Incision of foot fascia at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$4,272.00
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.
$7,120.00
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.
$173.35 with Highmark Wholecare (prev Gateway) vs $9,699.87 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 | $173.35 | ↓ -96% |
| UPMC Health Plan | Managed Medicaid | $177.45 | ↓ -96% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $184.28 | ↓ -96% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $185.91 | ↓ -96% |
| Geisinger | Medicaid/CHIP | $198.83 | ↓ -95% |
| PA Health & Wellness | PA Medicaid HMO | $232.62 | ↓ -95% |
| UPMC Work Partners | Workers Comp | $781.74 | ↓ -82% |
| Prime Net | Managed Medicare | $975.44 | ↓ -77% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,163.28 | ↓ -73% |
| Capital Blue Cross | Medicare Advantage | $1,424.00 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $1,424.00 | ↓ -67% |
| UPMC Health Plan | CHIP | $2,637.54 | ↓ -38% |
| Prime Net | Legacy Commercial | $2,776.80 | ↓ -35% |
| Prime Net | ACO | $2,798.16 | ↓ -35% |
| Aetna | ACO | $2,798.16 | ↓ -35% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $3,072.82 | ↓ -28% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $3,072.82 | ↓ -28% |
| Humana | Medicare | $3,103.86 | ↓ -27% |
| Aetna | Medicare | $3,237.33 | ↓ -24% |
| Geisinger | Medicare | $3,259.05 | ↓ -24% |
| Cigna | Medicare | $3,259.05 | ↓ -24% |
| Prime Net | NonGateKeeper | $3,310.80 | ↓ -23% |
| United Healthcare | Medicare | $3,321.13 | ↓ -22% |
| Prime Net | GateKeeper | $3,332.16 | ↓ -22% |
| Aetna | Commercial | $3,332.16 | ↓ -22% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $3,352.17 | ↓ -22% |
| Capital Blue Cross | Commercial | $3,894.64 | ↓ -9% |
| Keystone Health Plan | Commercial | $3,894.64 | ↓ -9% |
| Capital Blue Cross | CHIP | $3,894.64 | ↓ -9% |
| Wellspan Population Health | PPO | $4,628.00 | ↑ +8% |
| Geisinger | Commercial | $4,662.18 | ↑ +9% |
| Keystone Autism Services | ACAP | $4,966.18 | ↑ +16% |
| UPMC Health Plan | Commercial | $4,984.00 | ↑ +17% |
| Prime Net | FH-Medical Rental | $5,382.72 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $6,052.00 | ↑ +42% |
| Cigna | Commercial | $6,413.00 | ↑ +50% |
| Highmark BCBS of PA | Community Blue PPO | $8,729.92 | ↑ +104% |
| Highmark BCBS of PA | CHIP - Managed Care | $9,099.28 | ↑ +113% |
| Highmark BCBS of PA | Commercial | $9,699.87 | ↑ +127% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| United Healthcare | Commercial | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
Comments
Incision of foot fascia at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Cole | Coudersport | $557.40 | $143.32 – $1,192.92 |
| UPMC Community Osteopathic | Harrisburg | $4,272.00 | $184.28 – $6,052.00 |
| UPMC Hanover | Hanover | $4,272.00 | $173.35 – $4,959.33 |
| UPMC Lititz | Lititz | $4,272.00 | $173.35 – $4,986.11 |
| UPMC Memorial | York | $4,272.00 | $173.35 – $4,978.02 |
| UPMC Somerset | Somerset | $4,272.00 | $150.15 – $3,093.35 |
| UPMC Williamsport | Williamsport | $5,397.60 | $150.15 – $1,136.64 |
| WellSpan Surgery & Rehabilitation Hospital | York PA 17403 | $2,590.40 | $170.63 – $464.10 |