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 |
|---|---|---|---|---|
| Chromosome analysis 15-20 cell count CPT 88262 | $626.40 | $783.00 | $92.74 – $585.65 | 25 |
| Chromosome karyotype study CPT 88280 | $140.00 | $175.00 | $18.48 – $151.95 | 25 |
| Cilastatin sodium injection HCPCS J0743 | $156.60 | $195.75 | $11.12 – $68.53 | 10 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | $98.00 | $122.50 | $3.14 – $19.38 | 10 |
| Circumcise/surg/28 days or < 54160 CPT 54160 | $433.60 | $542.00 | $160.00 – $5,670.70 | 8 |
| Circumcision (newborn) CPT 54150 | $412.80 | $516.00 | $98.75 – $5,670.70 | 8 |
| Clearance of airways CPT 31720 | $309.60 | $387.00 | $41.25 – $1,131.20 | 22 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $156.80 | $196.00 | $1.39 – $6.11 | 10 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | $177.00 | $221.25 | $13.80 – $60.75 | 10 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $1,480.00 | $1,850.00 | $231.25 – $5,670.70 | 8 |
| Closed tx humerus fx without manip 23600 CPT 23600 | $952.80 | $1,191.00 | $145.63 – $1,131.20 | 22 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $1,112.00 | $1,390.00 | $203.75 – $1,131.20 | 8 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $685.60 | $857.00 | $68.13 – $1,131.20 | 22 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | $806.40 | $1,008.00 | $138.75 – $1,131.20 | 22 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $595.20 | $744.00 | $123.75 – $1,131.20 | 22 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | $1,907.20 | $2,384.00 | $150.63 – $1,131.20 | 22 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $452.00 | $565.00 | $88.13 – $1,131.20 | 22 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $824.00 | $1,030.00 | $60.00 – $1,131.20 | 22 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $405.60 | $507.00 | $66.25 – $1,131.20 | 22 |
| Clsd tx fracture of radius 25500 CPT 25500 | $824.00 | $1,030.00 | $98.13 – $1,131.20 | 22 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | $1,374.40 | $1,718.00 | $68.75 – $1,131.20 | 22 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $544.80 | $681.00 | $83.13 – $1,131.20 | 22 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $664.80 | $831.00 | $143.13 – $1,131.20 | 22 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $1,279.20 | $1,599.00 | $207.50 – $2,448.60 | 8 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $668.80 | $836.00 | $143.13 – $1,131.20 | 22 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $974.40 | $1,218.00 | $250.63 – $2,448.60 | 8 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | $1,024.00 | $1,280.00 | $196.25 – $1,131.20 | 22 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $3,321.60 | $4,152.00 | $236.96 – $1,131.20 | 22 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $1,196.00 | $1,495.00 | $86.88 – $1,131.20 | 22 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $1,408.00 | $1,760.00 | $132.50 – $1,131.20 | 22 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $1,834.40 | $2,293.00 | $105.63 – $1,131.20 | 22 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $744.80 | $931.00 | $181.25 – $1,131.20 | 8 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $532.00 | $665.00 | $127.50 – $1,131.20 | 22 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $885.60 | $1,107.00 | $163.75 – $1,131.20 | 22 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $775.20 | $969.00 | $70.00 – $1,131.20 | 22 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $440.00 | $550.00 | $128.75 – $1,131.20 | 22 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $1,056.80 | $1,321.00 | $148.13 – $2,448.60 | 8 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $423.20 | $529.00 | $36.23 – $1,131.20 | 22 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $610.40 | $763.00 | $60.63 – $1,131.20 | 22 |
| Clsd tx trimall ankle fx without manip 27816 CPT 27816 | $470.40 | $588.00 | $196.25 – $1,131.20 | 22 |
| Clsd tx trimall ankle fx w/manip 27818 CPT 27818 | $709.60 | $887.00 | $298.75 – $2,448.60 | 8 |
| Clsd tx wrist scaphoid fx without manip 25622 CPT 25622 | $1,369.60 | $1,712.00 | $152.50 – $1,131.20 | 22 |
| Cmv pcr-sendout CPT 87496 | $145.60 | $182.00 | $35.09 – $159.31 | 25 |
| Coagulation time activated teg CPT 85347 | $28.80 | $36.00 | $4.28 – $27.73 | 25 |
| Cold agglutinin titer CPT 86157 | $33.60 | $42.00 | $8.06 – $52.47 | 25 |
| Collar cerv patriot adlt HCPCS L0150 | $164.00 | $205.00 | $112.84 – $236.39 | 16 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $100.00 | $353.00 | $96.68 – $1,131.20 | 17 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $100.00 | $374.00 | $96.68 – $1,131.20 | 17 |
| Collection of venous blood by venipuncture CPT 36415 | $5.00 | $15.00 | $2.70 – $26.49 | 21 |
| Colonoscopy & polypectomy 44392 CPT 44392 | not published | not published | $1,101.92 – $2,620.00 | 17 |
| Colonoscopy stoma w/snare 44394 CPT 44394 | not published | not published | $1,101.92 – $2,620.00 | 17 |
| Colonoscopy w/ablation CPT 45388 | not published | not published | $1,101.92 – $4,396.00 | 17 |
| Colonoscopy w/control bleed CPT 45382 | not published | not published | $582.36 – $2,620.00 | 17 |
| Colpopexy extraperitoneal CPT 57282 | not published | not published | $1,101.92 – $22,094.65 | 3 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $653.60 | $817.00 | $26.25 – $488.22 | 22 |
| Compatibility test each unit electronic CPT 86923 | $653.60 | $817.00 | $26.25 – $488.22 | 22 |
| Compatibility test each unit immediate spin technique CPT 86920 | $653.60 | $817.00 | $26.25 – $488.22 | 22 |
| Complement antigen each component c3 CPT 86160 | $49.60 | $62.00 | $12.00 – $78.15 | 25 |
| Complex repair trunk 2.6-7.5cm 13101 CPT 13101 | not published | not published | $1,101.92 – $4,841.06 | 3 |
| Complx repair fccmnaxghf 13131 CPT 13131 | $877.60 | $1,097.00 | $88.75 – $2,402.40 | 22 |
| Comprehensive hearing test CPT 92557 | $256.80 | $321.00 | $36.25 – $270.46 | 21 |
| Concentration infection agents any type CPT 87015 | $27.20 | $34.00 | $6.68 – $30.33 | 25 |
| Conditioning play audiometry 92582 CPT 92582 | $112.80 | $141.00 | $25.38 – $270.46 | 16 |
| Condylomata destruction 56420 CPT 56420 | $632.00 | $790.00 | $63.13 – $1,131.20 | 22 |
| Conjugated estrogens 25 mg solution for injection HCPCS J1410 | $2,712.60 | $3,390.75 | $297.75 – $1,340.12 | 25 |
| Consultation pathology during surgery cytological exam initial site CPT 88333 | $261.60 | $327.00 | $84.84 – $2,457.87 | 25 |
| Consultation pathology during surgery frozen section each additional block CPT 88332 | $312.80 | $391.00 | $43.65 – $239.98 | 11 |
| Consultation pathology during surgery frozen section first tissue block CPT 88331 | $567.20 | $709.00 | $40.63 – $488.22 | 25 |
| Consultation/report referred material w/preparation of slides CPT 88323 | $211.20 | $264.00 | $52.78 – $503.94 | 25 |
| Consultation/report referred slides prepared elsewhere CPT 88321 | $143.20 | $179.00 | $38.77 – $368.15 | 19 |
| Contrast baths charges CPT 97034 | $118.40 | $148.00 | $13.09 – $136.00 | 21 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $6,960.00 | $8,700.00 | $48.75 – $17,462.81 | 9 |
| Control nosebleed pack+caut 30905 CPT 30905 | $649.60 | $812.00 | $99.38 – $1,131.20 | 22 |
| Control of nosebleed ant comp 30903 CPT 30903 | $575.20 | $719.00 | $50.63 – $1,131.20 | 22 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $575.20 | $719.00 | $33.75 – $1,131.20 | 22 |
| Convert nephrostomy catheter CPT 50434 | $3,669.60 | $4,587.00 | $212.15 – $2,620.00 | 8 |
| Coombs direct CPT 86880 | $238.40 | $298.00 | $9.29 – $102.69 | 25 |
| Coombs indirect qualitative each reagent red cell reference CPT 86885 | $653.60 | $817.00 | $9.88 – $296.22 | 25 |
| Copper intrauterine device HCPCS J7300 | $7,249.00 | $9,061.25 | $762.65 – $4,371.20 | 10 |
| Core ndl bx lng/med perq CPT 32408 | $2,955.20 | $3,694.00 | $151.50 – $4,396.00 | 8 |
| Cor hlx vlgs prx phlx osteot CPT 28298 | not published | not published | $1,101.92 – $21,344.46 | 3 |
| Coronary angio/cath placement bypass graft/lv gram/lt heart CPT 93459 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Coronary angio/lv gram/lt heart CPT 93458 | $13,615.20 | $17,019.00 | $3,063.42 – $3,216.41 | 2 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $14,824.80 | $18,531.00 | $3,216.41 – $3,335.58 | 2 |
| Coronary art/grft angio s&i CPT 93455 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $13,621.60 | $17,027.00 | $3,064.86 – $3,216.41 | 2 |
| Cortisol acth stimulation test - sendout CPT 80400 | $136.00 | $170.00 | $32.62 – $153.20 | 25 |
| Cortisol total am CPT 82533 | $68.00 | $85.00 | $15.00 – $74.00 | 25 |
| Cosyntropin 0.25 mg solution for injection HCPCS J0834 | $215.20 | $269.00 | $19.26 – $116.90 | 10 |
| Co-treatment - group 15 mins, st CPT 92508 | $108.00 | $135.00 | $22.67 – $136.00 | 21 |
| C-peptide CPT 84681 | $86.40 | $108.00 | $20.81 – $97.75 | 25 |
| C-reactive protein CPT 86140 | $20.00 | $27.00 | $3.75 – $33.70 | 26 |
| C-reactive protein high sensitivity CPT 86141 | $54.40 | $68.00 | $12.95 – $68.32 | 25 |
| Creatine kinase CPT 82550 | $27.20 | $34.00 | $6.51 – $29.56 | 25 |
| Creatine kinase mb CPT 82553 | $48.00 | $60.00 | $11.24 – $52.44 | 25 |
| Creatinine CPT 82565 | $15.00 | $27.00 | $5.12 – $23.24 | 25 |
| Creatinine 24 hour urine CPT 82570 | $20.00 | $27.00 | $5.18 – $24.31 | 26 |
| Creatinine clearance urine CPT 82575 | $39.20 | $49.00 | $9.46 – $42.95 | 25 |
| #creutz-prot.,western blot CPT 84182 | $121.60 | $152.00 | $26.28 – $132.61 | 25 |
| Critical care 30-74 minutes CPT 99291 | $2,227.20 | $2,784.00 | $189.54 – $1,456.61 | 20 |
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.