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 |
|---|---|---|---|---|
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $268.80 | $336.00 | $12.50 – $109.41 | 11 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $643.00 | $803.75 | $12.50 – $328.25 | 9 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $144.60 | $180.75 | $12.50 – $77.63 | 11 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $413.60 | $517.00 | $12.50 – $674.14 | 10 |
| Vaccine mmr live subcutaneous CPT 90707 | $347.60 | $434.50 | $12.50 – $373.17 | 10 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $1,898.00 | $2,372.50 | $12.50 – $1,076.43 | 11 |
| Vaccine rabies im CPT 90675 | $1,368.40 | $1,710.50 | $12.50 – $1,622.53 | 26 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $750.80 | $938.50 | $12.50 – $2,180.05 | 10 |
| Vaccine tdap >=7 years im CPT 90715 | $466.60 | $583.25 | $12.50 – $191.10 | 11 |
| Valproic acid total therapeutic drug level CPT 80164 | $56.80 | $71.00 | $13.54 – $63.65 | 25 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $1,521.00 | $1,901.25 | $0.03 – $5.02 | 9 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | $148.80 | $186.00 | $0.12 – $28.80 | 9 |
| Vancomycin peak therapeutic drug level CPT 80202 | $56.80 | $71.00 | $13.54 – $63.65 | 25 |
| Varicella zoster antibody igg CPT 86787 | $53.60 | $67.00 | $12.88 – $60.55 | 25 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | $280.60 | $350.75 | $1.00 – $99.40 | 10 |
| Vein x-ray liver w/hemodynam CPT 75889 | $6,960.00 | $8,700.00 | $196.82 – $17,462.81 | 9 |
| Ven blood coll snf/hha HCPCS G0471 | $16.80 | $21.00 | $3.78 – $22.29 | 18 |
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $3,320.00 | $4,150.00 | $46.88 – $8,774.10 | 9 |
| Venous mech thrombectomy CPT 37187 | $10,528.00 | $13,160.00 | $6,420.00 – $12,006.00 | 3 |
| Ventilator each subsequent day CPT 94003 | $2,317.60 | $2,897.00 | $59.73 – $1,142.84 | 16 |
| Ventilator initial day CPT 94002 | $2,317.60 | $2,897.00 | $82.19 – $1,142.84 | 16 |
| Visual audiometry (vra) CPT 92579 | $140.80 | $176.00 | $50.00 – $270.46 | 21 |
| Vital capacity test CPT 94150 | $210.40 | $263.00 | $5.00 – $270.46 | 21 |
| Vitamin b-12 CPT 82607 | $40.00 | $78.00 | $15.08 – $68.46 | 26 |
| Vitamin D Test CPT 82306 | $100.00 | $154.00 | $29.60 – $139.09 | 26 |
| Vulvectomy simple partial CPT 56620 | not published | not published | $1,101.92 – $9,499.98 | 3 |
| Warde 1003990 aldosterone CPT 82088 | $169.60 | $212.00 | $32.50 – $185.01 | 25 |
| Warde 1005020 citrate 24 hour urine CPT 82507 | $116.00 | $145.00 | $26.10 – $126.21 | 20 |
| Warde 1005055 5-hiaa 24 hour urine CPT 83497 | $54.40 | $68.00 | $12.90 – $58.57 | 25 |
| Warde 1006955 catecholamines fractionated 24 hour urine CPT 82384 | $104.80 | $131.00 | $25.25 – $114.64 | 25 |
| Warde 1007138 vanillymandelic acid 24 hour urine CPT 84585 | $64.80 | $81.00 | $15.00 – $70.37 | 25 |
| Warde 1015200 kappa light chain free CPT 83521 | $71.20 | $89.00 | $17.27 – $78.41 | 25 |
| Warde 3004000 immunoglobulin subclass 1 CPT 82787 | $40.00 | $50.00 | $8.02 – $38.08 | 25 |
| Warde 3008005 oligoclonal bands CPT 83916 | $113.60 | $142.00 | $18.75 – $124.35 | 25 |
| Warde 3016000 west nile virus antibody CPT 86788 | $69.60 | $87.00 | $16.85 – $76.50 | 25 |
| Warde 3016000 west nile virus antibody igg CPT 86789 | $60.00 | $75.00 | $14.39 – $65.33 | 25 |
| Warde 3016300 saccharomyces cerevisiae iga antibody CPT 86671 | $50.40 | $63.00 | $9.19 – $78.13 | 21 |
| Warde 3400652 ova & parasites direct smear concentration and id CPT 87177 | $37.60 | $47.00 | $8.90 – $57.91 | 25 |
| Warde 3400652 smear complex special stain ova/parasites CPT 87209 | $75.20 | $94.00 | $17.98 – $81.63 | 25 |
| Warde 3400683 amplification rna markers infectious disease bacterial vaginosis CPT 81513 | $398.40 | $498.00 | $89.64 – $647.54 | 19 |
| Warde 3400852 arsenic CPT 82175 | $79.20 | $99.00 | $17.82 – $86.12 | 20 |
| Warde 3708165 mercury urine CPT 83825 | $67.20 | $84.00 | $15.00 – $73.82 | 25 |
| Warde acetylcholine receptor blocking antibody CPT 86042 | $76.80 | $96.00 | $18.40 – $69.29 | 23 |
| Warde actin (smooth muscle) antibody each CPT 86015 | $60.00 | $75.00 | $11.53 – $54.71 | 25 |
| Warde adenosine deaminase pleural fluid CPT 84311 | $34.40 | $43.00 | $7.74 – $36.77 | 20 |
| Warde adrenocorticotropic hormone (acth) CPT 82024 | $160.80 | $201.00 | $38.62 – $175.33 | 25 |
| Warde aldolase CPT 82085 | $40.80 | $51.00 | $9.71 – $44.08 | 25 |
| Warde amino acids 6 or more quantitative each specimen CPT 82139 | $69.60 | $87.00 | $16.87 – $79.22 | 25 |
| Warde amiodarone therapeutic drug level CPT 80151 | $77.60 | $97.00 | $13.98 – $84.63 | 22 |
| Warde analysis gene hfe common variants CPT 81256 | $326.40 | $408.00 | $65.36 – $296.73 | 23 |
| Warde analysis translocation bcr/abl1 major breakpoint qualitative/quantitative CPT 81206 | $682.40 | $853.00 | $163.96 – $744.38 | 18 |
| Warde anti-mullerian hormone CPT 82166 | $160.80 | $201.00 | $36.18 – $115.86 | 18 |
| Warde apolipoprotein b CPT 82172 | $87.20 | $109.00 | $21.09 – $95.75 | 25 |
| Warde cadmium blood CPT 82300 | $98.40 | $123.00 | $23.64 – $107.33 | 25 |
| Warde calcitonin CPT 82308 | $111.20 | $139.00 | $26.16 – $121.63 | 25 |
| Warde calculus (stone) infrared CPT 82365 | $54.40 | $68.00 | $12.50 – $58.57 | 25 |
| Warde clozapine therapeutic drug level CPT 80159 | $84.00 | $105.00 | $20.15 – $91.48 | 25 |
| Warde cobalt heavy metal quantitative each nes CPT 83018 | $91.20 | $114.00 | $21.96 – $103.19 | 25 |
| Warde collagen cross links c-telopeptide CPT 82523 | $77.60 | $97.00 | $15.85 – $84.81 | 20 |
| Warde complement total hemolytic CPT 86162 | $84.80 | $106.00 | $20.32 – $132.28 | 25 |
| Warde copper CPT 82525 | $51.20 | $64.00 | $12.41 – $56.34 | 25 |
| Warde cryoglobulin CPT 82595 | $26.40 | $33.00 | $6.47 – $29.37 | 25 |
| Warde erythropoietin CPT 82668 | $78.40 | $98.00 | $18.75 – $85.31 | 25 |
| Warde fluorescent antibody screen endomysial iga CPT 86231 | $49.60 | $62.00 | $12.09 – $54.89 | 25 |
| Warde folic acid rbc CPT 82747 | $73.60 | $92.00 | $17.65 – $80.13 | 25 |
| Warde g6pd (glucose 6 phosphate dehydrogenase) quantitative CPT 82955 | $40.80 | $51.00 | $9.70 – $44.04 | 25 |
| Warde gastrin CPT 82941 | $73.60 | $92.00 | $17.50 – $80.04 | 25 |
| Warde growth hormone (hgh) CPT 83003 | $83.20 | $104.00 | $10.00 – $75.68 | 25 |
| Warde haloperidol therapeutic drug level CPT 80173 | $65.60 | $82.00 | $15.78 – $71.64 | 25 |
| Warde helminth antibody strongyloides igg CPT 86682 | $54.40 | $68.00 | $9.76 – $59.07 | 21 |
| Warde hemoglobin fractionation/quantitation electrophoresis CPT 83020 | $53.60 | $67.00 | $12.87 – $58.43 | 25 |
| Warde hepatitis a antibody CPT 86708 | $51.20 | $64.00 | $12.39 – $80.65 | 25 |
| Warde hepatitis be antibody CPT 86707 | $48.00 | $60.00 | $11.57 – $75.30 | 25 |
| Warde immunofixation electrophoresis urine CPT 86335 | $122.40 | $153.00 | $15.30 – $133.25 | 25 |
| Warde infectious agent antigen immunoassay ql/sq multi step hepatitis be agn CPT 87350 | $48.00 | $60.00 | $11.53 – $52.35 | 25 |
| Warde infectious agent nucleic acid genotype hepatitis c CPT 87902 | $1,070.40 | $1,338.00 | $98.99 – $1,168.82 | 20 |
| Warde islet cell antibody zinc transporter 8 CPT 86341 | $98.40 | $123.00 | $23.57 – $107.01 | 25 |
| Warde lipoprotein (a) CPT 83695 | $71.20 | $89.00 | $14.32 – $65.01 | 25 |
| Warde mitochondrial antibody each CPT 86381 | $127.20 | $159.00 | $25.45 – $115.54 | 20 |
| Warde neutralization rabies CPT 86382 | $70.40 | $88.00 | $15.84 – $76.77 | 20 |
| Warde oxcarbazepine therapeutic drug level CPT 80183 | $55.20 | $69.00 | $13.25 – $60.16 | 25 |
| Warde pancreatic elastase fecal quantitative CPT 82653 | $115.20 | $144.00 | $22.97 – $104.28 | 25 |
| Warde protein c antigen CPT 85302 | $89.60 | $112.00 | $12.01 – $56.47 | 25 |
| Warde sex hormone binding globulin CPT 84270 | $90.40 | $113.00 | $21.73 – $98.65 | 25 |
| Warde somatomedin CPT 84305 | $88.00 | $110.00 | $21.26 – $96.52 | 25 |
| Warde sugars single qualitative each specimen stool CPT 84376 | $23.20 | $29.00 | $5.50 – $24.97 | 25 |
| Warde t3 (triiodothyronine) reverse CPT 84482 | $65.60 | $82.00 | $15.76 – $74.05 | 25 |
| Warde thyroid stimulating immunoglobulins CPT 84445 | $211.20 | $264.00 | $25.00 – $230.90 | 25 |
| Warde topiramate therapeutic drug level CPT 80201 | $49.60 | $62.00 | $11.92 – $54.12 | 25 |
| Warde virus isolation tissue culture innoculation presumptive id herpes simplex CPT 87252 | $108.00 | $135.00 | $26.07 – $122.47 | 25 |
| Warde viscosity CPT 85810 | $81.60 | $102.00 | $5.00 – $57.75 | 25 |
| Warde vitamin a CPT 84590 | $48.00 | $60.00 | $11.61 – $52.71 | 25 |
| Warde vitamin b-1 (thiamine) CPT 84425 | $88.00 | $110.00 | $8.75 – $96.38 | 25 |
| Warde vitamin b6 (pyridoxine) CPT 84207 | $117.60 | $147.00 | $28.10 – $131.99 | 25 |
| Warde vitamin c (ascorbic acid) CPT 82180 | $40.80 | $51.00 | $8.75 – $44.90 | 25 |
| Warde vitamin d (1 25 dihydroxy) CPT 82652 | $160.80 | $201.00 | $38.50 – $182.85 | 25 |
| Warde vitamin e (alpha-tocopherol) CPT 84446 | $59.20 | $74.00 | $12.50 – $64.38 | 25 |
| Warde zinc CPT 84630 | $47.20 | $59.00 | $11.39 – $51.71 | 25 |
| Wbc automated CPT 85048 | $18.40 | $23.00 | $2.54 – $11.97 | 25 |
| Western blot test CPT 84181 | $70.40 | $88.00 | $17.03 – $79.02 | 25 |
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.