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 |
|---|---|---|---|---|
| Antinuclear antibodies titer CPT 86039 | $46.40 | $58.00 | $11.16 – $71.36 | 25 |
| Antiphosphatidylserine antibody CPT 86148 | $66.40 | $83.00 | $12.05 – $104.55 | 21 |
| Antistreptolysin o titer CPT 86060 | $30.40 | $38.00 | $7.30 – $47.53 | 25 |
| Antithrombin iii activity CPT 85300 | $66.40 | $83.00 | $11.75 – $56.93 | 25 |
| App high cost ss f/n/g/h/f <100sq cm addl <25sq cm CPT 15276 | $204.00 | $255.00 | $24.60 – $1,209.00 | 2 |
| App high cost ss t/a/l >100sq cm 1st 100sq cm CPT 15273 | $845.60 | $1,057.00 | $205.93 – $6,328.67 | 17 |
| App high cost ss t/a/l >100sq cm addl 100sq cm CPT 15274 | $213.60 | $267.00 | $43.48 – $2,448.60 | 2 |
| App high cost ss t/a/l <100sq cm addl <25sq cm CPT 15272 | $213.60 | $267.00 | $17.11 – $1,209.00 | 2 |
| Application finger splntstatic 29130 CPT 29130 | $415.20 | $519.00 | $93.42 – $1,131.20 | 18 |
| Application long leg splint 29505 CPT 29505 | $413.60 | $517.00 | $46.25 – $1,131.20 | 22 |
| Application lower leg splint 29515 CPT 29515 | $413.60 | $517.00 | $43.75 – $1,131.20 | 22 |
| Application multi layer compression below knee (both sides) CPT 29581 | $862.40 | $1,078.00 | $31.59 – $1,131.20 | 22 |
| Application of paste boot 29580 CPT 29580 | $430.40 | $538.00 | $96.84 – $1,131.20 | 17 |
| Application skin substitute graft face/scalp/neck/genit/hnd/ft <100 sq cm 1st 25 sq cm CPT 15275 | $1,904.80 | $2,381.00 | $100.55 – $3,162.16 | 18 |
| Application skin substitute graft trunk/arms/legs <100 sq cm 1st 25 sq cm CPT 15271 | $4,908.80 | $6,136.00 | $86.41 – $3,162.16 | 18 |
| Appl modality 1/> areas paraffin bath 97018 CPT 97018 | $104.80 | $131.00 | $5.84 – $136.00 | 21 |
| Apply of finger splint 29131 CPT 29131 | $192.00 | $240.00 | $34.64 – $1,131.20 | 22 |
| Apply rigid leg cast 29445 CPT 29445 | $917.60 | $1,147.00 | $126.84 – $1,131.20 | 22 |
| Aquaporin-4 antibody cba each CPT 86052 | $52.80 | $66.00 | $12.05 – $54.71 | 25 |
| Aqua therapy w/exercise/ea 15 min 97113 CPT 97113 | $256.00 | $320.00 | $35.02 – $136.00 | 21 |
| Aquatic exercise - group charge CPT 97150 | $218.40 | $273.00 | $16.88 – $56.80 | 20 |
| Argatroban nonesrd use 1mg HCPCS J0883 | $606.00 | $757.50 | $0.86 – $831.25 | 25 |
| Arterial blood draw/perc 36620 CPT 36620 | $1,788.00 | $2,235.00 | $59.48 – $161.77 | 7 |
| Artery xray each vessel 7577426 CPT 75774 | $3,147.20 | $3,934.00 | $46.88 – $188.48 | 8 |
| Artery xray of abdomen 75726-26 CPT 75726 | $10,811.20 | $13,514.00 | $46.88 – $30,106.54 | 9 |
| Artery x-rays arm/leg 75710-26 CPT 75710 | $6,960.00 | $8,700.00 | $46.88 – $17,462.81 | 9 |
| Artery x-rays arms/legs 75716-26 CPT 75716 | $6,960.00 | $8,700.00 | $46.88 – $17,462.81 | 9 |
| Artery xrays of pelvis 75736 26 CPT 75736 | $10,811.20 | $13,514.00 | $46.88 – $30,106.54 | 9 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $781.60 | $977.00 | $26.88 – $1,131.20 | 22 |
| Arthrocentesis/aspiration/injection major joint/bursa w/ultrasound guidance (both sides) CPT 20611 | $1,244.80 | $1,556.00 | $62.28 – $1,131.20 | 22 |
| Arthrocentesis/aspiration/injection small joint/bursa without ultrasound guidance CPT 20600 | $526.40 | $658.00 | $22.50 – $1,131.20 | 22 |
| Arthrocentesis/aspiration/inj major joint/bursa without Ultrasound guidance (both sides) CPT 20610 | $815.20 | $1,019.00 | $29.38 – $1,131.20 | 22 |
| Arthrocentesis aspir+/injection small jt/bursa with Ultrasound 20604 CPT 20604 | $889.60 | $1,112.00 | $46.31 – $1,131.20 | 22 |
| Arthrt elbw jt expl bx rmvl CPT 24101 | not published | not published | $1,101.92 – $9,694.44 | 3 |
| Arth shld srg decompr subacrml sp w/prt acrmplsty w/crccrml sep proc lt(rest method ii cah) CPT 29826 | not published | not published | $1,101.92 – $21,344.46 | 3 |
| Asp & inj w/heparin pleurx cath CPT 32999 | $349.60 | $437.00 | $78.66 – $2,402.40 | 18 |
| Aspirate bladder/sprapubic cath 51102 CPT 51102 | $3,553.60 | $4,442.00 | $192.93 – $5,670.70 | 8 |
| Aspirate pleura without imaging 32554 CPT 32554 | $911.20 | $1,139.00 | $88.61 – $2,402.40 | 22 |
| Aspiration fine needle (fna) biopsy w/ultrasound guidance 1st lesion CPT 10005 | $1,326.40 | $1,658.00 | $74.73 – $2,620.00 | 22 |
| Assay alkaline phosphatase CPT 84078 | $34.40 | $43.00 | $6.20 – $37.50 | 21 |
| Assay dir meas fr estradiol CPT 82681 | $140.00 | $175.00 | $20.96 – $126.85 | 21 |
| Assay of urine sulfate CPT 84392 | $22.40 | $28.00 | $5.04 – $24.92 | 20 |
| Assess cyst contrast inject CPT 49424 | $120.00 | $150.00 | $39.00 – $106.08 | 7 |
| Ast/sgot CPT 84450 | $21.60 | $27.00 | $5.18 – $24.24 | 25 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $161.00 | $201.25 | $0.11 – $38.50 | 10 |
| Audiometry air + bone CPT 92553 | $163.20 | $204.00 | $17.50 – $270.46 | 21 |
| Auditory function 60 min CPT 92620 | $111.20 | $139.00 | $154.55 – $270.46 | 15 |
| Augumentation percutaneous vertebral including cavity creation 1 vertebral body thoracic CPT 22513 | $11,607.20 | $14,509.00 | $546.80 – $26,645.50 | 2 |
| Av fuse uppr arm basilic CPT 36819 | not published | not published | $1,101.92 – $16,151.47 | 3 |
| Avulsion nail plate partial/complete simple single nail plate CPT 11730 | $560.80 | $701.00 | $127.30 – $2,638.40 | 22 |
| Azathioprine 50 mg tablet HCPCS J7500 | $10.60 | $13.25 | $0.05 – $6.85 | 10 |
| Azithromycin 500 mg intravenous solution HCPCS J0456 | $25.40 | $31.75 | $1.55 – $8.35 | 10 |
| Aztreonam 1 gram solution for injection HCPCS J0457 | $655.00 | $818.75 | $2.75 – $86.80 | 10 |
| Baclofen eval charges CPT 97750 | $211.20 | $264.00 | $31.95 – $136.00 | 21 |
| Bacterial meningitis antigen CPT 86403 | $48.00 | $60.00 | $11.54 – $66.34 | 25 |
| Bacterial vaginosis pcr CPT 87801 | $292.00 | $365.00 | $48.50 – $318.71 | 25 |
| #bac vag cand-c. albicans naa CPT 87481 | $140.00 | $175.00 | $35.09 – $159.31 | 25 |
| B cells total count CPT 86355 | $157.60 | $197.00 | $37.73 – $171.29 | 25 |
| Benztropine 1 mg/ml injection solution HCPCS J0515 | $229.00 | $286.25 | $16.63 – $117.39 | 10 |
| Beta 2 glycoprotein 1 antibody iga CPT 86146 | $105.60 | $132.00 | $25.45 – $115.54 | 25 |
| Beta-2 microglobulin CPT 82232 | $67.20 | $84.00 | $16.18 – $73.46 | 25 |
| Betamethasone acetate and sodium phos 6 mg/ml suspension for injection HCPCS J0702 | $432.80 | $541.00 | $7.55 – $239.75 | 10 |
| Bilateral n block inj occipital 64405 CPT 64405 | $2,314.40 | $2,893.00 | $43.75 – $2,402.40 | 22 |
| Bilateral n block inj trigeminal 64400 CPT 64400 | $1,064.80 | $1,331.00 | $16.25 – $1,131.20 | 22 |
| Bilicheck CPT 88720 | $24.80 | $31.00 | $5.02 – $22.79 | 25 |
| Bilirubin direct CPT 82248 | $24.80 | $31.00 | $5.02 – $23.56 | 25 |
| Bilirubin total CPT 82247 | $10.00 | $31.00 | $5.02 – $23.56 | 25 |
| Binder abdominal lg 12 x 62-74 HCPCS L0625 | $80.80 | $101.00 | $36.56 – $63.98 | 16 |
| Biopsy abdominal mass CPT 49180 | $2,391.20 | $2,989.00 | $101.21 – $4,109.00 | 8 |
| Biopsy bone trocar/needle superficial CPT 20220 | $1,646.40 | $2,058.00 | $78.75 – $2,620.00 | 8 |
| Biopsy cervixsingle/multiple 57500 CPT 57500 | not published | not published | $1,101.92 – $9,499.98 | 3 |
| Biopsy(ies) & aspiration(s) bone marrow diagnostic (both sides) CPT 38222 | $2,620.80 | $3,276.00 | $79.15 – $4,396.00 | 8 |
| Biopsy muscle percutaneous needle CPT 20206 | $2,362.40 | $2,953.00 | $70.49 – $2,620.00 | 8 |
| Biopsy needle liver percutaneous CPT 47000 | $2,307.20 | $2,884.00 | $112.06 – $4,109.00 | 8 |
| Biopsy needle lymph node superficial CPT 38505 | $2,307.20 | $2,884.00 | $84.29 – $2,620.00 | 8 |
| Biopsy of salivary gland 42400 CPT 42400 | $1,200.00 | $1,500.00 | $43.75 – $2,448.60 | 22 |
| Biopsy renal percutaneous trocar/needle (both sides) CPT 50200 | $1,992.80 | $2,491.00 | $171.39 – $4,109.00 | 8 |
| Biopsy skin incisional single lesion CPT 11106 | $617.60 | $772.00 | $61.51 – $2,571.00 | 22 |
| Bivalirudin HCPCS J0583 | $1,489.00 | $1,861.25 | $0.18 – $141.28 | 10 |
| Bladder irrigate/lavage/instill 51700 CPT 51700 | $1,051.20 | $1,314.00 | $35.88 – $1,131.20 | 22 |
| Bld prd mix CPT 86965 | $653.60 | $817.00 | $128.52 – $488.22 | 18 |
| Bld push tfuj 2 yr/< CPT 36440 | $694.40 | $868.00 | $43.75 – $2,402.40 | 22 |
| Blood Clotting (PT/INR) Test CPT 85610 | $15.00 | $44.00 | $4.29 – $25.59 | 26 |
| Blood Clotting (PTT) Test CPT 85730 | $30.00 | $57.00 | $6.01 – $39.05 | 25 |
| Blood Count (CBC) Test CPT 85025 | $15.00 | $74.00 | $7.50 – $35.28 | 26 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $15.00 | $61.00 | $6.47 – $29.37 | 26 |
| Blood count spun microhematocrit CPT 85013 | $28.80 | $36.00 | $3.46 – $31.78 | 25 |
| Blood Culture Test CPT 87040 | $43.20 | $54.00 | $10.32 – $47.60 | 25 |
| Blood gases o2 saturation direct measurement CPT 82805 | $328.00 | $410.00 | $41.43 – $357.62 | 25 |
| Blood gases ph venous CPT 82800 | $45.60 | $57.00 | $11.00 – $45.43 | 24 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $36.00 | $65.00 | $18.05 – $72.28 | 25 |
| Blood occult feces 1-3 determinations other than neoplasm screening qualitative CPT 82272 | $16.80 | $21.00 | $4.23 – $19.20 | 25 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $15.00 | $22.00 | $4.34 – $19.89 | 25 |
| Blood occult peroxidase activity qualitative gastric CPT 82271 | $21.60 | $27.00 | $4.54 – $24.15 | 25 |
| Blood smear microscopic w manual differential wbc count CPT 85007 | $27.20 | $34.00 | $3.80 – $17.25 | 25 |
| Blood split unit HCPCS P9011 | $861.60 | $1,077.00 | $106.35 – $248.15 | 17 |
| Blood typing abo CPT 86900 | $146.00 | $242.00 | $5.15 – $222.83 | 25 |
| Blood typing ag donor ea ag CPT 86902 | $166.40 | $208.00 | $3.53 – $621.85 | 25 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $257.60 | $322.00 | $4.10 – $621.85 | 25 |
| Blood typing rh (d) CPT 86901 | $43.00 | $88.00 | $5.21 – $67.85 | 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.