Ins/rpl ldless pm right vent w img & eval 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

$5,923.20

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.

$7,404.00

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.

$1,332.72 with Aetna_Better_Health_Kids vs $68,654.49 with Highmark — 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
Aetna_Better_Health_Kids All_Plans $1,332.72 ↓ -78%
Aetna All_Plans $4,146.24 ↓ -30%
UPMC UPMC_For_Kids $4,442.40 ↓ -25%
Geisinger All_Plans $4,442.40 ↓ -25%
WellSpan_Capital_Blue_Cross All_Plans $4,442.40 ↓ -25%
UPMC Employees_And_Dependents $4,442.40 ↓ -25%
First_Health_Network All_Plans $4,560.86 ↓ -23%
Cigna All_Plans $4,725.23 ↓ -20%
PHC All_Plans $5,923.20 ↑ +0%
United_Healthcare All_Plans $6,944.95 ↑ +17%
Blue_Cross Capital_Cares_4_kids $11,416.30 ↑ +93%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $13,047.20 ↑ +120%
Blue_Cross_BlueJourney_Medicare All_Plans $18,838.87 ↑ +218%
Highmark_Medicare All_Plans $19,027.26 ↑ +221%
Health_Partners_Medicaid All_Other_Plans $19,071.16 ↑ +222%
Aetna_Advantra_Medicare All_Plans $19,404.04 ↑ +228%
Aetna_Medicare All_Plans $19,404.04 ↑ +228%
Geisinger_Gold_Medicare All_Plans $19,780.81 ↑ +234%
Devoted_Medicare All_Plans $19,780.81 ↑ +234%
United_Medicare ISNP_DSNP_Plans $19,780.81 ↑ +234%
Highmark_Wholecare_Gateway_Medicare All_Plans $19,865.59 ↑ +235%
UPMC_Medicare UPMC_for_Life_Complete_Care $19,875.01 ↑ +236%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $19,875.01 ↑ +236%
Amerihealth_Medicare All_Plans $19,875.01 ↑ +236%
Jefferson_Health_Medicare_Advantage All_Plans $20,345.98 ↑ +243%
PA_Health_&_Wellness_Medicare All_Plans $20,345.98 ↑ +243%
Blue_Cross Capital_Blue_Performance_PPO $28,500.00 ↑ +381%
Highmark Higmark_Healthy_Kids $29,200.25 ↑ +393%
Health_Partners_Medicaid Kidz_Partners $31,084.14 ↑ +425%
United_Medicaid Community_Plan_For_Kids $32,968.02 ↑ +457%
Blue_Cross All_Other_Plans $38,065.00 ↑ +543%
Highmark Blue_Cross_High_Performance_Network $56,981.93 ↑ +862%
Highmark Choice_Blue_PPO $56,981.93 ↑ +862%
Highmark Performance_Blue $56,981.93 ↑ +862%
Highmark All_Other_Plans $68,654.49 ↑ +1059%

Visitor-reported prices

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Ins/rpl ldless pm right vent w img & eval at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $15,600.00 $307.59 – $20,800.00
UPMC Carlisle Carlisle $24,161.40 $638.52 – $34,228.65
UPMC Community Osteopathic Harrisburg $24,161.40 $638.52 – $34,228.65
UPMC Hamot Erie $17,683.80 $307.59 – $26,444.52
UPMC Hanover Hanover $24,161.40 $638.52 – $29,149.89
UPMC Lititz Lititz $24,161.40 $638.52 – $29,307.34
UPMC Magee Pittsburgh $1,543.20 $310.52 – $20,000.27
UPMC Memorial York $24,161.40 $250.70 – $29,259.74

All Pennsylvania hospitals for this procedure →