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Fragmenting of kidney stone at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
not published by hospital
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.
not published by hospital
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.
$316.87 with Highmark Wholecare (prev Gateway) vs $16,693.00 with Cigna — 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 | $316.87 | — |
| UPMC Health Plan | Managed Medicaid | $324.35 | — |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $336.82 | — |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $339.82 | — |
| Geisinger | Medicaid/CHIP | $363.42 | — |
| PA Health & Wellness | PA Medicaid HMO | $425.20 | — |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | — |
| UPMC Work Partners | Workers Comp | $1,947.66 | — |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $3,266.36 | — |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $3,266.36 | — |
| Humana | Medicare | $3,299.35 | — |
| Aetna | Medicare | $3,441.22 | — |
| Cigna | Medicare | $3,464.32 | — |
| Geisinger | Medicare | $3,464.32 | — |
| United Healthcare | Medicare | $3,530.30 | — |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,563.30 | — |
| UPMC Health Plan | CHIP | $5,149.59 | — |
| Keystone Autism Services | ACAP | $5,278.96 | — |
| Highmark BCBS of PA | Community Blue PPO | $9,279.75 | — |
| Highmark BCBS of PA | CHIP - Managed Care | $9,672.37 | — |
| Highmark BCBS of PA | Commercial | $10,310.80 | — |
| Cigna | Commercial | $16,693.00 | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
Visitor-reported prices
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Fragmenting of kidney stone at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Presbyterian | Pittsburgh | $9,055.80 | $274.45 – $12,829.05 |
| UPMC Altoona | Altoona | not published | $249.50 – $3,551.23 |
| UPMC Northwest | Seneca | not published | $274.45 – $3,452.59 |
| UPMC Muncy | Muncy | not published | $274.45 – $2,140.86 |
| UPMC Wellsboro | Wellsboro | not published | $274.45 – $1,861.10 |