Thrombectomy/inf pq dialysis circuit w/pta 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

$21,760.80

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.

$27,201.00

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.

$439.41 with PA_Health_&_Wellness_Medicaid vs $40,825.05 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
PA_Health_&_Wellness_Medicaid All_Plans $439.41 ↓ -98%
Geisinger_Medicaid All_Plans $439.41 ↓ -98%
Health_Partners_Medicaid All_Other_Plans $439.41 ↓ -98%
UPMC_Medicaid All_Plans $439.41 ↓ -98%
Highmark_Wholecare_Gateway_Medicaid All_Plans $439.41 ↓ -98%
Amerihealth_Caritas_Medicaid All_Plans $499.17 ↓ -98%
Aetna_Better_Health_Kids All_Plans $1,195.20 ↓ -95%
Blue_Cross Capital_Cares_4_kids $11,122.49 ↓ -49%
Blue_Cross_BlueJourney_Medicare All_Plans $11,202.44 ↓ -49%
Highmark_Medicare All_Plans $11,314.46 ↓ -48%
Aetna_Medicare All_Plans $11,538.51 ↓ -47%
Aetna_Advantra_Medicare All_Plans $11,538.51 ↓ -47%
Geisinger_Gold_Medicare All_Plans $11,762.56 ↓ -46%
United_Medicare ISNP_DSNP_Plans $11,762.56 ↓ -46%
Devoted_Medicare All_Plans $11,762.56 ↓ -46%
Highmark_Wholecare_Gateway_Medicare All_Plans $11,812.97 ↓ -46%
Amerihealth_Medicare All_Plans $11,818.57 ↓ -46%
UPMC_Medicare UPMC_for_Life_Complete_Care $11,818.57 ↓ -46%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $11,818.57 ↓ -46%
Jefferson_Health_Medicare_Advantage All_Plans $12,098.64 ↓ -44%
PA_Health_&_Wellness_Medicare All_Plans $12,098.64 ↓ -44%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $12,711.03 ↓ -42%
Aetna All_Plans $15,232.56 ↓ -30%
Geisinger All_Plans $16,320.60 ↓ -25%
WellSpan_Capital_Blue_Cross All_Plans $16,320.60 ↓ -25%
UPMC Employees_And_Dependents $16,320.60 ↓ -25%
UPMC UPMC_For_Kids $16,320.60 ↓ -25%
First_Health_Network All_Plans $16,755.82 ↓ -23%
Cigna All_Plans $17,359.68 ↓ -20%
Highmark Higmark_Healthy_Kids $17,363.78 ↓ -20%
Health_Partners_Medicaid Kidz_Partners $18,484.03 ↓ -15%
United_Medicaid Community_Plan_For_Kids $19,604.27 ↓ -10%
PHC All_Plans $21,760.80 ↑ +0%
United_Healthcare All_Plans $25,514.54 ↑ +17%
Blue_Cross Capital_Blue_Performance_PPO $28,500.00 ↑ +31%
Highmark Performance_Blue $33,884.02 ↑ +56%
Highmark Blue_Cross_High_Performance_Network $33,884.02 ↑ +56%
Highmark Choice_Blue_PPO $33,884.02 ↑ +56%
Blue_Cross All_Other_Plans $38,065.00 ↑ +75%
Highmark All_Other_Plans $40,825.05 ↑ +88%

Visitor-reported prices

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Thrombectomy/inf pq dialysis circuit w/pta at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Carlisle Carlisle $24,300.00 $446.44 – $34,425.00
UPMC Community Osteopathic Harrisburg $24,300.00 $446.44 – $34,425.00
UPMC East Monroeville $7,662.00 $386.68 – $11,352.46
UPMC Hamot Erie $5,134.20 $386.68 – $15,725.10
UPMC Hanover Hanover $24,300.00 $446.44 – $17,333.84
UPMC Lititz Lititz $24,300.00 $446.44 – $17,427.46
UPMC Magee Pittsburgh $7,348.80 $386.68 – $11,676.82
UPMC McKeesport Mckeesport $9,645.00 $386.68 – $11,893.06

All Pennsylvania hospitals for this procedure →