Ghs lac repair mouth.ant tong 2.5cm/less 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

$496.80

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.

$621.00

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.

$39.38 with Geisinger_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
Geisinger_Medicaid All_Plans $39.38 ↓ -92%
UPMC_Medicaid All_Plans $39.38 ↓ -92%
PA_Health_&_Wellness_Medicaid All_Plans $39.38 ↓ -92%
Highmark_Wholecare_Gateway_Medicaid All_Plans $39.38 ↓ -92%
Health_Partners_Medicaid All_Other_Plans $39.38 ↓ -92%
Amerihealth_Caritas_Medicaid All_Plans $44.73 ↓ -91%
Aetna_Better_Health_Kids All_Plans $107.10 ↓ -78%
WellSpan_Capital_Blue_Cross All_Plans $372.60 ↓ -25%
UPMC Employees_And_Dependents $372.60 ↓ -25%
Geisinger All_Plans $372.60 ↓ -25%
UPMC UPMC_For_Kids $372.60 ↓ -25%
Blue_Cross_BlueJourney_Medicare All_Plans $394.18 ↓ -21%
Cigna All_Plans $396.32 ↓ -20%
Highmark_Medicare All_Plans $398.12 ↓ -20%
Aetna_Advantra_Medicare All_Plans $406.01 ↓ -18%
Aetna_Medicare All_Plans $406.01 ↓ -18%
Devoted_Medicare All_Plans $413.89 ↓ -17%
Geisinger_Gold_Medicare All_Plans $413.89 ↓ -17%
United_Medicare ISNP_DSNP_Plans $413.89 ↓ -17%
Highmark_Wholecare_Gateway_Medicare All_Plans $415.66 ↓ -16%
UPMC_Medicare UPMC_for_Life_Complete_Care $415.86 ↓ -16%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $415.86 ↓ -16%
Amerihealth_Medicare All_Plans $415.86 ↓ -16%
Jefferson_Health_Medicare_Advantage All_Plans $425.71 ↓ -14%
PA_Health_&_Wellness_Medicare All_Plans $425.71 ↓ -14%
PHC All_Plans $496.80 ↑ +0%
Aetna All_Plans $504.25 ↑ +1%
First_Health_Network All_Plans $554.55 ↑ +12%
United_Healthcare All_Plans $582.50 ↑ +17%
Highmark Higmark_Healthy_Kids $610.98 ↑ +23%
Health_Partners_Medicaid Kidz_Partners $650.40 ↑ +31%
United_Medicaid Community_Plan_For_Kids $689.82 ↑ +39%
Blue_Cross Capital_Cares_4_kids $1,131.20 ↑ +128%
Highmark Performance_Blue $1,192.28 ↑ +140%
Highmark Choice_Blue_PPO $1,192.28 ↑ +140%
Highmark Blue_Cross_High_Performance_Network $1,192.28 ↑ +140%
Blue_Cross Capital_Blue_Performance_PPO $1,209.00 ↑ +143%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $1,292.80 ↑ +160%
Highmark All_Other_Plans $1,436.51 ↑ +189%
Blue_Cross All_Other_Plans $1,616.00 ↑ +225%

Visitor-reported prices

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Ghs lac repair mouth.ant tong 2.5cm/less at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $3,184.80 $31.50 – $4,246.40
UPMC Bedford Everett $4,300.80 $33.08 – $6,451.20
UPMC Carlisle Carlisle $724.20 $40.01 – $1,025.95
UPMC Cole Coudersport $1,693.20 $33.08 – $1,041.88
UPMC Community Osteopathic Harrisburg $724.20 $40.01 – $2,297.85
UPMC East Monroeville $3,055.20 $34.65 – $4,073.60
UPMC Hamot Erie $3,098.40 $34.65 – $729.80
UPMC Northwest Seneca $4,779.60 $34.65 – $399.46

All Pennsylvania hospitals for this procedure →