Complx repair fccmnaxghf 13131 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$911.40
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.
$1,519.00
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.
$90.17 with AmeriHealth Caritas vs $2,315.26 with UPMC Health Plan — 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 |
|---|---|---|---|
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $90.17 | ↓ -90% |
| Highmark Wholecare (prev Gateway) | Medicaid | $90.17 | ↓ -90% |
| UPMC Health Plan | Managed Medicaid | $92.30 | ↓ -90% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $96.70 | ↓ -89% |
| Geisinger | Medicaid/CHIP | $103.42 | ↓ -89% |
| PA Health & Wellness | PA Medicaid HMO | $121.00 | ↓ -87% |
| Prime Net | Managed Medicare | $208.10 | ↓ -77% |
| Capital Blue Cross | Medicare Advantage | $303.80 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $303.80 | ↓ -67% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $378.38 | ↓ -58% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $378.38 | ↓ -58% |
| Humana | Medicare | $382.20 | ↓ -58% |
| Aetna | Medicare | $398.63 | ↓ -56% |
| Cigna | Medicare | $401.31 | ↓ -56% |
| Geisinger | Medicare | $401.31 | ↓ -56% |
| United Healthcare | Medicare | $408.95 | ↓ -55% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $412.78 | ↓ -55% |
| UPMC Work Partners | Workers Comp | $469.02 | ↓ -49% |
| Prime Net | Legacy Commercial | $592.41 | ↓ -35% |
| Aetna | ACO | $596.97 | ↓ -34% |
| Prime Net | ACO | $596.97 | ↓ -34% |
| Keystone Autism Services | ACAP | $611.52 | ↓ -33% |
| Prime Net | NonGateKeeper | $706.34 | ↓ -22% |
| Aetna | Commercial | $710.89 | ↓ -22% |
| Prime Net | GateKeeper | $710.89 | ↓ -22% |
| Capital Blue Cross | CHIP | $830.89 | ↓ -9% |
| Capital Blue Cross | Commercial | $830.89 | ↓ -9% |
| Keystone Health Plan | Commercial | $830.89 | ↓ -9% |
| Wellspan Population Health | PPO | $987.35 | ↑ +8% |
| Geisinger | Commercial | $994.64 | ↑ +9% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↑ +12% |
| UPMC Health Plan | Commercial | $1,063.30 | ↑ +17% |
| Highmark BCBS of PA | Community Blue PPO | $1,074.98 | ↑ +18% |
| Highmark BCBS of PA | CHIP - Managed Care | $1,120.46 | ↑ +23% |
| Prime Net | FH-Medical Rental | $1,148.36 | ↑ +26% |
| Cigna | Commercial | $1,184.82 | ↑ +30% |
| Highmark BCBS of PA | Commercial | $1,194.41 | ↑ +31% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,291.15 | ↑ +42% |
| UPMC Health Plan | CHIP | $2,315.26 | ↑ +154% |
| 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
Complx repair fccmnaxghf 13131 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,440.60 | $71.00 – $1,920.80 |
| UPMC Bedford | Everett | $4,893.00 | $74.55 – $7,339.50 |
| UPMC Cole | Coudersport | $1,693.20 | $74.55 – $1,041.88 |
| UPMC Community Osteopathic | Harrisburg | $911.40 | $90.17 – $2,315.26 |
| UPMC East | Monroeville | $3,824.40 | $78.10 – $5,099.20 |
| UPMC Hamot | Erie | $3,123.00 | $78.10 – $729.80 |
| UPMC Northwest | Seneca | $2,186.40 | $78.10 – $479.78 |
| UPMC Hanover | Hanover | $911.40 | $90.17 – $1,016.56 |