Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug 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

$330.40

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.

$413.00

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.

$16.26 with PA_Health_&_Wellness_Medicaid vs $387.39 with United_Healthcare — 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 $16.26 ↓ -95%
Geisinger_Medicaid All_Plans $16.26 ↓ -95%
UPMC_Medicaid All_Plans $16.26 ↓ -95%
Highmark_Wholecare_Gateway_Medicaid All_Plans $16.26 ↓ -95%
Health_Partners_Medicaid All_Other_Plans $16.26 ↓ -95%
Amerihealth_Caritas_Medicaid All_Plans $18.47 ↓ -94%
Aetna_Better_Health_Kids All_Plans $44.23 ↓ -87%
Blue_Cross_BlueJourney_Medicare All_Plans $45.58 ↓ -86%
Highmark_Medicare All_Plans $46.04 ↓ -86%
Aetna_Medicare All_Plans $46.95 ↓ -86%
Aetna_Advantra_Medicare All_Plans $46.95 ↓ -86%
Devoted_Medicare All_Plans $47.86 ↓ -86%
United_Medicare ISNP_DSNP_Plans $47.86 ↓ -86%
Geisinger_Gold_Medicare All_Plans $47.86 ↓ -86%
Highmark_Wholecare_Gateway_Medicare All_Plans $48.06 ↓ -85%
Amerihealth_Medicare All_Plans $48.09 ↓ -85%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $48.09 ↓ -85%
UPMC_Medicare UPMC_for_Life_Complete_Care $48.09 ↓ -85%
PA_Health_&_Wellness_Medicare All_Plans $49.23 ↓ -85%
Jefferson_Health_Medicare_Advantage All_Plans $49.23 ↓ -85%
Highmark Higmark_Healthy_Kids $70.65 ↓ -79%
Health_Partners_Medicaid Kidz_Partners $75.21 ↓ -77%
United_Medicaid Community_Plan_For_Kids $79.77 ↓ -76%
Highmark Blue_Cross_High_Performance_Network $137.87 ↓ -58%
Highmark Choice_Blue_PPO $137.87 ↓ -58%
Highmark Performance_Blue $137.87 ↓ -58%
Highmark All_Other_Plans $166.11 ↓ -50%
Blue_Cross Capital_Cares_4_kids $168.88 ↓ -49%
Blue_Cross Capital_Blue_Performance_PPO $177.01 ↓ -46%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $192.99 ↓ -42%
Blue_Cross All_Other_Plans $241.23 ↓ -27%
WellSpan_Capital_Blue_Cross All_Plans $247.80 ↓ -25%
UPMC Employees_And_Dependents $247.80 ↓ -25%
UPMC UPMC_For_Kids $247.80 ↓ -25%
Geisinger All_Plans $247.80 ↓ -25%
Cigna All_Plans $263.58 ↓ -20%
PHC All_Plans $330.40 ↑ +0%
Aetna All_Plans $335.36 ↑ +2%
First_Health_Network All_Plans $368.81 ↑ +12%
United_Healthcare All_Plans $387.39 ↑ +17%

Visitor-reported prices

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Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $108.60 $13.01 – $144.80
UPMC Bedford Everett $125.40 $13.66 – $188.10
UPMC Carlisle Carlisle $108.00 $16.52 – $153.00
UPMC Cole Coudersport $111.00 $12.47 – $51.80
UPMC Community Osteopathic Harrisburg $108.00 $16.52 – $111.35
UPMC East Monroeville $259.20 $14.31 – $345.60
UPMC Hamot Erie $158.40 $14.31 – $54.83
UPMC Northwest Seneca $144.60 $14.31 – $46.19

All Pennsylvania hospitals for this procedure →