Phenylep ketorolac opth soln at WellSpan Good Samaritan Hospital
252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500
$3,530.40
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.
$4,413.00
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.
$114.28 with WellSpan_Capital_Blue_Cross vs $3,517.08 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 |
|---|---|---|---|
| WellSpan_Capital_Blue_Cross | All_Plans | $114.28 | ↓ -97% |
| Blue_Cross | Capital_Blue_Performance_PPO | $117.53 | ↓ -97% |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $290.52 | ↓ -92% |
| Blue_Cross | Capital_Cares_4_kids | $329.08 | ↓ -91% |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $387.64 | ↓ -89% |
| Health_Partners_Medicaid | All_Other_Plans | $387.64 | ↓ -89% |
| Highmark_Medicare | All_Plans | $391.52 | ↓ -89% |
| Aetna_Advantra_Medicare | All_Plans | $399.27 | ↓ -89% |
| Aetna_Medicare | All_Plans | $399.27 | ↓ -89% |
| Devoted_Medicare | All_Plans | $407.02 | ↓ -88% |
| United_Medicare | ISNP_DSNP_Plans | $407.02 | ↓ -88% |
| Geisinger_Gold_Medicare | All_Plans | $407.02 | ↓ -88% |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $408.77 | ↓ -88% |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $408.96 | ↓ -88% |
| Amerihealth_Medicare | All_Plans | $408.96 | ↓ -88% |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $408.96 | ↓ -88% |
| Jefferson_Health_Medicare_Advantage | All_Plans | $418.65 | ↓ -88% |
| PA_Health_&_Wellness_Medicare | All_Plans | $418.65 | ↓ -88% |
| Blue_Cross | All_Other_Plans | $470.12 | ↓ -87% |
| Highmark | Higmark_Healthy_Kids | $600.84 | ↓ -83% |
| Health_Partners_Medicaid | Kidz_Partners | $639.61 | ↓ -82% |
| United_Medicaid | Community_Plan_For_Kids | $678.37 | ↓ -81% |
| Aetna_Better_Health_Kids | All_Plans | $708.93 | ↓ -80% |
| Highmark | Blue_Cross_High_Performance_Network | $1,172.49 | ↓ -67% |
| Highmark | Choice_Blue_PPO | $1,172.49 | ↓ -67% |
| Highmark | Performance_Blue | $1,172.49 | ↓ -67% |
| United_Healthcare | All_Plans | $1,246.98 | ↓ -65% |
| Highmark | All_Other_Plans | $1,412.68 | ↓ -60% |
| Cigna | All_Plans | $1,685.04 | ↓ -52% |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $1,840.46 | ↓ -48% |
| UPMC | UPMC_For_Kids | $2,363.10 | ↓ -33% |
| Geisinger | All_Plans | $2,363.10 | ↓ -33% |
| UPMC | Employees_And_Dependents | $2,363.10 | ↓ -33% |
| PHC | All_Plans | $3,150.80 | ↓ -11% |
| Aetna | All_Plans | $3,198.06 | ↓ -9% |
| First_Health_Network | All_Plans | $3,517.08 | ↓ -0% |
Visitor-reported prices
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Phenylep ketorolac opth soln at other Pennsylvania hospitals
| Hospital | City | Cash price | Negotiated range |
|---|---|---|---|
| WellSpan Gettysburg Hospital | Gettysburg | $3,240.20 | $114.28 – $1,685.04 |