CMS Price Transparency Data

Hip or knee replacement (inpatient stay)

Facility: UPMC Carlisle

Billing Code: 470 (MS-DRG)

The BaseRate · fair price high confidence

A fair price for this

$17,519

about 1.2× the $14,044 Medicare rate · typically $14,718–$20,758

modeled estimate · not a bill or quote

What this hospital charges insurers

$15,011

Below the fair price — a good deal

about $2,508 under the fair price · 1.1× Medicare

Medicare pays $14,044 Fair price $17,519 This hospital $15,011

How we calculate the fair BaseRate →

How this hospital compares to other PA hospitals

Highest price of the 9 PA hospitals we have prices for — worth calling around.

Cheapest $13,221 Priciest $15,011

Black dot = this hospital, among the 9 PA hospitals with a price for this procedure. Full list below.

A fair price for a Hip or knee replacement (inpatient stay) is about $17,519 (about 1.2× the $14,044 Medicare rate). UPMC Carlisle charges insurers about $15,011 — below the fair price — a good deal. Located in Carlisle, PA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$14,872 - $40,785	106%
Blue Cross Blue Shieldmajor	$2,535 - $46,212	18%
Aetnamajor	$14,497	103%
Cignamajor	$14,594 - $45,329	104%
Humanamajor	$13,899	99%
Geisinger	$14,594	104%
UPMC Health Plan	$23,004 - $27,445	164%
+ 3 smaller / regional plans	$13,899 - $38,790

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price, before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the MS-DRG code on your bill matches exactly: 470.

Insurance Before you use insurance

Call your insurance company to confirm UPMC Carlisle is in-network.
Ask your insurer whether prior approval is required for MS-DRG code 470.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at UPMC Carlisle

Compare: Hip or knee replacement (inpatient stay) at other PA hospitals

Chan Soon- Shiong Medical Center at Windber · Windber $13,221
Penn State Health Lancaster Medical Center · Lancaster $13,535
Meadville Medical Center · Meadville $13,726
Allegheny Valley Hospital · Natrona $13,765
Canonsburg General Hospital · Canonsburg $13,776
Advanced Surgical Hospital · Washington $13,991
Ahn Wexford Hospital · Wexford $14,185
Punxsutawney Area Hospital · Punxsutawney $14,210

Insurance negotiated median for the same procedure, sorted lowest first.