Fna bx w/mr gdn 1st les at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$1,498.20
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.
?
What you pay up front if you don't use insurance.
$2,497.00
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.
$170.48 with Highmark Wholecare (prev Gateway) vs $2,122.45 with Multiplan — 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $170.48 | ↓ -89% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $170.48 | ↓ -89% |
| UPMC Health Plan | Managed Medicaid | $174.51 | ↓ -88% |
| United Healthcare Community Plan for Families | PA Medicaid | $175.85 | ↓ -88% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $182.83 | ↓ -88% |
| Geisinger | Medicaid/CHIP | $195.53 | ↓ -87% |
| PA Health & Wellness | PA Medicaid HMO | $228.77 | ↓ -85% |
| Prime Net | Managed Medicare | $342.09 | ↓ -77% |
| Capital Blue Cross | Medicare Advantage | $499.40 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $499.40 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $666.34 | ↓ -56% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $666.34 | ↓ -56% |
| Humana | Medicare | $673.07 | ↓ -55% |
| Aetna | Medicare | $702.01 | ↓ -53% |
| Geisinger | Medicare | $706.72 | ↓ -53% |
| Cigna | Medicare | $706.72 | ↓ -53% |
| United Healthcare | Medicare | $720.18 | ↓ -52% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $726.92 | ↓ -51% |
| Prime Net | Legacy Commercial | $973.83 | ↓ -35% |
| Aetna | ACO | $981.32 | ↓ -35% |
| Prime Net | ACO | $981.32 | ↓ -35% |
| Keystone Autism Services | ACAP | $1,076.91 | ↓ -28% |
| Prime Net | NonGateKeeper | $1,161.11 | ↓ -22% |
| Prime Net | GateKeeper | $1,168.60 | ↓ -22% |
| Aetna | Commercial | $1,168.60 | ↓ -22% |
| Keystone Health Plan | Commercial | $1,365.86 | ↓ -9% |
| Capital Blue Cross | CHIP | $1,365.86 | ↓ -9% |
| Capital Blue Cross | Commercial | $1,365.86 | ↓ -9% |
| Wellspan Population Health | PPO | $1,623.05 | ↑ +8% |
| Geisinger | Commercial | $1,635.04 | ↑ +9% |
| UPMC Health Plan | Commercial | $1,747.90 | ↑ +17% |
| UPMC Health Plan | CHIP | $1,747.90 | ↑ +17% |
| United Healthcare | Commercial | $1,837.79 | ↑ +23% |
| Prime Net | FH-Medical Rental | $1,887.73 | ↑ +26% |
| Highmark BCBS of PA | Community Blue PPO | $1,893.08 | ↑ +26% |
| Cigna | Commercial | $1,947.66 | ↑ +30% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,973.17 | ↑ +32% |
| Highmark BCBS of PA | Commercial | $2,103.41 | ↑ +40% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $2,122.45 | ↑ +42% |
| Tricare | East Region | not published by hospital | — |
| UPMC Work Partners | Workers Comp | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Fna bx w/mr gdn 1st les at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $559.20 | $76.08 – $745.60 |
| UPMC Bedford | Everett | $1,597.80 | $140.95 – $2,396.70 |
| UPMC Community Osteopathic | Harrisburg | $1,498.20 | $170.48 – $2,122.45 |
| UPMC Hamot | Erie | $543.60 | $76.08 – $975.61 |
| UPMC Hanover | Hanover | $1,498.20 | $170.48 – $1,075.42 |
| UPMC Horizon-Greenville | Greenville | $741.00 | $147.66 – $724.45 |
| UPMC Jameson | New Castle | $858.60 | $77.42 – $905.57 |
| UPMC Lititz | Lititz | $1,498.20 | $170.48 – $1,081.23 |