Tenotomy open tndn flxr toe sgl tndn spx at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$5,153.40
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.
$8,589.00
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.
$105.41 with Highmark Wholecare (prev Gateway) vs $7,300.65 with Multiplan — 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 | $105.41 | ↓ -98% |
| AmeriHealth Caritas | Community HealthChoices (CHC)/Medicaid | $105.41 | ↓ -98% |
| UPMC Health Plan | Managed Medicaid | $107.90 | ↓ -98% |
| Health Partners Plans (Jefferson Health Plan) | Medicaid/CHIP | $113.05 | ↓ -98% |
| Geisinger | Medicaid/CHIP | $120.90 | ↓ -98% |
| PA Health & Wellness | PA Medicaid HMO | $141.45 | ↓ -97% |
| UPMC Work Partners | Workers Comp | $475.57 | ↓ -91% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↓ -80% |
| Prime Net | Managed Medicare | $1,176.69 | ↓ -77% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $1,515.67 | ↓ -71% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $1,515.67 | ↓ -71% |
| Humana | Medicare | $1,530.98 | ↓ -70% |
| Aetna | Medicare | $1,596.81 | ↓ -69% |
| Cigna | Medicare | $1,607.53 | ↓ -69% |
| Geisinger | Medicare | $1,607.53 | ↓ -69% |
| United Healthcare | Medicare | $1,638.15 | ↓ -68% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $1,653.46 | ↓ -68% |
| UPMC Health Plan | CHIP | $1,714.94 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $1,717.80 | ↓ -67% |
| Keystone Health Plan | Medicare Advantage | $1,717.80 | ↓ -67% |
| Keystone Autism Services | ACAP | $2,449.57 | ↓ -52% |
| Prime Net | Legacy Commercial | $3,349.71 | ↓ -35% |
| Prime Net | ACO | $3,375.48 | ↓ -34% |
| Aetna | ACO | $3,375.48 | ↓ -34% |
| Prime Net | NonGateKeeper | $3,993.89 | ↓ -22% |
| Prime Net | GateKeeper | $4,019.65 | ↓ -22% |
| Aetna | Commercial | $4,019.65 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $4,306.03 | ↓ -16% |
| Highmark BCBS of PA | CHIP - Managed Care | $4,488.22 | ↓ -13% |
| Keystone Health Plan | Commercial | $4,698.18 | ↓ -9% |
| Capital Blue Cross | CHIP | $4,698.18 | ↓ -9% |
| Capital Blue Cross | Commercial | $4,698.18 | ↓ -9% |
| Highmark BCBS of PA | Commercial | $4,784.47 | ↓ -7% |
| Wellspan Population Health | PPO | $5,582.85 | ↑ +8% |
| Geisinger | Commercial | $5,624.08 | ↑ +9% |
| UPMC Health Plan | Commercial | $6,012.30 | ↑ +17% |
| Prime Net | FH-Medical Rental | $6,493.28 | ↑ +26% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $7,300.65 | ↑ +42% |
| US Family Health Plan | Tricare Prime | not published by hospital | — |
| Tricare | East Region | not published by hospital | — |
Visitor-reported prices
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Tenotomy open tndn flxr toe sgl tndn spx at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $3,355.80 | $83.00 – $4,474.40 |
| UPMC Cole | Coudersport | $486.60 | $87.15 – $2,325.85 |
| UPMC Hanover | Hanover | $5,153.40 | $105.41 – $2,446.19 |
| UPMC Lititz | Lititz | $5,153.40 | $105.41 – $2,459.41 |
| UPMC Passavant-McCandless | Pittsburgh | $2,854.80 | $91.30 – $1,678.38 |
| UPMC East | Monroeville | not published | $91.30 – $1,678.38 |
| UPMC Hamot | Erie | not published | $91.30 – $2,219.16 |
| UPMC Memorial | York | not published | $105.41 – $2,455.41 |