Vaccine pneumonococcal conjugate 20 valent (pcv20) 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

$1,898.00

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.

$2,372.50

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 PA_Health_&_Wellness_Medicaid vs $1,926.47 with Aetna — 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
PA_Health_&_Wellness_Medicaid All_Plans $12.50 ↓ -99%
Highmark_Wholecare_Gateway_Medicaid All_Plans $12.50 ↓ -99%
Health_Partners_Medicaid All_Other_Plans $12.50 ↓ -99%
UPMC_Medicaid All_Plans $12.50 ↓ -99%
Geisinger_Medicaid All_Plans $12.50 ↓ -99%
Aetna_Better_Health_Kids All_Plans $34.00 ↓ -98%
Blue_Cross Capital_Cares_4_kids $230.56 ↓ -88%
Amerihealth_Caritas_Medicaid All_Plans $312.90 ↓ -84%
Blue_Cross All_Other_Plans $329.37 ↓ -83%
Blue_Cross Capital_Blue_Performance_PPO $329.37 ↓ -83%
Highmark_Medicare All_Plans $527.17 ↓ -72%
Aetna_Advantra_Medicare All_Plans $537.61 ↓ -72%
Aetna_Medicare All_Plans $537.61 ↓ -72%
United_Medicare ISNP_DSNP_Plans $548.05 ↓ -71%
Devoted_Medicare All_Plans $548.05 ↓ -71%
Geisinger_Gold_Medicare All_Plans $548.05 ↓ -71%
Highmark_Wholecare_Gateway_Medicare All_Plans $550.40 ↓ -71%
UPMC_Medicare UPMC_for_Life_Community_HealthChoices $550.66 ↓ -71%
UPMC_Medicare UPMC_for_Life_Complete_Care $550.66 ↓ -71%
PA_Health_&_Wellness_Medicare All_Plans $563.71 ↓ -70%
Jefferson_Health_Medicare_Advantage All_Plans $563.71 ↓ -70%
Health_Partners_Medicaid Kidz_Partners $711.75 ↓ -63%
Highmark Higmark_Healthy_Kids $809.02 ↓ -57%
United_Medicaid Community_Plan_For_Kids $913.41 ↓ -52%
United_Healthcare All_Plans $1,001.28 ↓ -47%
First_Health_Network All_Plans $1,046.34 ↓ -45%
Cigna All_Plans $1,076.43 ↓ -43%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $1,108.67 ↓ -42%
WellSpan_Capital_Blue_Cross All_Plans $1,423.50 ↓ -25%
UPMC Employees_And_Dependents $1,423.50 ↓ -25%
UPMC UPMC_For_Kids $1,423.50 ↓ -25%
Geisinger All_Plans $1,423.50 ↓ -25%
Highmark Performance_Blue $1,578.74 ↓ -17%
Highmark Choice_Blue_PPO $1,578.74 ↓ -17%
Highmark Blue_Cross_High_Performance_Network $1,578.74 ↓ -17%
PHC All_Plans $1,898.00 ↑ +0%
Highmark All_Other_Plans $1,902.14 ↑ +0%
Aetna All_Plans $1,926.47 ↑ +2%

Visitor-reported prices

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Vaccine pneumonococcal conjugate 20 valent (pcv20) im at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $192.00 $10.00 – $894.12
UPMC Bedford Everett $192.00 $10.50 – $312.90
UPMC Carlisle Carlisle $322.80 $10.50 – $442.85
UPMC Community Osteopathic Harrisburg $322.80 $10.50 – $442.85
UPMC East Monroeville $192.00 $11.00 – $312.90
UPMC Hamot Erie $192.00 $11.00 – $785.88
UPMC Northwest Seneca $192.00 $11.00 – $312.90
UPMC Hanover Hanover $322.80 $10.50 – $2,027.12

All Pennsylvania hospitals for this procedure →