Plcmt sft tiss loc pq w/img 1st lsn 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

$1,201.60

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.

$1,502.00

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.

$87.83 with Highmark_Wholecare_Gateway_Medicaid vs $3,498.00 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 $87.83 ↓ -93%
Geisinger_Medicaid All_Plans $87.83 ↓ -93%
Health_Partners_Medicaid All_Other_Plans $87.83 ↓ -93%
UPMC_Medicaid All_Plans $87.83 ↓ -93%
PA_Health_&_Wellness_Medicaid All_Plans $87.83 ↓ -93%
Amerihealth_Caritas_Medicaid All_Plans $99.77 ↓ -92%
Aetna_Better_Health_Kids All_Plans $238.88 ↓ -80%
Blue_Cross_BlueJourney_Medicare All_Plans $695.02 ↓ -42%
Highmark_Medicare All_Plans $701.97 ↓ -42%
Aetna_Advantra_Medicare All_Plans $715.87 ↓ -40%
Aetna_Medicare All_Plans $715.87 ↓ -40%
Geisinger_Gold_Medicare All_Plans $729.77 ↓ -39%
United_Medicare ISNP_DSNP_Plans $729.77 ↓ -39%
Devoted_Medicare All_Plans $729.77 ↓ -39%
Highmark_Wholecare_Gateway_Medicare All_Plans $732.90 ↓ -39%
UPMC_Medicare UPMC_for_Life_Complete_Care $733.25 ↓ -39%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $733.25 ↓ -39%
Amerihealth_Medicare All_Plans $733.25 ↓ -39%
PA_Health_&_Wellness_Medicare All_Plans $750.62 ↓ -38%
Jefferson_Health_Medicare_Advantage All_Plans $750.62 ↓ -38%
Aetna All_Plans $841.12 ↓ -30%
Geisinger All_Plans $901.20 ↓ -25%
WellSpan_Capital_Blue_Cross All_Plans $901.20 ↓ -25%
UPMC Employees_And_Dependents $901.20 ↓ -25%
UPMC UPMC_For_Kids $901.20 ↓ -25%
First_Health_Network All_Plans $925.23 ↓ -23%
Cigna All_Plans $958.58 ↓ -20%
Highmark Higmark_Healthy_Kids $1,077.28 ↓ -10%
Health_Partners_Medicaid Kidz_Partners $1,146.78 ↓ -5%
PHC All_Plans $1,201.60 ↑ +0%
United_Medicaid Community_Plan_For_Kids $1,216.29 ↑ +1%
United_Healthcare All_Plans $1,408.88 ↑ +17%
Highmark Blue_Cross_High_Performance_Network $2,102.23 ↑ +75%
Highmark Choice_Blue_PPO $2,102.23 ↑ +75%
Highmark Performance_Blue $2,102.23 ↑ +75%
Blue_Cross Capital_Cares_4_kids $2,448.60 ↑ +104%
Highmark All_Other_Plans $2,532.86 ↑ +111%
Blue_Cross Capital_Blue_Performance_PPO $2,620.00 ↑ +118%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $2,798.40 ↑ +133%
Blue_Cross All_Other_Plans $3,498.00 ↑ +191%

Visitor-reported prices

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Plcmt sft tiss loc pq w/img 1st lsn at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Carlisle Carlisle $1,387.20 $89.23 – $1,965.20
UPMC Community Osteopathic Harrisburg $1,387.20 $92.04 – $1,965.20
UPMC Northwest Seneca $1,473.60 $77.29 – $704.33
UPMC Hanover Hanover $1,387.20 $89.23 – $1,075.42
UPMC Lititz Lititz $1,387.20 $89.23 – $1,081.23
UPMC Magee Pittsburgh $1,437.60 $77.29 – $724.45
UPMC Memorial York $1,387.20 $89.23 – $1,079.47
UPMC Somerset Somerset $1,387.20 $77.29 – $682.05

All Pennsylvania hospitals for this procedure →