Valvuloplasty pulmonary at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$15,019.80
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.
$25,033.00
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 $33,903.02 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 | ↓ -93% |
| UPMC Health Plan | CHIP | $1,677.31 | ↓ -89% |
| UPMC Work Partners | Workers Comp | $2,349.57 | ↓ -84% |
| Prime Net | Managed Medicare | $3,429.52 | ↓ -77% |
| Keystone Health Plan | Medicare Advantage | $5,006.60 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $5,006.60 | ↓ -67% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $5,966.74 | ↓ -60% |
| Prime Net | Legacy Commercial | $9,762.87 | ↓ -35% |
| Aetna | ACO | $9,837.97 | ↓ -34% |
| Prime Net | ACO | $9,837.97 | ↓ -34% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $10,740.13 | ↓ -28% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $10,740.13 | ↓ -28% |
| Humana | Medicare | $10,848.62 | ↓ -28% |
| Aetna | Medicare | $11,315.11 | ↓ -25% |
| Geisinger | Medicare | $11,391.05 | ↓ -24% |
| Cigna | Medicare | $11,391.05 | ↓ -24% |
| United Healthcare | Medicare | $11,608.02 | ↓ -23% |
| Prime Net | NonGateKeeper | $11,640.34 | ↓ -23% |
| Prime Net | GateKeeper | $11,715.44 | ↓ -22% |
| Aetna | Commercial | $11,715.44 | ↓ -22% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $11,716.51 | ↓ -22% |
| Keystone Health Plan | Commercial | $13,693.05 | ↓ -9% |
| Capital Blue Cross | CHIP | $13,693.05 | ↓ -9% |
| Capital Blue Cross | Commercial | $13,693.05 | ↓ -9% |
| Geisinger | Medicaid/CHIP | $13,768.15 | ↓ -8% |
| PA Health & Wellness | PA Medicaid HMO | $13,768.15 | ↓ -8% |
| Wellspan Population Health | PPO | $16,271.45 | ↑ +8% |
| Geisinger | Commercial | $16,391.61 | ↑ +9% |
| Cigna | Commercial | $17,298.00 | ↑ +15% |
| Keystone Autism Services | ACAP | $17,357.79 | ↑ +16% |
| UPMC Health Plan | Commercial | $17,523.10 | ↑ +17% |
| Prime Net | FH-Medical Rental | $18,924.95 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $21,278.05 | ↑ +42% |
| Highmark BCBS of PA | Community Blue PPO | $30,512.83 | ↑ +103% |
| Highmark BCBS of PA | CHIP - Managed Care | $31,803.81 | ↑ +112% |
| Highmark BCBS of PA | Commercial | $33,903.02 | ↑ +126% |
| Tricare | East Region | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
Visitor-reported prices
Comments
Valvuloplasty pulmonary at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $5,455.80 | $790.45 – $11,676.82 |
| UPMC Community Osteopathic | Harrisburg | $15,019.80 | $1,016.56 – $21,278.05 |
| UPMC Hanover | Hanover | $15,019.80 | $1,016.56 – $17,333.84 |
| UPMC Lititz | Lititz | $15,019.80 | $1,016.56 – $17,427.46 |
| UPMC Memorial | York | $15,019.80 | $644.25 – $17,399.15 |
| UPMC Presbyterian | Pittsburgh | $14,880.00 | $797.98 – $11,893.06 |
| UPMC Somerset | Somerset | $15,019.80 | $782.46 – $11,675.74 |