Mycophenolate mofetil 250 mg capsule at WellSpan Good Samaritan Hospital
252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500
$2,490.00
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.
$3,112.50
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.
$0.12 with Blue_Cross vs $4.35 with WellSpan_Capital_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 →
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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_Cares_4_kids | $0.12 | ↓ -100% |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $0.14 | ↓ -100% |
| Amerihealth_Caritas_Medicaid | All_Plans | $0.16 | ↓ -100% |
| Health_Partners_Medicaid | All_Other_Plans | $0.16 | ↓ -100% |
| Geisinger_Medicaid | All_Plans | $0.16 | ↓ -100% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $0.16 | ↓ -100% |
| UPMC_Medicaid | All_Plans | $0.16 | ↓ -100% |
| Blue_Cross | Capital_Blue_Performance_PPO | $0.17 | ↓ -100% |
| Blue_Cross | All_Other_Plans | $0.17 | ↓ -100% |
| Aetna | All_Plans | $0.48 | ↓ -100% |
| United_Healthcare | All_Plans | $0.51 | ↓ -100% |
| Cigna | All_Plans | $0.53 | ↓ -100% |
| First_Health_Network | All_Plans | $0.53 | ↓ -100% |
| Geisinger | All_Plans | $2.40 | ↓ -100% |
| UPMC | UPMC_For_Kids | $2.40 | ↓ -100% |
| UPMC | Employees_And_Dependents | $2.40 | ↓ -100% |
| PHC | All_Plans | $3.20 | ↓ -100% |
| WellSpan_Capital_Blue_Cross | All_Plans | $4.35 | ↓ -100% |
Visitor-reported prices
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Mycophenolate mofetil 250 mg capsule at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| UPMC Altoona | Altoona | $8.40 | $0.10 – $3.98 |
| UPMC Bedford | Everett | $1.00 | $0.10 – $11.03 |
| UPMC Carlisle | Carlisle | $10.20 | $0.14 – $0.85 |
| UPMC Community Osteopathic | Harrisburg | $10.20 | $0.16 – $6.62 |
| UPMC East | Monroeville | $55.20 | $0.10 – $9.60 |
| UPMC Hamot | Erie | $42.60 | $0.10 – $0.51 |
| UPMC Northwest | Seneca | $34.40 | $0.10 – $10.32 |
| UPMC Hanover | Hanover | $10.20 | $0.16 – $0.27 |