Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im 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

$413.60

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.

$517.00

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.

$12.50 with Geisinger_Medicaid vs $674.14 with Cigna — 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
Geisinger_Medicaid All_Plans $12.50 ↓ -97%
Health_Partners_Medicaid All_Other_Plans $12.50 ↓ -97%
Highmark_Wholecare_Gateway_Medicaid All_Plans $12.50 ↓ -97%
UPMC_Medicaid All_Plans $12.50 ↓ -97%
PA_Health_&_Wellness_Medicaid All_Plans $12.50 ↓ -97%
Amerihealth_Caritas_Medicaid All_Plans $14.20 ↓ -97%
Aetna_Better_Health_Kids All_Plans $34.00 ↓ -92%
Blue_Cross Capital_Cares_4_kids $144.35 ↓ -65%
Health_Partners_Medicaid Kidz_Partners $155.10 ↓ -63%
Blue_Cross Capital_Blue_Performance_PPO $206.22 ↓ -50%
Blue_Cross All_Other_Plans $206.22 ↓ -50%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $241.59 ↓ -42%
WellSpan_Capital_Blue_Cross All_Plans $310.20 ↓ -25%
UPMC Employees_And_Dependents $310.20 ↓ -25%
UPMC UPMC_For_Kids $310.20 ↓ -25%
Geisinger All_Plans $310.20 ↓ -25%
PHC All_Plans $413.60 ↑ +0%
Aetna All_Plans $419.80 ↑ +1%
First_Health_Network All_Plans $461.68 ↑ +12%
United_Healthcare All_Plans $659.87 ↑ +60%
Cigna All_Plans $674.14 ↑ +63%

Visitor-reported prices

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Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $82.20 $10.00 – $618.63
UPMC Horizon-Greenville Greenville $82.20 $10.50 – $206.21
UPMC Kane Kane $384.60 $11.00 – $340.25
UPMC Magee Pittsburgh $97.80 $11.00 – $79.85
UPMC Passavant-McCandless Pittsburgh $97.80 $11.00 – $79.85
UPMC St. Margaret Pittsburgh $82.20 $11.00 – $79.85
UPMC Wellsboro Wellsboro $86.40 $11.00 – $17.04
Uniontown Hospital Uniontown $147.00 $11.00 – $294.00

All Pennsylvania hospitals for this procedure →