | $4,440.60 | $166.62 – $3,001.48 |