Rerepair ing hernia blocked at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$5,185.20
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.
$8,642.00
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.
$1,016.56 with United Healthcare Community Plan for Families vs $18,653.94 with Highmark BCBS of PA — 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 |
|---|---|---|---|
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -80% |
| Prime Net | Managed Medicare | $1,183.95 | ↓ -77% |
| UPMC Work Partners | Workers Comp | $1,474.79 | ↓ -72% |
| Keystone Health Plan | Medicare Advantage | $1,728.40 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $1,728.40 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $3,282.99 | ↓ -37% |
| Prime Net | Legacy Commercial | $3,370.38 | ↓ -35% |
| Aetna | ACO | $3,396.31 | ↓ -34% |
| Prime Net | ACO | $3,396.31 | ↓ -34% |
| Prime Net | NonGateKeeper | $4,018.53 | ↓ -23% |
| Prime Net | GateKeeper | $4,044.46 | ↓ -22% |
| Aetna | Commercial | $4,044.46 | ↓ -22% |
| Keystone Health Plan | Commercial | $4,727.17 | ↓ -9% |
| Capital Blue Cross | Commercial | $4,727.17 | ↓ -9% |
| Capital Blue Cross | CHIP | $4,727.17 | ↓ -9% |
| Geisinger | Medicaid/CHIP | $4,753.10 | ↓ -8% |
| PA Health & Wellness | PA Medicaid HMO | $4,753.10 | ↓ -8% |
| UPMC Health Plan | CHIP | $5,151.89 | ↓ -1% |
| Wellspan Population Health | PPO | $5,617.30 | ↑ +8% |
| Geisinger | Commercial | $5,658.78 | ↑ +9% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $5,909.38 | ↑ +14% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $5,909.38 | ↑ +14% |
| Humana | Medicare | $5,969.07 | ↑ +15% |
| UPMC Health Plan | Commercial | $6,049.40 | ↑ +17% |
| Aetna | Medicare | $6,225.74 | ↑ +20% |
| Geisinger | Medicare | $6,267.52 | ↑ +21% |
| Cigna | Medicare | $6,267.52 | ↑ +21% |
| United Healthcare | Medicare | $6,386.90 | ↑ +23% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $6,446.60 | ↑ +24% |
| Prime Net | FH-Medical Rental | $6,533.35 | ↑ +26% |
| Cigna | Commercial | $6,740.76 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $7,345.70 | ↑ +42% |
| Keystone Autism Services | ACAP | $9,550.51 | ↑ +84% |
| Highmark BCBS of PA | Community Blue PPO | $16,788.61 | ↑ +224% |
| Highmark BCBS of PA | CHIP - Managed Care | $17,498.93 | ↑ +237% |
| Highmark BCBS of PA | Commercial | $18,653.94 | ↑ +260% |
| United Healthcare | Commercial | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Rerepair ing hernia blocked at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $1,417.80 | $655.02 – $2,325.85 |
| UPMC Community Osteopathic | Harrisburg | $5,185.20 | $1,016.56 – $7,345.70 |
| UPMC Hanover | Hanover | $5,185.20 | $1,016.56 – $9,537.33 |
| UPMC Lititz | Lititz | $5,185.20 | $1,016.56 – $9,588.85 |
| UPMC Memorial | York | $5,185.20 | $1,016.56 – $9,573.28 |
| UPMC Somerset | Somerset | $5,185.20 | $892.40 – $6,424.16 |
| Uniontown Hospital | Uniontown | $2,740.00 | $205.80 – $13,032.74 |
| UPMC Hamot | Erie | not published | $1,519.03 – $7,414.98 |