Mayo ethosuximide therapeutic drug level 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

$68.00

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.

$85.00

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.

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The hospital's undiscounted list price — almost no one pays this.

$16.25 with Health_Partners_Medicaid vs $151.96 with Blue_Cross — 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
Health_Partners_Medicaid All_Other_Plans $16.25 ↓ -76%
Highmark_Wholecare_Gateway_Medicaid All_Plans $16.25 ↓ -76%
PA_Health_&_Wellness_Medicaid All_Plans $16.25 ↓ -76%
UPMC_Medicaid All_Plans $16.25 ↓ -76%
Geisinger_Medicaid All_Plans $16.25 ↓ -76%
Blue_Cross_BlueJourney_Medicare All_Plans $16.34 ↓ -76%
Highmark_Medicare All_Plans $16.50 ↓ -76%
Aetna_Advantra_Medicare All_Plans $16.83 ↓ -75%
Aetna_Medicare All_Plans $16.83 ↓ -75%
United_Medicare ISNP_DSNP_Plans $17.16 ↓ -75%
Geisinger_Gold_Medicare All_Plans $17.16 ↓ -75%
Devoted_Medicare All_Plans $17.16 ↓ -75%
Highmark_Wholecare_Gateway_Medicare All_Plans $17.23 ↓ -75%
UPMC_Medicare UPMC_for_Life_Complete_Care $17.24 ↓ -75%
Amerihealth_Medicare All_Plans $17.24 ↓ -75%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $17.24 ↓ -75%
Jefferson_Health_Medicare_Advantage All_Plans $17.65 ↓ -74%
PA_Health_&_Wellness_Medicare All_Plans $17.65 ↓ -74%
Amerihealth_Caritas_Medicaid All_Plans $18.46 ↓ -73%
Blue_Cross Capital_Blue_Performance_PPO $23.86 ↓ -65%
Highmark Higmark_Healthy_Kids $25.33 ↓ -63%
Health_Partners_Medicaid Kidz_Partners $26.96 ↓ -60%
United_Medicaid Community_Plan_For_Kids $28.60 ↓ -58%
Aetna_Better_Health_Kids All_Plans $44.20 ↓ -35%
United_Healthcare All_Plans $49.02 ↓ -28%
Highmark Blue_Cross_High_Performance_Network $49.42 ↓ -27%
Highmark Choice_Blue_PPO $49.42 ↓ -27%
Highmark Performance_Blue $49.42 ↓ -27%
WellSpan_Capital_Blue_Cross All_Plans $51.00 ↓ -25%
UPMC Employees_And_Dependents $51.00 ↓ -25%
UPMC UPMC_For_Kids $51.00 ↓ -25%
Geisinger All_Plans $51.00 ↓ -25%
Highmark All_Other_Plans $59.55 ↓ -12%
Aetna All_Plans $67.48 ↓ -1%
PHC All_Plans $68.00 ↑ +0%
Cigna All_Plans $70.94 ↑ +4%
First_Health_Network All_Plans $74.18 ↑ +9%
Blue_Cross Capital_Cares_4_kids $106.38 ↑ +56%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $121.57 ↑ +79%
Blue_Cross All_Other_Plans $151.96 ↑ +123%

Visitor-reported prices

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Mayo ethosuximide therapeutic drug level at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $143.40 $13.00 – $191.20
UPMC Bedford Everett $192.60 $5.90 – $288.90
UPMC Carlisle Carlisle $117.00 $13.00 – $165.75
UPMC Cole Coudersport $111.60 $10.62 – $148.80
UPMC Community Osteopathic Harrisburg $117.00 $13.00 – $165.75
UPMC East Monroeville $162.00 $13.00 – $216.00
UPMC Hamot Erie $284.40 $13.00 – $31.58
UPMC Northwest Seneca $80.40 $14.30 – $17.65

All Pennsylvania hospitals for this procedure →