Debride/subq tissue/ea add 20sq cm 11045 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

$1,077.60

Cash price

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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.

$1,347.00

Gross charge

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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.

$18.06 with Highmark_Wholecare_Gateway_Medicaid vs $1,616.00 with Blue_Cross — 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 →

Payer
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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
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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_Gateway_Medicaid All_Plans $18.06 ↓ -98%
UPMC Employees_And_Dependents $808.20 ↓ -25%
UPMC UPMC_For_Kids $808.20 ↓ -25%
Geisinger All_Plans $808.20 ↓ -25%
WellSpan_Capital_Blue_Cross All_Plans $808.20 ↓ -25%
Cigna All_Plans $859.66 ↓ -20%
PHC All_Plans $1,077.60 ↑ +0%
Aetna All_Plans $1,093.76 ↑ +1%
Blue_Cross Capital_Cares_4_kids $1,131.20 ↑ +5%
First_Health_Network All_Plans $1,202.87 ↑ +12%
Blue_Cross Capital_Blue_Performance_PPO $1,209.00 ↑ +12%
United_Healthcare All_Plans $1,263.49 ↑ +17%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $1,292.80 ↑ +20%
Blue_Cross All_Other_Plans $1,616.00 ↑ +50%

Visitor-reported prices

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Debride/subq tissue/ea add 20sq cm 11045 at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $704.40 $46.42 – $939.20
UPMC Bedford Everett $1,456.20 $46.42 – $2,184.30
UPMC Carlisle Carlisle $822.00 $18.93 – $9,539.00
UPMC Cole Coudersport $316.20 $7.48 – $1,041.88
UPMC East Monroeville $315.60 $46.42 – $420.80
UPMC Hamot Erie $1,602.60 $46.42 – $618.09
UPMC Northwest Seneca $1,588.80 $46.42 – $235.18
UPMC Hanover Hanover $822.00 $18.93 – $497.84

All Pennsylvania hospitals for this procedure →