Indigotindisulfonate 8 mg/ml soln 5 ml ampule at WellSpan Good Samaritan Hospital
252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500
$2,447.20
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.
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What you pay up front if you don't use insurance.
$3,059.00
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.
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The hospital's undiscounted list price — almost no one pays this.
$9.96 with Blue_Cross vs $2,731.69 with First_Health_Network — 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 →
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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 ?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 |
|---|---|---|---|
| Blue_Cross | Capital_Blue_Performance_PPO | $9.96 | ↓ -100% |
| WellSpan_Capital_Blue_Cross | All_Plans | $11.74 | ↓ -100% |
| Blue_Cross | Capital_Cares_4_kids | $278.88 | ↓ -89% |
| Health_Partners_Medicaid | All_Other_Plans | $398.24 | ↓ -84% |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $398.24 | ↓ -84% |
| Blue_Cross | All_Other_Plans | $398.40 | ↓ -84% |
| Highmark_Medicare | All_Plans | $402.22 | ↓ -84% |
| Aetna_Medicare | All_Plans | $410.19 | ↓ -83% |
| Aetna_Advantra_Medicare | All_Plans | $410.19 | ↓ -83% |
| United_Medicare | ISNP_DSNP_Plans | $418.15 | ↓ -83% |
| Geisinger_Gold_Medicare | All_Plans | $418.15 | ↓ -83% |
| Devoted_Medicare | All_Plans | $418.15 | ↓ -83% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $419.94 | ↓ -83% |
| Amerihealth_Medicare | All_Plans | $420.14 | ↓ -83% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $420.14 | ↓ -83% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $420.14 | ↓ -83% |
| PA_Health_&_Wellness_Medicare | All_Plans | $430.10 | ↓ -82% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $430.10 | ↓ -82% |
| Aetna_Better_Health_Kids | All_Plans | $550.62 | ↓ -78% |
| Highmark | Higmark_Healthy_Kids | $617.27 | ↓ -75% |
| Health_Partners_Medicaid | Kidz_Partners | $657.10 | ↓ -73% |
| United_Medicaid | Community_Plan_For_Kids | $696.92 | ↓ -72% |
| Highmark | Blue_Cross_High_Performance_Network | $1,204.56 | ↓ -51% |
| Highmark | Performance_Blue | $1,204.56 | ↓ -51% |
| Highmark | Choice_Blue_PPO | $1,204.56 | ↓ -51% |
| United_Healthcare | All_Plans | $1,274.88 | ↓ -48% |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $1,429.47 | ↓ -42% |
| Highmark | All_Other_Plans | $1,451.31 | ↓ -41% |
| Geisinger | All_Plans | $1,835.40 | ↓ -25% |
| UPMC | Employees_And_Dependents | $1,835.40 | ↓ -25% |
| UPMC | UPMC_For_Kids | $1,835.40 | ↓ -25% |
| Cigna | All_Plans | $1,952.25 | ↓ -20% |
| PHC | All_Plans | $2,447.20 | ↑ +0% |
| Aetna | All_Plans | $2,483.91 | ↑ +2% |
| First_Health_Network | All_Plans | $2,731.69 | ↑ +12% |
Visitor-reported prices
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Indigotindisulfonate 8 mg/ml soln 5 ml ampule at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| WellSpan Chambersburg Hospital | Chambersburg | $902.60 | $9.96 – $1,771.49 |
| WellSpan Ephrata Community Hospital | Ephrata | $2,003.60 | $11.74 – $1,274.88 |
| WellSpan Gettysburg Hospital | Gettysburg | $2,246.00 | $11.74 – $1,274.88 |