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 |
|---|---|---|---|---|
| Bone biopsy open superficial CPT 20240 | not published | not published | $1,101.92 – $8,551.40 | 3 |
| Bone Density Scan (DEXA) CPT 77080 | $237.00 | $627.00 | $58.00 – $602.31 | 24 |
| Bone/joint imaging ltd area CPT 78300 | $1,713.60 | $2,142.00 | $86.25 – $2,259.58 | 23 |
| Bone marrow biopsyneedle/trocar 38221 CPT 38221 | $2,307.20 | $2,884.00 | $87.28 – $2,402.40 | 8 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $70.40 | $88.00 | $17.03 – $80.04 | 25 |
| Borrelia miyamotoi amp prb CPT 87478 | $162.40 | $203.00 | $35.09 – $159.31 | 25 |
| (both sides) smear without diff wbc count CPT 85008 | $27.20 | $34.00 | $3.43 – $15.57 | 25 |
| Braf gene CPT 81210 | $729.60 | $912.00 | $175.40 – $796.32 | 24 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $473.50 | $2,225.00 | $238.78 – $1,342.45 | 24 |
| Brain MRI (with and without contrast) CPT 70553 | $701.50 | $2,390.00 | $352.78 – $2,106.92 | 24 |
| Brain MRI (with contrast) CPT 70552 | $635.50 | $2,350.00 | $352.78 – $2,106.92 | 24 |
| Brain MRI (without contrast) CPT 70551 | $455.00 | $2,225.00 | $238.78 – $1,342.45 | 24 |
| Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 | $2,720.80 | $3,401.00 | $173.61 – $4,109.00 | 8 |
| Breast punct aspir cyst, bil CPT 19000 | $1,594.40 | $1,993.00 | $45.63 – $2,402.40 | 22 |
| Bronchial allergy tests CPT 95070 | $873.60 | $1,092.00 | $26.88 – $917.25 | 21 |
| Bronchial challenge CPT 94070 | $873.60 | $1,092.00 | $23.75 – $538.32 | 21 |
| Bronchoscopy w/biopsy(s) 31625 CPT 31625 | not published | not published | $1,101.92 – $11,016.08 | 3 |
| Br punct aspir ea add, l CPT 19001 | $303.20 | $379.00 | $25.49 – $1,131.20 | 8 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | $50.00 | $62.50 | $0.40 – $9.76 | 24 |
| Bundled special stain group 1 microorganisms CPT 88312 | $195.20 | $244.00 | $52.78 – $486.32 | 25 |
| Bundled special stain group 2 CPT 88313 | $143.20 | $179.00 | $63.76 – $352.62 | 25 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | $66.00 | $82.50 | $0.01 – $1.75 | 10 |
| Butorphanol tartrate 1 mg HCPCS J0595 | $153.80 | $192.25 | $6.98 – $39.11 | 9 |
| Bx bone trocar/ndl deep CPT 20225 | $2,640.80 | $3,301.00 | $122.50 – $4,109.00 | 8 |
| Bx breast 1st lesion mr imag CPT 19085 | $1,585.60 | $1,982.00 | $202.63 – $4,109.00 | 8 |
| Bx breast 1st lesion strtctc CPT 19081 | $2,720.80 | $3,401.00 | $185.38 – $4,109.00 | 8 |
| Bx breast add lesion mr imag CPT 19086 | $910.40 | $1,138.00 | $89.58 – $243.64 | 7 |
| Bx breast add lesion strtctc CPT 19082 | $867.20 | $1,084.00 | $87.98 – $239.29 | 7 |
| Bx breast add lesion Ultrasound imag CPT 19084 | $1,360.00 | $1,700.00 | $82.65 – $224.81 | 7 |
| Bx breast pq tomo guide CPT 19499 | $2,471.20 | $3,089.00 | $157.32 – $6,066.00 | 3 |
| Bx pancreas pq ndl CPT 48102 | $2,881.60 | $3,602.00 | $289.17 – $4,396.00 | 3 |
| Bx perianal mass CPT 46999 | not published | not published | $900.61 – $2,571.00 | 17 |
| Bx pleura pq ndl CPT 32400 | $2,664.00 | $3,330.00 | $101.30 – $4,109.00 | 8 |
| Bypass temp external fem-fem CPT 37799 | $5,223.20 | $6,529.00 | $463.70 – $4,109.00 | 19 |
| C-1 esterase, berinert HCPCS J0597 | $13,986.60 | $17,483.25 | $82.30 – $12,683.62 | 25 |
| C1 esterase inhibitor func - sendout CPT 86161 | $49.60 | $62.00 | $12.00 – $78.15 | 25 |
| Calcitonin (salmon) 200 unit/ml injection solution HCPCS J0630 | $3,445.00 | $4,306.25 | $484.97 – $5,355.00 | 19 |
| Calcium 24 hour urine CPT 82340 | $24.80 | $31.00 | $6.03 – $27.38 | 25 |
| Calcium gluconate 100 mg/ml (10 %) intravenous solution HCPCS J0612 | $123.80 | $154.75 | $0.04 – $17.50 | 10 |
| Calcium gluconate 2 gram/100 ml in sodium chloride,iso-osm IV solution HCPCS J0613 | $222.80 | $278.50 | $0.09 – $25.60 | 10 |
| Calcium ionized CPT 82330 | $56.80 | $71.00 | $11.06 – $62.11 | 25 |
| Calcium total CPT 82310 | $21.60 | $27.00 | $5.16 – $24.17 | 25 |
| Calprotectin fecal CPT 83993 | $81.60 | $102.00 | $19.63 – $89.12 | 25 |
| Carbamazepine free CPT 80157 | $55.20 | $69.00 | $13.25 – $60.16 | 25 |
| Carbamazepine free -sendout CPT 80161 | $77.60 | $97.00 | $13.98 – $84.63 | 22 |
| Carbamazepine total therapeutic drug level CPT 80156 | $60.80 | $76.00 | $14.57 – $66.15 | 25 |
| Carbon dioxide CPT 82374 | $20.00 | $25.00 | $4.88 – $22.85 | 25 |
| Carboprost tromethamine 250 mcg/ml intramuscular solution HCPCS J0675 | $1,921.80 | $2,402.25 | $52.59 – $178.68 | 18 |
| Carboxyhemoglobin quantitative CPT 82375 | $61.60 | $77.00 | $7.00 – $55.93 | 25 |
| Carcinoembryonic ag (cea) CPT 82378 | $65.00 | $99.00 | $18.96 – $86.08 | 25 |
| Cardiac perf spect sgl/ef/wm rst/strs CPT 78451 | $4,720.00 | $5,900.00 | $143.92 – $7,779.35 | 23 |
| Cardiac rehabilitation op phase 2 w/continous ecg monitoring CPT 93798 | $296.00 | $370.00 | $50.00 – $217.67 | 21 |
| Cardiac rehabilitation op phase 2 without continous ecg monitoring CPT 93797 | $304.00 | $380.00 | $68.40 – $217.67 | 16 |
| Cardiolipin antibody iga CPT 86147 | $105.60 | $132.00 | $25.45 – $119.54 | 25 |
| Cardioversion elective electrical conversion arrhythmia external CPT 92960 | $1,771.20 | $2,214.00 | $646.41 – $6,420.00 | 16 |
| Carotene CPT 82380 | $38.40 | $48.00 | $9.22 – $41.86 | 25 |
| Carotid Artery Ultrasound (Duplex) CPT 93880 | $1,346.40 | $1,683.00 | $184.83 – $502.72 | 21 |
| Car seat/bed test 60 minutes CPT 94780 | $137.60 | $172.00 | $29.44 – $67.85 | 17 |
| Catheter stripping venous CPT 36595 | $5,223.20 | $6,529.00 | $220.43 – $6,956.60 | 8 |
| Cath place 1st order venous 36011 CPT 36011 | $896.00 | $1,120.00 | $143.13 – $389.30 | 7 |
| Cath plc art ang/grft lt/rt hr CPT 93461 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Cath plc art/angio/rt hrt cath CPT 93456 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Cath plc art/grft/angio right hrt CPT 93457 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Cath right heart w/o2 sat & card CPT 93451 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Cath/saline/contrast/sis/hysteosal 58340 CPT 58340 | $275.20 | $344.00 | $65.00 – $176.80 | 7 |
| Cath segmntl pulm art CPT 36015 | $497.60 | $622.00 | $143.13 – $389.30 | 7 |
| Cauterization chemical granulation tissue CPT 17250 | $187.20 | $234.00 | $32.28 – $1,131.20 | 22 |
| Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 | $52.40 | $65.50 | $0.61 – $2.91 | 10 |
| Cefepime 1 gram solution for injection HCPCS J0692 | $117.80 | $147.25 | $1.33 – $8.40 | 10 |
| Ceftaroline fosamil 600 mg intravenous solution HCPCS J0712 | $1,825.40 | $2,281.75 | $4.59 – $848.31 | 25 |
| Ceftazidime 4.5 mg/0.2 ml intraocular injection - cnr HCPCS J0713 | $69.20 | $86.50 | $1.70 – $11.20 | 10 |
| Ceftazidime and avibactam HCPCS J0714 | $2,988.00 | $3,735.00 | $113.62 – $1,407.00 | 25 |
| Ceftriaxone 1 gram solution for injection HCPCS J0696 | $52.40 | $65.50 | $0.47 – $6.86 | 10 |
| Cell count body fluid CPT 89050 | $20.00 | $25.00 | $4.72 – $30.76 | 25 |
| Cell count w differential body fluid CPT 89051 | $23.20 | $29.00 | $5.60 – $34.64 | 25 |
| Cell function assay w/stim CPT 86352 | $564.80 | $706.00 | $97.30 – $616.80 | 25 |
| Change cystostomy tube; complex 51710 CPT 51710 | $1,457.60 | $1,822.00 | $35.00 – $4,109.00 | 8 |
| Change cystostomy tube simple CPT 51705 | $564.80 | $706.00 | $35.00 – $1,131.20 | 22 |
| Change g-tube to g-j perc CPT 49446 | $2,888.00 | $3,610.00 | $157.30 – $2,620.00 | 8 |
| Change nephroureteral cath CPT 50387 | $3,511.20 | $4,389.00 | $102.36 – $4,396.00 | 8 |
| Change of ureter tube/stent CPT 50688 | $3,307.20 | $4,134.00 | $744.12 – $4,396.00 | 3 |
| Change of windpipe airway 31502 CPT 31502 | $595.20 | $744.00 | $133.92 – $1,131.20 | 17 |
| Chest 2 vws w oblique CPT 71048 | $501.60 | $627.00 | $24.30 – $602.31 | 24 |
| Chest apical lordotic proj CPT 71047 | $416.00 | $520.00 | $23.62 – $497.84 | 24 |
| Chest CT scan (with and without contrast) CPT 71270 | $562.00 | $2,645.00 | $175.85 – $1,006.60 | 24 |
| Chest CT scan (with contrast) CPT 71260 | $470.00 | $2,362.00 | $175.85 – $1,006.60 | 24 |
| Chest CT scan (without contrast) CPT 71250 | $285.00 | $1,610.00 | $105.04 – $602.31 | 24 |
| Chest X-ray CPT 71046 | $322.40 | $403.00 | $18.57 – $497.84 | 24 |
| Chest X-ray (single view) CPT 71045 | $292.80 | $366.00 | $10.14 – $497.84 | 24 |
| Chg radiologic exam esophagus double contrast CPT 74221 | $479.20 | $599.00 | $70.01 – $1,006.60 | 23 |
| Chloride CPT 82435 | $19.20 | $24.00 | $4.60 – $21.56 | 25 |
| Chloride 24 hour urine CPT 82436 | $24.00 | $30.00 | $5.75 – $26.11 | 25 |
| Chloroprocaine hcl injection HCPCS J2401 | $223.80 | $279.75 | $0.04 – $56.00 | 10 |
| Chlorothiazide sodium 500 mg intravenous solution HCPCS J1205 | $294.00 | $367.50 | $29.96 – $131.91 | 10 |
| Chlorpromazine 0.125 mg/ml IV syringe - cnr HCPCS J3230 | $250.40 | $313.00 | $19.19 – $101.64 | 10 |
| Cholangiogram percutaneous compl CPT 47532 | $6,234.40 | $7,793.00 | $220.28 – $7,441.00 | 8 |
| Cholecystostomy complete w/supervision & interpretation CPT 47490 | $8,569.60 | $10,712.00 | $236.25 – $7,441.00 | 2 |
| Cholesterol CPT 82465 | $18.40 | $23.00 | $4.35 – $20.43 | 25 |
| Cholesterol (Lipid) Test CPT 80061 | $40.00 | $70.00 | $13.39 – $60.79 | 26 |
| Chromo high res and frag x - sendout CPT 81243 | $284.80 | $356.00 | $57.04 – $258.96 | 24 |
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.