Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml 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

$750.80

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.

$938.50

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 Geisinger_Medicaid vs $2,180.05 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 ↓ -98%
Health_Partners_Medicaid All_Other_Plans $12.50 ↓ -98%
Highmark_Wholecare_Gateway_Medicaid All_Plans $12.50 ↓ -98%
UPMC_Medicaid All_Plans $12.50 ↓ -98%
PA_Health_&_Wellness_Medicaid All_Plans $12.50 ↓ -98%
Amerihealth_Caritas_Medicaid All_Plans $14.20 ↓ -98%
Aetna_Better_Health_Kids All_Plans $34.00 ↓ -95%
Health_Partners_Medicaid Kidz_Partners $281.55 ↓ -63%
Blue_Cross Capital_Cares_4_kids $387.74 ↓ -48%
Blue_Cross Capital_Blue_Cross_Healthy_Benefits_PPO $438.56 ↓ -42%
Blue_Cross Capital_Blue_Performance_PPO $553.91 ↓ -26%
Blue_Cross All_Other_Plans $553.91 ↓ -26%
WellSpan_Capital_Blue_Cross All_Plans $563.10 ↓ -25%
UPMC Employees_And_Dependents $563.10 ↓ -25%
UPMC UPMC_For_Kids $563.10 ↓ -25%
Geisinger All_Plans $563.10 ↓ -25%
PHC All_Plans $750.80 ↑ +0%
Aetna All_Plans $762.06 ↑ +1%
First_Health_Network All_Plans $838.08 ↑ +12%
United_Healthcare All_Plans $2,135.55 ↑ +184%
Cigna All_Plans $2,180.05 ↑ +190%

Visitor-reported prices

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Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im at other Pennsylvania hospitals

Hospital City Cash price Negotiated range
UPMC Altoona Altoona $1,184.80 $10.00 – $3,742.20
UPMC Bedford Everett $1,196.00 $10.50 – $3,368.08
UPMC East Monroeville $1,196.00 $11.00 – $1,226.11
UPMC Hamot Erie $1,196.00 $11.00 – $3,234.33
UPMC Northwest Seneca $1,196.00 $11.00 – $3,152.20
UPMC Horizon-Greenville Greenville $1,196.00 $10.50 – $3,095.35
UPMC Jameson New Castle $1,196.00 $11.00 – $1,235.97
UPMC Magee Pittsburgh $1,195.80 $11.00 – $1,226.11

All Pennsylvania hospitals for this procedure →