healthcosts.net
Avul nail plate addl at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$370.80
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.
?
What you pay up front if you don't use insurance.
$618.00
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.
$32.70 with AmeriHealth Caritas vs $525.30 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $32.70 | ↓ -91% |
| Highmark Wholecare (prev Gateway) | Medicaid | $32.70 | ↓ -91% |
| UPMC Health Plan | Managed Medicaid | $33.48 | ↓ -91% |
| United Healthcare Community Plan for Families | PA Medicaid | $33.73 | ↓ -91% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $35.07 | ↓ -91% |
| Geisinger | Medicaid/CHIP | $37.51 | ↓ -90% |
| PA Health & Wellness | PA Medicaid HMO | $43.88 | ↓ -88% |
| UPMC Work Partners | Workers Comp | $60.73 | ↓ -84% |
| Prime Net | Managed Medicare | $84.67 | ↓ -77% |
| Aetna | Medicare | $101.97 | ↓ -73% |
| Keystone Health Plan | Medicare Advantage | $123.60 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $123.60 | ↓ -67% |
| Prime Net | Legacy Commercial | $241.02 | ↓ -35% |
| Prime Net | ACO | $242.87 | ↓ -35% |
| Aetna | ACO | $242.87 | ↓ -35% |
| UPMC Health Plan | CHIP | $283.08 | ↓ -24% |
| Prime Net | NonGateKeeper | $287.37 | ↓ -23% |
| Aetna | Commercial | $289.22 | ↓ -22% |
| Prime Net | GateKeeper | $289.22 | ↓ -22% |
| Keystone Health Plan | Commercial | $338.05 | ↓ -9% |
| Capital Blue Cross | Commercial | $338.05 | ↓ -9% |
| Capital Blue Cross | CHIP | $338.05 | ↓ -9% |
| Wellspan Population Health | PPO | $401.70 | ↑ +8% |
| Geisinger | Commercial | $404.67 | ↑ +9% |
| UPMC Health Plan | Commercial | $432.60 | ↑ +17% |
| Prime Net | FH-Medical Rental | $467.21 | ↑ +26% |
| Cigna | Commercial | $482.04 | ↑ +30% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $525.30 | ↑ +42% |
| United Healthcare | Commercial | not published by hospital | — |
Visitor-reported prices
Comments
Avul nail plate addl at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Bedford | Everett | $622.20 | $27.04 – $933.30 |
| UPMC Northwest | Seneca | $571.80 | $28.32 – $810.05 |
| UPMC Mercy | Pittsburgh | $388.20 | $28.32 – $582.30 |
| UPMC Muncy | Muncy | $114.00 | $28.32 – $152.00 |
| UPMC Passavant-McCandless | Pittsburgh | $357.00 | $28.32 – $505.75 |
| UPMC Presbyterian | Pittsburgh | $456.60 | $28.32 – $646.85 |
| UPMC Somerset | Somerset | $370.80 | $28.32 – $463.50 |
| UPMC Wellsboro | Wellsboro | $31.20 | $5.04 – $58.03 |