WellSpan Good Samaritan Hospital
252 S. 4th St., Lebanon, PA · Wellspan · · NPI 1407928500
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $178.40 | $223.00 | $32.13 – $194.49 | 21 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $178.40 | $223.00 | $42.84 – $194.49 | 25 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $178.40 | $223.00 | $41.31 – $194.49 | 25 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $354.40 | $443.00 | $82.00 – $394.71 | 25 |
| Initiation & management bipap/cpap initial day CPT 94660 | $1,038.40 | $1,298.00 | $200.91 – $351.59 | 15 |
| Inj acetaminophen -fresenius HCPCS J0134 | $106.20 | $132.75 | $0.06 – $19.20 | 10 |
| Inj, acetaminophen (hikma) HCPCS J0137 | $58.80 | $73.50 | $0.05 – $16.39 | 10 |
| Inj, bupivacaine liposome HCPCS J0666 | $2,421.60 | $3,027.00 | $1.59 – $1,322.02 | 25 |
| Inj cefazolin sodium, hikma HCPCS J0688 | $149.80 | $187.25 | $1.00 – $58.24 | 24 |
| Inj cefazolin (wg crit care) HCPCS J0687 | $76.80 | $96.00 | $1.03 – $20.37 | 24 |
| Inj, cefiderocol, 10 mg HCPCS J0699 | $1,675.80 | $2,094.75 | $2.62 – $798.00 | 24 |
| Inj ceftolozane tazobactam HCPCS J0695 | $1,255.00 | $1,568.75 | $9.84 – $606.33 | 25 |
| Inj cntr knee arthro incl ct/mri CPT 27369 | $660.80 | $826.00 | $41.56 – $113.05 | 7 |
| Inj dx for sinogram CPT 20501 | $124.00 | $155.00 | $43.75 – $119.00 | 7 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $164.80 | $206.00 | $60.00 – $163.20 | 7 |
| Injection, cangrelor HCPCS C9460 | $7,191.60 | $8,989.50 | $23.56 – $3,575.25 | 20 |
| Injection epidural blood patch or clot CPT 62273 | not published | not published | $684.09 – $2,571.00 | 17 |
| Injection for arthrography wrist (both sides) CPT 25246 | $164.80 | $206.00 | $43.75 – $119.00 | 7 |
| Injection for bladder x-ray CPT 51600 | $1,326.40 | $1,658.00 | $40.00 – $108.80 | 7 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $164.80 | $206.00 | $41.25 – $112.20 | 7 |
| Injection for ureter x-ray CPT 50690 | $963.20 | $1,204.00 | $53.75 – $146.20 | 7 |
| Injection,onabotulinumtoxina HCPCS J0585 | $4,942.40 | $6,178.00 | $7.05 – $2,180.50 | 25 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $940.00 | $1,175.00 | $211.50 – $1,131.20 | 17 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | not published | not published | $684.09 – $2,571.00 | 17 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $1,635.20 | $2,044.00 | $26.25 – $2,402.40 | 22 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | not published | not published | $1,101.92 – $5,834.62 | 3 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $548.80 | $686.00 | $38.83 – $1,131.20 | 22 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $330.40 | $413.00 | $16.26 – $79.77 | 21 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $420.80 | $526.00 | $38.78 – $364.21 | 21 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $216.00 | $270.00 | $15.88 – $123.03 | 21 |
| Injection treatment of nerve CPT 64681 | $2,692.80 | $3,366.00 | $243.71 – $4,109.00 | 22 |
| Inj epidural sgl cerv-thor without img CPT 62320 | not published | not published | $342.04 – $2,620.00 | 17 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | not published | not published | $879.45 – $2,620.00 | 17 |
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | $1,112.80 | $1,391.00 | $7.96 – $500.50 | 24 |
| Inj for ext venography CPT 36005 | $443.20 | $554.00 | $54.56 – $148.41 | 7 |
| Inj hydroxocobalamin IV 25mg HCPCS J3424 | $3,902.60 | $4,878.25 | $5.22 – $3,563.00 | 21 |
| Inj mepivacaine hcl/10 ml HCPCS J0670 | $94.20 | $117.75 | $9.01 – $39.67 | 10 |
| Inj multihance HCPCS A9577 | $4.00 | $5.00 | $4.87 – $6.37 | 4 |
| Inj nephrosto/ureterogram w/img exstng access CPT 50431 | $1,516.80 | $1,896.00 | $66.88 – $2,448.60 | 8 |
| Inj proc elbow arthro CPT 24220 | $962.40 | $1,203.00 | $43.75 – $119.00 | 7 |
| Inj proc myelogram lumbar CPT 62284 | $5,222.40 | $6,528.00 | $99.43 – $270.44 | 7 |
| Inj retro urethrocysto CPT 51610 | $285.60 | $357.00 | $43.13 – $117.30 | 7 |
| Inj w/fluor eval cv device CPT 36598 | $595.20 | $744.00 | $72.50 – $1,131.20 | 17 |
| Ins cath ren art 1st bi CPT 36252 | $5,274.40 | $6,593.00 | $6,420.00 – $6,956.60 | 2 |
| Ins cath ren art 2nd+ uni CPT 36253 | $5,274.40 | $6,593.00 | $6,420.00 – $7,441.00 | 2 |
| Ins cerv dilator (sep proc) CPT 59200 | $476.80 | $596.00 | $107.28 – $2,402.40 | 17 |
| Insert cath pleura with image CPT 32557 | $1,232.00 | $1,540.00 | $165.75 – $2,402.40 | 8 |
| Insert cath pleura without image CPT 32556 | $1,231.20 | $1,539.00 | $121.63 – $2,448.60 | 8 |
| Insert drug delivery implant CPT 11981 | $192.80 | $241.00 | $94.66 – $257.48 | 21 |
| Insertion catheter bladder non indwelling CPT 51701 | $481.60 | $602.00 | $31.81 – $222.83 | 21 |
| Insertion catheter bladder temporary simple CPT 51702 | $481.60 | $602.00 | $34.39 – $222.83 | 21 |
| Insertion catheter pleural indwelling tunneled with cuff CPT 32550 | $6,028.00 | $7,535.00 | $209.79 – $7,441.00 | 2 |
| Insertion intravascular vena cava (ivc) access supervision & interpretation w/imaging guidance CPT 37191 | $8,252.80 | $10,316.00 | $238.90 – $12,006.00 | 2 |
| Insertion nontunneled centrally inserted central venous catheter >= 5 years old CPT 36556 | $2,099.20 | $2,624.00 | $141.51 – $4,396.00 | 8 |
| Insertion of new/replacement ppm w/transvenous electrode(s) atrial & ventricular CPT 33208 | $37,080.80 | $46,351.00 | $6,420.00 – $28,500.00 | 2 |
| Insertion of new/replacement ppm w/transvenous electrode(s) ventricular CPT 33207 | $47,248.80 | $59,061.00 | $6,420.00 – $28,500.00 | 2 |
| Insertion pacing electrode lv pacing w/insertion of ppm/implantable defibrillator CPT 33225 | $72,056.00 | $90,070.00 | $28,500.00 – $28,500.00 | 1 |
| Insertion peripherally inserted central venous catheter (picc) without port/pump/img gud >= 5 years CPT 36569 | $605.60 | $757.00 | $109.24 – $4,109.00 | 8 |
| Insertion picc without port or pump with imaging guidance=>5y CPT 36573 | $1,962.40 | $2,453.00 | $87.20 – $4,396.00 | 8 |
| Insertion/replacement implantable defibrillator w/lead(s) single/dual chamber CPT 33249 | $71,448.80 | $89,311.00 | $6,420.00 – $32,061.58 | 3 |
| Insertion/replacement temporary single chamber electrode/pacemaker catheter CPT 33210 | $21,556.00 | $26,945.00 | $6,420.00 – $12,006.00 | 2 |
| Insertion single tranvenous electrode/ppm/implantable defibrillator CPT 33216 | $12,016.00 | $15,020.00 | $6,420.00 – $12,006.00 | 2 |
| Insertion subcutaneous cardiac rhythm monitor CPT 33285 | $25,711.20 | $32,139.00 | $6,420.00 – $28,500.00 | 3 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | $5,223.20 | $6,529.00 | $399.15 – $7,441.00 | 2 |
| Insert/repl sq defib w/eltrd CPT 33270 | $72,809.60 | $91,012.00 | $6,420.00 – $32,061.58 | 3 |
| Insert self-contd prosthesis CPT 54401 | not published | not published | $1,101.92 – $60,141.29 | 3 |
| Insert swan-ganz cath CPT 93503 | $12,335.20 | $15,419.00 | $1,553.44 – $6,420.00 | 2 |
| In situ hybridization per specimen each additional single probe stain CPT 88364 | $235.20 | $294.00 | $27.77 – $591.34 | 11 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $333.60 | $417.00 | $58.13 – $781.20 | 25 |
| Ins pq tunnld ip cath w/img CPT 49418 | $2,670.40 | $3,338.00 | $233.98 – $7,441.00 | 2 |
| Ins/rpl ldless pm right vent w img & eval CPT 33274 | $5,923.20 | $7,404.00 | $1,332.72 – $28,500.00 | 3 |
| Ins/rpl pm w/tv ld atrl CPT 33206 | $37,716.80 | $47,146.00 | $6,420.00 – $28,500.00 | 3 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $638.40 | $798.00 | $83.68 – $10,305.03 | 9 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $2,836.00 | $3,545.00 | $331.88 – $7,441.00 | 8 |
| Insulin total CPT 83525 | $47.20 | $59.00 | $11.43 – $51.89 | 25 |
| Interdiscal perq aspir dx CPT 62267 | $1,187.20 | $1,484.00 | $122.26 – $2,402.40 | 18 |
| Intrinsic factor antibody CPT 86340 | $62.40 | $78.00 | $15.08 – $70.82 | 25 |
| Intro cath dialysis circuit CPT 36901 | $1,716.00 | $2,145.00 | $149.05 – $4,396.00 | 8 |
| Intro cath dialysis circuit w/pta CPT 36902 | $10,528.00 | $13,160.00 | $222.08 – $16,056.00 | 8 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $21,761.60 | $27,202.00 | $304.01 – $28,500.00 | 8 |
| Intro cath svc/ivc CPT 36010 | $1,604.80 | $2,006.00 | $143.13 – $389.30 | 7 |
| Intubation endotracheal emergency procedure CPT 31500 | $1,185.60 | $1,482.00 | $90.00 – $1,131.20 | 22 |
| Iron CPT 83540 | $20.00 | $33.00 | $6.47 – $29.37 | 26 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $268.40 | $335.50 | $0.25 – $84.00 | 10 |
| Ivc venogram s&i CPT 75825 | $9,049.60 | $11,312.00 | $46.88 – $17,462.81 | 8 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $223.20 | $279.00 | $24.05 – $123.03 | 21 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $160.00 | $200.00 | $14.29 – $38.86 | 7 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $162.40 | $203.00 | $15.36 – $79.77 | 21 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $773.60 | $967.00 | $49.13 – $364.21 | 21 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $34.40 | $43.00 | $6.25 – $37.09 | 25 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $30.00 | $37.50 | $0.23 – $1.75 | 25 |
| Kidney function study CPT 78725 | $1,713.60 | $2,142.00 | $74.01 – $2,259.58 | 23 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $1,428.80 | $1,786.00 | $86.36 – $602.31 | 24 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | not published | not published | $1,101.92 – $21,344.46 | 3 |
| Knee arthroscopy/surgery CPT 29879 | not published | not published | $1,101.92 – $9,694.44 | 3 |
| Knee MRI (with and without contrast) CPT 73723 | $712.50 | $2,805.00 | $352.78 – $2,106.92 | 24 |
| Knee MRI (with contrast) CPT 73722 | $645.00 | $2,481.00 | $397.53 – $4,386.56 | 24 |
| Knee MRI (without contrast) CPT 73721 | $462.00 | $2,225.00 | $238.78 – $1,342.45 | 24 |
| Knee X-ray CPT 73564 | $529.60 | $662.00 | $25.91 – $602.31 | 24 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $39.60 | $49.50 | $0.26 – $1.47 | 10 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.