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 |
|---|---|---|---|---|
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $151.80 | $189.75 | $22.91 – $103.04 | 10 |
| Phenobarbital therapeutic drug level CPT 80184 | $64.00 | $80.00 | $15.30 – $69.46 | 25 |
| Phentolaine mesylate inj HCPCS J2760 | $2,159.20 | $2,699.00 | $328.09 – $1,572.55 | 25 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $29.40 | $36.75 | $0.01 – $17.50 | 10 |
| Phenylep ketorolac opth soln HCPCS J1097 | $3,530.40 | $4,413.00 | $114.28 – $1,685.04 | 21 |
| Phenytoin total therapeutic drug level CPT 80185 | $55.20 | $69.00 | $13.25 – $60.16 | 25 |
| Phlebotomy therapeutic CPT 99195 | $110.00 | $677.00 | $12.50 – $222.83 | 21 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | $4,314.40 | $5,393.00 | $446.03 – $7,441.00 | 3 |
| Phleb veins 1 extrm >20 stab CPT 37766 | not published | not published | $1,101.92 – $16,151.47 | 3 |
| Phosphorus CPT 84100 | $15.00 | $25.00 | $4.74 – $22.27 | 25 |
| Phosphorus 24 hour urine CPT 84105 | $24.00 | $30.00 | $5.78 – $26.24 | 25 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $537.20 | $671.50 | $2.07 – $9.12 | 10 |
| Pinworm exam CPT 87172 | $17.60 | $22.00 | $3.96 – $27.78 | 20 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $150.40 | $188.00 | $1.16 – $11.76 | 10 |
| Place duod/jej tube perc CPT 49441 | $3,120.00 | $3,900.00 | $240.30 – $2,620.00 | 8 |
| Place gastrostomy tube perc CPT 49440 | $3,048.80 | $3,811.00 | $220.68 – $2,620.00 | 8 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $1,616.80 | $2,021.00 | $103.24 – $1,131.20 | 8 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $288.80 | $361.00 | $49.16 – $133.72 | 7 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $1,272.00 | $1,590.00 | $88.39 – $1,216.29 | 22 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $3,552.80 | $4,441.00 | $224.45 – $6,066.00 | 8 |
| Placement stent(s) intravascular transcatheter artery initial CPT 37236 | $22,448.00 | $28,060.00 | $6,420.00 – $28,500.00 | 2 |
| Platelet automated CPT 85049 | $91.20 | $114.00 | $3.75 – $20.34 | 25 |
| Platelets leukocytes reduced each unit HCPCS P9031 | $634.40 | $793.00 | $37.50 – $220.10 | 21 |
| Platelets leukocytes reduced irradiated each unit HCPCS P9033 | $1,183.20 | $1,479.00 | $37.50 – $359.43 | 21 |
| Platelets pheresis leukocytes reduced each unit HCPCS P9035 | $2,944.00 | $3,680.00 | $37.50 – $852.43 | 21 |
| Platelets pheresis leukocytes reduced irradiated each unit HCPCS P9037 | $3,188.00 | $3,985.00 | $37.50 – $1,182.41 | 21 |
| Plcmnt ureteral stent pq w/img exstng trct CPT 50693 | $5,650.40 | $7,063.00 | $222.03 – $7,441.00 | 8 |
| Plcmnt ureteral stent pq w/img new w/cath CPT 50695 | $6,046.40 | $7,558.00 | $364.48 – $7,441.00 | 8 |
| Plcmt sft tiss loc pq w/img 1st lsn CPT 10035 | $1,201.60 | $1,502.00 | $87.83 – $2,448.60 | 22 |
| Plcmt sft tiss loc pq w/img ea addl lsn CPT 10036 | $600.80 | $751.00 | $44.26 – $120.39 | 7 |
| Plc pq device breast ea addl lesion Ultrasound guide CPT 19286 | $129.60 | $162.00 | $42.48 – $115.53 | 7 |
| Plethysmography lung volumes/airway resistance CPT 94726 | $318.40 | $398.00 | $50.08 – $538.32 | 21 |
| Plmt nephroureteral catheter CPT 50433 | $3,511.20 | $4,389.00 | $276.89 – $6,066.00 | 8 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $108.00 | $135.00 | $26.07 – $107.67 | 24 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $4,164.80 | $5,206.00 | $809.45 – $2,201.70 | 21 |
| Postop app non-wgt bear dsg HCPCS L5450 | $1,272.69 | $1,590.86 | $317.81 – $901.55 | 16 |
| Potassium 24 hour urine CPT 84133 | $20.00 | $25.00 | $4.73 – $21.47 | 25 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $147.80 | $184.75 | $0.08 – $3.68 | 10 |
| Potassium serum/plasma/whole blood CPT 84132 | $25.60 | $32.00 | $4.76 – $21.61 | 25 |
| Pq dr cath chg w cont s&i CPT 75984 | $907.20 | $1,134.00 | $21.88 – $71.68 | 8 |
| Pq kyphplsty 1 bdy lumb w/img CPT 22514 | $11,748.00 | $14,685.00 | $509.29 – $26,645.50 | 2 |
| Pq thr inj ext pse CPT 36002 | $724.80 | $906.00 | $129.16 – $1,131.20 | 22 |
| Pr amput fgr/thumb prim/sec any joint/phal sgl incl neurectomies w dir clsr CPT 26951 | $5,050.40 | $6,313.00 | $228.13 – $9,694.44 | 9 |
| Pr application of long arm splint CPT 29105 | $465.60 | $582.00 | $41.88 – $1,131.20 | 22 |
| Pr application splint static short arm CPT 29125 | $452.80 | $566.00 | $32.50 – $1,131.20 | 22 |
| Pr biopsy skin punch single lesion CPT 11104 | $617.60 | $772.00 | $50.54 – $1,209.00 | 22 |
| Pr debridement open wound topical appl/wound asmt per session 20 sq cm/< CPT 97597 | $604.80 | $756.00 | $39.43 – $343.49 | 21 |
| Prealbumin CPT 84134 | $60.80 | $76.00 | $14.59 – $68.54 | 25 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $688.00 | $860.00 | $0.25 – $123.55 | 9 |
| Prednisone 1 mg tablet HCPCS J7512 | $4.80 | $6.00 | $0.01 – $4.51 | 9 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $1,080.00 | $1,350.00 | $89.42 – $602.31 | 24 |
| Pregnancy Ultrasound (first trimester) CPT 76801 | $891.20 | $1,114.00 | $75.41 – $602.31 | 24 |
| Prep skin to 100cm2 trk/ext CPT 15002 | not published | not published | $1,101.92 – $3,162.16 | 17 |
| Pressure max expiratory/inspiratory CPT 94799 | $197.60 | $247.00 | $44.46 – $270.46 | 17 |
| Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm CPT 11420 | not published | not published | $1,101.92 – $4,841.06 | 3 |
| Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm CPT 11404 | not published | not published | $1,101.92 – $4,841.06 | 3 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $796.00 | $995.00 | $125.00 – $2,402.40 | 19 |
| Prim art mech thrmbc non-intracranial CPT 37184 | $9,149.60 | $11,437.00 | $6,420.00 – $17,956.72 | 3 |
| Pr incision & drainage abscess complicated/multiple CPT 10061 | $907.20 | $1,134.00 | $65.63 – $1,131.20 | 22 |
| Pr incision & drainage abscess simple/single CPT 10060 | $569.60 | $712.00 | $29.38 – $1,131.20 | 22 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $985.60 | $1,232.00 | $117.26 – $2,402.40 | 22 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $578.40 | $723.00 | $38.13 – $1,131.20 | 22 |
| Pr moderate sedation same physician >= 5 years initial 15 minutes CPT 99152 | $566.40 | $708.00 | $12.38 – $33.66 | 7 |
| Procalcitonin CPT 84145 | $136.00 | $170.00 | $27.22 – $123.58 | 25 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $39.20 | $49.00 | $1.37 – $10.22 | 10 |
| Progesterone CPT 84144 | $86.40 | $108.00 | $20.86 – $94.70 | 25 |
| Prolactin CPT 84146 | $80.80 | $101.00 | $19.38 – $87.99 | 25 |
| Promethazine hcl injection HCPCS J2550 | $25.60 | $32.00 | $2.24 – $11.59 | 10 |
| Propofol infusion 10 mg/ml HCPCS J2704 | $116.00 | $145.00 | $0.10 – $28.80 | 10 |
| Prostate biopsy, any mthd HCPCS G0416 | $264.00 | $330.00 | $42.50 – $1,575.43 | 21 |
| Prosthetic sock multi ply bk HCPCS L8420 | $60.74 | $75.93 | $12.39 – $43.03 | 16 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | $361.80 | $452.25 | $1.89 – $131.20 | 10 |
| Protein c activity CPT 85303 | $104.00 | $130.00 | $13.84 – $90.01 | 25 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $40.00 | $56.00 | $10.74 – $49.81 | 25 |
| Protein s total CPT 85305 | $87.20 | $109.00 | $11.61 – $54.47 | 25 |
| Protein total 24 hour urine CPT 84156 | $15.20 | $19.00 | $3.67 – $16.66 | 25 |
| Protein total body fluid CPT 84157 | $16.80 | $21.00 | $4.00 – $18.16 | 25 |
| Protein total serum plasma whole blood CPT 84155 | $15.20 | $19.00 | $3.67 – $16.66 | 25 |
| Pr planning advance care 1st 30 minutes CPT 99497 | $234.40 | $293.00 | $19.79 – $159.90 | 22 |
| Pr removal drug delivery implant CPT 11982 | $659.20 | $824.00 | $115.41 – $689.82 | 21 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $464.80 | $581.00 | $37.50 – $222.83 | 21 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $967.20 | $1,209.00 | $41.25 – $2,402.40 | 22 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $561.60 | $702.00 | $39.38 – $1,131.20 | 22 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $1,188.80 | $1,486.00 | $59.38 – $1,131.20 | 22 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $589.60 | $737.00 | $30.63 – $1,131.20 | 22 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $1,188.80 | $1,486.00 | $44.38 – $1,131.20 | 22 |
| Pr split-thickness autograft trunk/arm/leg 1st 100 sq cm/<tbsa infant/child CPT 15100 | not published | not published | $1,101.92 – $6,066.00 | 17 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $2,039.20 | $2,549.00 | $166.20 – $2,402.40 | 8 |
| PSA (Prostate) Test CPT 84153 | $45.00 | $96.00 | $18.39 – $83.49 | 25 |
| Pt application of modality >=1 area electrical stimulation each 15 minutes CPT 97032 | $204.00 | $255.00 | $13.78 – $136.00 | 21 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $186.40 | $233.00 | $18.00 – $136.00 | 21 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $164.00 | $205.00 | $13.39 – $136.00 | 21 |
| Pt application of modality traction mechanical CPT 97012 | $172.00 | $215.00 | $13.78 – $136.00 | 21 |
| Pt evaluation high complexity patient/family CPT 97163 | $518.40 | $648.00 | $79.51 – $216.27 | 21 |
| Pt evaluation low complexity patient/family CPT 97161 | $470.40 | $588.00 | $79.51 – $216.27 | 21 |
| Pt evaluation moderate complexity patient/family CPT 97162 | $480.80 | $601.00 | $79.51 – $216.27 | 21 |
| Pt re-evaluation patient/family CPT 97164 | $271.20 | $339.00 | $53.90 – $146.61 | 21 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $204.00 | $255.00 | $39.85 – $69.74 | 21 |
| Pt therapeutic procedure >=1 area gait training each 15 minutes CPT 97116 | $186.40 | $233.00 | $27.75 – $136.00 | 21 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $173.60 | $217.00 | $28.41 – $136.00 | 21 |
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.