Treatment of fibula fracture 27780 at UPMC Carlisle
361 Alexander Spring Road, Carlisle, PA · UPMC · · NPI 1689107328
$769.80
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.
$1,283.00
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.
$126.21 with AmeriHealth Caritas vs $1,732.75 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 | $126.21 | ↓ -84% |
| Prime Net | Managed Medicare | $175.77 | ↓ -77% |
| Highmark BCBS of PA | Community Blue Medicare Advantage/Complete Blue Medicare Advantage/Security Blue Medicare Advantage/Together Blue Medicare Advantage | $227.18 | ↓ -70% |
| Highmark BCBS of PA | Freedom Blue Medicare Advantage | $227.18 | ↓ -70% |
| Humana | Medicare | $229.47 | ↓ -70% |
| Aetna | Medicare | $239.34 | ↓ -69% |
| Cigna | Medicare | $240.94 | ↓ -69% |
| Geisinger | Medicare | $240.94 | ↓ -69% |
| United Healthcare | Medicare | $245.53 | ↓ -68% |
| PA Health & Wellness | Allwell Medicare Advantage DSNP/Medicare Advantage (Allwell by Wellcare) | $247.83 | ↓ -68% |
| Keystone Health Plan | Medicare Advantage | $256.60 | ↓ -67% |
| Capital Blue Cross | Medicare Advantage | $256.60 | ↓ -67% |
| Keystone Autism Services | ACAP | $367.15 | ↓ -52% |
| Prime Net | Legacy Commercial | $500.37 | ↓ -35% |
| Aetna | ACO | $504.22 | ↓ -34% |
| Prime Net | ACO | $504.22 | ↓ -34% |
| UPMC Work Partners | Workers Comp | $534.88 | ↓ -31% |
| Prime Net | NonGateKeeper | $596.60 | ↓ -22% |
| Prime Net | GateKeeper | $600.44 | ↓ -22% |
| Aetna | Commercial | $600.44 | ↓ -22% |
| Highmark BCBS of PA | Community Blue PPO | $645.41 | ↓ -16% |
| Highmark BCBS of PA | CHIP - Managed Care | $672.71 | ↓ -13% |
| Capital Blue Cross | CHIP | $701.80 | ↓ -9% |
| Keystone Health Plan | Commercial | $701.80 | ↓ -9% |
| Capital Blue Cross | Commercial | $701.80 | ↓ -9% |
| PA Health & Wellness | PA Medicaid HMO | $705.65 | ↓ -8% |
| Geisinger | Medicaid/CHIP | $705.65 | ↓ -8% |
| Highmark BCBS of PA | Commercial | $717.12 | ↓ -7% |
| Wellspan Population Health | PPO | $833.95 | ↑ +8% |
| Geisinger | Commercial | $840.11 | ↑ +9% |
| UPMC Health Plan | Commercial | $898.10 | ↑ +17% |
| Prime Net | FH-Medical Rental | $969.95 | ↑ +26% |
| Cigna | Commercial | $1,000.74 | ↑ +30% |
| United Healthcare Community Plan for Families | PA Medicaid | $1,016.56 | ↑ +32% |
| Multiplan | PPO (Includes PHCS and Humana as Payers) | $1,090.55 | ↑ +42% |
| UPMC Health Plan | CHIP | $1,732.75 | ↑ +125% |
| 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
Treatment of fibula fracture 27780 at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Bedford | Everett | $1,537.20 | $82.51 – $2,305.80 |
| UPMC Cole | Coudersport | $1,266.00 | $66.25 – $771.51 |
| UPMC Community Osteopathic | Harrisburg | $769.80 | $233.61 – $1,732.75 |
| UPMC Hanover | Hanover | $769.80 | $226.87 – $1,732.75 |
| UPMC Lititz | Lititz | $769.80 | $228.10 – $1,732.75 |
| UPMC Memorial | York | $769.80 | $239.91 – $1,732.75 |
| UPMC Muncy | Muncy | $825.60 | $511.98 – $993.28 |
| UPMC Somerset | Somerset | $769.80 | $226.41 – $892.40 |