Artery xrays of pelvis 75736 26 at WellSpan Good Samaritan Hospital

252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500

Source: hospital's published price file ↗ · Published Jan 1, 2026 · Ingested Sep 17, 2026

$10,811.20

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.

Full explanation →

What you pay up front if you don't use insurance.

$13,514.00

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.

Full explanation →

The hospital's undiscounted list price — almost no one pays this.

$46.88 with Health_Partners_Medicaid vs $30,106.54 with United_Healthcare — same scan, same building. Share

Negotiated rates by payer
?

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
Health_Partners_Medicaid All_Other_Plans $46.88 ↓ -100%
Geisinger_Medicaid All_Plans $46.88 ↓ -100%
PA_Health_&_Wellness_Medicaid All_Plans $46.88 ↓ -100%
Highmark_Wholecare_Gateway_Medicaid All_Plans $46.88 ↓ -100%
UPMC_Medicaid All_Plans $46.88 ↓ -100%
Amerihealth_Caritas_Medicaid All_Plans $53.25 ↓ -100%
Aetna_Better_Health_Kids All_Plans $127.50 ↓ -99%
Blue_Cross Capital_Blue_Performance_PPO $215.17 ↓ -98%
Blue_Cross Capital_Cares_4_kids $987.16 ↓ -91%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $1,128.18 ↓ -90%
Blue_Cross All_Other_Plans $1,410.22 ↓ -87%
Blue_Cross_BlueJourney_Medicare All_Plans $5,339.86 ↓ -51%
Highmark_Medicare All_Plans $5,393.26 ↓ -50%
Aetna_Medicare All_Plans $5,500.06 ↓ -49%
Aetna_Advantra_Medicare All_Plans $5,500.06 ↓ -49%
Devoted_Medicare All_Plans $5,606.85 ↓ -48%
Geisinger_Gold_Medicare All_Plans $5,606.85 ↓ -48%
United_Medicare ISNP_DSNP_Plans $5,606.85 ↓ -48%
Highmark_Wholecare_Gateway_Medicare All_Plans $5,630.88 ↓ -48%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $5,633.55 ↓ -48%
UPMC_Medicare UPMC_for_Life_Complete_Care $5,633.55 ↓ -48%
Amerihealth_Medicare All_Plans $5,633.55 ↓ -48%
PA_Health_&_Wellness_Medicare All_Plans $5,767.05 ↓ -47%
Jefferson_Health_Medicare_Advantage All_Plans $5,767.05 ↓ -47%
Cigna All_Plans $7,961.10 ↓ -26%
WellSpan_Capital_Blue_Cross All_Plans $8,108.40 ↓ -25%
UPMC Employees_And_Dependents $8,108.40 ↓ -25%
UPMC UPMC_For_Kids $8,108.40 ↓ -25%
Geisinger All_Plans $8,108.40 ↓ -25%
Highmark Higmark_Healthy_Kids $8,276.78 ↓ -23%
Health_Partners_Medicaid Kidz_Partners $8,810.77 ↓ -19%
United_Medicaid Community_Plan_For_Kids $9,344.76 ↓ -14%
PHC All_Plans $10,811.20 ↑ +0%
Aetna All_Plans $10,973.37 ↑ +2%
First_Health_Network All_Plans $12,068.00 ↑ +12%
Highmark Choice_Blue_PPO $16,151.47 ↑ +49%
Highmark Blue_Cross_High_Performance_Network $16,151.47 ↑ +49%
Highmark Performance_Blue $16,151.47 ↑ +49%
Highmark All_Other_Plans $19,460.05 ↑ +80%
United_Healthcare All_Plans $30,106.54 ↑ +178%

Visitor-reported prices

visitor-reported
Report what you paid sign in to post

Comments

Add a comment sign in to post

Artery xrays of pelvis 75736 26 at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $2,422.80 $22.50 – $3,230.40
UPMC Carlisle Carlisle $9,796.20 $29.48 – $13,877.95
UPMC Community Osteopathic Harrisburg $9,796.20 $29.48 – $13,877.95
UPMC Hamot Erie $3,612.00 $41.25 – $6,823.64
UPMC Hanover Hanover $9,796.20 $29.48 – $8,262.51
UPMC Jameson New Castle $3,606.00 $25.88 – $6,442.11
UPMC Lititz Lititz $9,796.20 $29.48 – $8,307.14
UPMC Magee Pittsburgh $2,849.40 $41.25 – $5,565.99

All Pennsylvania hospitals for this procedure →