Fomepizole 1 gram/ml intravenous solution at WellSpan Good Samaritan Hospital
252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500
$5,021.60
Cash price 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.
?
What you pay up front if you don't use insurance.
$6,277.00
Gross charge 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.
?
The hospital's undiscounted list price — almost no one pays this.
$7.40 with WellSpan_Capital_Blue_Cross vs $5,279.19 with First_Health_Network — same scan, same building. Share
Negotiated rates by payer
?
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 →
?
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 ?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 ?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 |
|---|---|---|---|
| WellSpan_Capital_Blue_Cross | All_Plans | $7.40 | ↓ -100% |
| Blue_Cross | Capital_Blue_Performance_PPO | $12.58 | ↓ -100% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $462.00 | ↓ -91% |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $627.70 | ↓ -88% |
| Health_Partners_Medicaid | All_Other_Plans | $627.70 | ↓ -88% |
| Highmark_Medicare | All_Plans | $633.98 | ↓ -87% |
| Aetna_Medicare | All_Plans | $646.53 | ↓ -87% |
| Aetna_Advantra_Medicare | All_Plans | $646.53 | ↓ -87% |
| Geisinger_Gold_Medicare | All_Plans | $659.09 | ↓ -87% |
| United_Medicare | ISNP_DSNP_Plans | $659.09 | ↓ -87% |
| Devoted_Medicare | All_Plans | $659.09 | ↓ -87% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $661.91 | ↓ -87% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $662.22 | ↓ -87% |
| Amerihealth_Medicare | All_Plans | $662.22 | ↓ -87% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $662.22 | ↓ -87% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $677.92 | ↓ -86% |
| PA_Health_&_Wellness_Medicare | All_Plans | $677.92 | ↓ -86% |
| Blue_Cross | Capital_Cares_4_kids | $880.60 | ↓ -82% |
| Highmark | Higmark_Healthy_Kids | $972.94 | ↓ -81% |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $1,006.40 | ↓ -80% |
| Health_Partners_Medicaid | Kidz_Partners | $1,035.71 | ↓ -79% |
| Aetna_Better_Health_Kids | All_Plans | $1,064.12 | ↓ -79% |
| United_Medicaid | Community_Plan_For_Kids | $1,098.48 | ↓ -78% |
| Blue_Cross | All_Other_Plans | $1,258.00 | ↓ -75% |
| Highmark | Performance_Blue | $1,898.60 | ↓ -62% |
| Highmark | Choice_Blue_PPO | $1,898.60 | ↓ -62% |
| Highmark | Blue_Cross_High_Performance_Network | $1,898.60 | ↓ -62% |
| United_Healthcare | All_Plans | $1,929.60 | ↓ -62% |
| Highmark | All_Other_Plans | $2,287.53 | ↓ -54% |
| UPMC | UPMC_For_Kids | $3,547.05 | ↓ -29% |
| UPMC | Employees_And_Dependents | $3,547.05 | ↓ -29% |
| Geisinger | All_Plans | $3,547.05 | ↓ -29% |
| Cigna | All_Plans | $4,511.50 | ↓ -10% |
| PHC | All_Plans | $4,729.40 | ↓ -6% |
| Aetna | All_Plans | $4,800.34 | ↓ -4% |
| First_Health_Network | All_Plans | $5,279.19 | ↑ +5% |
Visitor-reported prices
Comments
Fomepizole 1 gram/ml intravenous solution at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $1,671.60 | $6.40 – $23.46 |
| UPMC Carlisle | Carlisle | $600.00 | $3.45 – $558.45 |
| UPMC Cole | Coudersport | $2,265.60 | $14.40 – $3,020.80 |
| UPMC Community Osteopathic | Harrisburg | $600.00 | $6.22 – $558.45 |
| UPMC East | Monroeville | $6,012.60 | $6.16 – $80.00 |
| UPMC Hamot | Erie | $3,905.40 | $6.28 – $15.30 |
| UPMC Hanover | Hanover | $600.00 | $6.22 – $10.05 |
| UPMC Horizon-Greenville | Greenville | $6,093.60 | $5.62 – $11.78 |