Transcath biopsy at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$6,966.60
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.
$11,611.00
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.
$144.78 with Highmark Wholecare (prev Gateway) vs $16,160.52 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 |
|---|---|---|---|
| Highmark Wholecare (prev Gateway) | Medicaid | $144.78 | ↓ -98% |
| UPMC Health Plan | Managed Medicaid | $148.20 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $153.90 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $155.27 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $166.05 | ↓ -98% |
| PA Health & Wellness | PA Medicaid HMO | $194.28 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $559.10 | ↓ -92% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -85% |
| Prime Net | Managed Medicare | $1,590.71 | ↓ -77% |
| Capital Blue Cross | Medicare Advantage | $2,322.20 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $2,322.20 | ↓ -67% |
| UPMC Health Plan | CHIP | $3,161.26 | ↓ -55% |
| Cigna | Commercial | $3,397.00 | ↓ -51% |
| Prime Net | Legacy Commercial | $4,528.29 | ↓ -35% |
| Prime Net | ACO | $4,563.12 | ↓ -35% |
| Aetna | ACO | $4,563.12 | ↓ -35% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $5,119.49 | ↓ -27% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $5,119.49 | ↓ -27% |
| Humana | Medicare | $5,171.20 | ↓ -26% |
| Aetna | Medicare | $5,393.56 | ↓ -23% |
| Prime Net | NonGateKeeper | $5,399.11 | ↓ -23% |
| Cigna | Medicare | $5,429.76 | ↓ -22% |
| Geisinger | Medicare | $5,429.76 | ↓ -22% |
| Prime Net | GateKeeper | $5,433.95 | ↓ -22% |
| Aetna | Commercial | $5,433.95 | ↓ -22% |
| United Healthcare | Medicare | $5,533.18 | ↓ -21% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $5,584.90 | ↓ -20% |
| Keystone Health Plan | Commercial | $6,351.22 | ↓ -9% |
| Capital Blue Cross | CHIP | $6,351.22 | ↓ -9% |
| Capital Blue Cross | Commercial | $6,351.22 | ↓ -9% |
| Wellspan Population Health | PPO | $7,547.15 | ↑ +8% |
| Geisinger | Commercial | $7,602.88 | ↑ +9% |
| UPMC Health Plan | Commercial | $8,127.70 | ↑ +17% |
| Keystone Autism Services | ACAP | $8,273.92 | ↑ +19% |
| Prime Net | FH-Medical Rental | $8,777.92 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $9,869.35 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $14,544.52 | ↑ +109% |
| Highmark BCBS of PA | CHIP - Managed Care | $15,159.89 | ↑ +118% |
| Highmark BCBS of PA | Commercial | $16,160.52 | ↑ +132% |
| 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
Transcath biopsy at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $2,782.80 | $114.00 – $3,710.40 |
| UPMC Community Osteopathic | Harrisburg | $6,966.60 | $153.90 – $9,869.35 |
| UPMC Hanover | Hanover | $6,966.60 | $144.78 – $8,262.51 |
| UPMC Lititz | Lititz | $6,966.60 | $144.78 – $8,307.14 |
| UPMC Magee | Pittsburgh | $7,158.00 | $125.40 – $5,565.99 |
| UPMC Memorial | York | $6,966.60 | $144.78 – $8,293.65 |
| UPMC Mercy | Pittsburgh | $2,978.40 | $125.40 – $5,669.06 |
| UPMC Passavant-McCandless | Pittsburgh | $9,409.80 | $125.40 – $5,669.06 |