Rmvl icd gen w/rplc icd gen dual lead sys 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

$49,040.00

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.

$61,300.00

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.

$6,420.00 with Aetna_Better_Health_Kids vs $80,804.34 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 $6,420.00 ↓ -87%
Blue_Cross_BlueJourney_Medicare All_Plans $22,172.80 ↓ -55%
Highmark_Medicare All_Plans $22,394.53 ↓ -54%
Health_Partners_Medicaid All_Other_Plans $22,446.19 ↓ -54%
Aetna_Advantra_Medicare All_Plans $22,837.98 ↓ -53%
Aetna_Medicare All_Plans $22,837.98 ↓ -53%
United_Medicare ISNP_DSNP_Plans $23,281.44 ↓ -53%
Devoted_Medicare All_Plans $23,281.44 ↓ -53%
Geisinger_Gold_Medicare All_Plans $23,281.44 ↓ -53%
Highmark_Wholecare_Gateway_Medicare All_Plans $23,381.22 ↓ -52%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $23,392.30 ↓ -52%
UPMC_Medicare UPMC_for_Life_Complete_Care $23,392.30 ↓ -52%
Amerihealth_Medicare All_Plans $23,392.30 ↓ -52%
PA_Health_&_Wellness_Medicare All_Plans $23,946.62 ↓ -51%
Jefferson_Health_Medicare_Advantage All_Plans $23,946.62 ↓ -51%
Blue_Cross Capital_Blue_Performance_PPO $28,500.00 ↓ -42%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $30,452.00 ↓ -38%
Aetna All_Plans $34,328.00 ↓ -30%
Highmark Higmark_Healthy_Kids $34,367.84 ↓ -30%
Health_Partners_Medicaid Kidz_Partners $36,585.12 ↓ -25%
WellSpan_Capital_Blue_Cross All_Plans $36,780.00 ↓ -25%
Geisinger All_Plans $36,780.00 ↓ -25%
UPMC Employees_And_Dependents $36,780.00 ↓ -25%
UPMC UPMC_For_Kids $36,780.00 ↓ -25%
First_Health_Network All_Plans $37,760.80 ↓ -23%
Blue_Cross All_Other_Plans $38,065.00 ↓ -22%
United_Medicaid Community_Plan_For_Kids $38,802.40 ↓ -21%
Cigna All_Plans $39,121.66 ↓ -20%
PHC All_Plans $49,040.00 ↑ +0%
United_Healthcare All_Plans $57,499.40 ↑ +17%
Highmark Blue_Cross_High_Performance_Network $67,066.07 ↑ +37%
Highmark Choice_Blue_PPO $67,066.07 ↑ +37%
Highmark Performance_Blue $67,066.07 ↑ +37%
Highmark All_Other_Plans $80,804.34 ↑ +65%

Visitor-reported prices

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Rmvl icd gen w/rplc icd gen dual lead sys at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $10,107.60 $485.56 – $23,111.73
UPMC Carlisle Carlisle $34,564.20 $588.20 – $48,965.95
UPMC Community Osteopathic Harrisburg $34,564.20 $588.20 – $48,965.95
UPMC East Monroeville $51,008.40 $490.18 – $68,011.20
UPMC Hamot Erie $32,186.40 $485.56 – $31,124.41
UPMC Hanover Hanover $34,564.20 $588.20 – $44,742.49
UPMC Lititz Lititz $34,564.20 $588.20 – $44,742.49
UPMC Memorial York $34,564.20 $395.75 – $44,742.49

All Pennsylvania hospitals for this procedure →