T4 (thyroxine) free 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

$35.00

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.

$47.00

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.

$9.02 with Blue_Cross_BlueJourney_Medicare vs $83.88 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
Blue_Cross_BlueJourney_Medicare All_Plans $9.02 ↓ -74%
Highmark_Medicare All_Plans $9.11 ↓ -74%
Aetna_Medicare All_Plans $9.29 ↓ -73%
Aetna_Advantra_Medicare All_Plans $9.29 ↓ -73%
Geisinger_Gold_Medicare All_Plans $9.47 ↓ -73%
United_Medicare ISNP_DSNP_Plans $9.47 ↓ -73%
Devoted_Medicare All_Plans $9.47 ↓ -73%
Highmark_Wholecare_Gateway_Medicare All_Plans $9.51 ↓ -73%
UPMC_Medicare UPMC_for_Life_Complete_Care $9.52 ↓ -73%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $9.52 ↓ -73%
Amerihealth_Medicare All_Plans $9.52 ↓ -73%
PA_Health_&_Wellness_Medicare All_Plans $9.74 ↓ -72%
Jefferson_Health_Medicare_Advantage All_Plans $9.74 ↓ -72%
PA_Health_&_Wellness_Medicaid All_Plans $10.00 ↓ -71%
UPMC_Medicaid All_Plans $10.00 ↓ -71%
Geisinger_Medicaid All_Plans $10.00 ↓ -71%
Health_Partners_Medicaid All_Other_Plans $10.00 ↓ -71%
Highmark_Wholecare_Gateway_Medicaid All_Plans $10.00 ↓ -71%
Amerihealth_Caritas_Medicaid All_Plans $11.36 ↓ -68%
Blue_Cross Capital_Blue_Performance_PPO $13.17 ↓ -62%
Highmark Higmark_Healthy_Kids $13.98 ↓ -60%
Health_Partners_Medicaid Kidz_Partners $14.88 ↓ -57%
United_Medicaid Community_Plan_For_Kids $15.79 ↓ -55%
United_Healthcare All_Plans $27.06 ↓ -23%
Aetna_Better_Health_Kids All_Plans $27.20 ↓ -22%
Highmark Performance_Blue $27.28 ↓ -22%
Highmark Choice_Blue_PPO $27.28 ↓ -22%
Highmark Blue_Cross_High_Performance_Network $27.28 ↓ -22%
UPMC UPMC_For_Kids $28.20 ↓ -19%
Geisinger All_Plans $28.20 ↓ -19%
UPMC Employees_And_Dependents $28.20 ↓ -19%
WellSpan_Capital_Blue_Cross All_Plans $31.00 ↓ -11%
Highmark All_Other_Plans $32.87 ↓ -6%
Aetna All_Plans $37.25 ↑ +6%
PHC All_Plans $37.60 ↑ +7%
Cigna All_Plans $39.23 ↑ +12%
First_Health_Network All_Plans $40.95 ↑ +17%
Blue_Cross Capital_Cares_4_kids $58.72 ↑ +68%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $67.10 ↑ +92%
Blue_Cross All_Other_Plans $83.88 ↑ +140%

Visitor-reported prices

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T4 (thyroxine) free at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $121.80 $8.00 – $162.40
UPMC Bedford Everett $49.80 $3.25 – $74.70
UPMC Carlisle Carlisle $45.60 $8.00 – $64.60
UPMC Cole Coudersport $64.20 $5.86 – $85.60
UPMC Community Osteopathic Harrisburg $45.60 $8.00 – $58.35
UPMC East Monroeville $136.20 $8.00 – $181.60
UPMC Hamot Erie $379.80 $8.00 – $17.44
UPMC Northwest Seneca $42.00 $8.18 – $9.74

All Pennsylvania hospitals for this procedure →