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PricedCare

Wellspan Good Samaritan Hospital

252 South 4Th Street, Lebanon, PA 17042 · (717) 270-7500

Acute Care HospitalsVoluntary non-profit - PrivateCMS rating 5/5Lebanon, PA metroWebsite ↗

Price file

Prices published

File dated 2026-01-01

1,806 price rows for 39 procedures

Published prices

cash · negotiated range · list
Basic metabolic panel (blood test)

CPT 80048 · metro median $20

$20
cash
CT scan of the abdomen and pelvis, with contrast

CPT 74177 · metro median $438

$438
cash
CT scan of the head, no contrast

CPT 70450 · metro median $296

$296
cash
CT scan of the pelvis, with contrast

CPT 72193 · metro median $476

$476
cash
Cesarean section hospital stay, no complications

MS-DRG 788

—
cash
Chlamydia test (DNA)

CPT 87491 · metro median $146

$146
cash
Complete blood count (CBC) with differential

CPT 85025 · metro median $15

$15
cash
Comprehensive metabolic panel (blood test)

CPT 80053 · metro median $25

$25
cash
Diagnostic mammogram (both breasts)

CPT 77066 · metro median $208

$208
cash
Established patient office visit (about 40 minutes)

CPT 99215 · lowest of 3 lines · metro median $241

$241
cash
Gonorrhea test (DNA)

CPT 87591 · metro median $146

$146
cash
Hip or knee replacement, no major complications

MS-DRG 470

—
cash
Hospital stay for digestive disorders, no complications

MS-DRG 392

—
cash
Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—
cash
Lipid panel (cholesterol test)

CPT 80061 · metro median $40

$40
cash
Liver function panel

CPT 80076 · metro median $25

$25
cash
MRI of the brain, with and without contrast

CPT 70553 · metro median $702

$702
cash
MRI of the knee or other lower joint, no contrast

CPT 73721 · metro median $462

$462
cash
MRI of the lower back (lumbar spine), no contrast

CPT 72148 · metro median $454

$454
cash
MRI of the neck (cervical spine), no contrast

CPT 72141 · metro median $454

$454
cash
New patient office visit (about 30 minutes)

CPT 99203 · lowest of 2 lines · metro median $122

$122
cash
New patient office visit (about 45 minutes)

CPT 99204 · lowest of 2 lines · metro median $175

$175
cash
New patient office visit (about 60 minutes)

CPT 99205 · lowest of 2 lines · metro median $231

$231
cash
PSA test (prostate)

CPT 84153 · metro median $45

$45
cash
Partial thromboplastin time (blood clotting test)

CPT 85730 · metro median $30

$30
cash
Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · lowest of 2 lines · metro median $204

$204
cash
Pregnancy ultrasound (after first trimester)

CPT 76805 · metro median $1,080

$1,080
cash
Prothrombin time (blood clotting test)

CPT 85610 · metro median $15

$15
cash
Removal of a breast lump (biopsy by excision)

CPT 19120

—
cash
Screening mammogram (both breasts)

CPT 77067 · metro median $225

$225
cash
Shoulder arthroscopy with decompression

CPT 29826

—
cash
Sleep study (overnight, attended)

CPT 95810 · metro median $3,935

$3,935
cash
Spinal injection, lower back, no imaging guidance

CPT 62322

—
cash
TSH test (thyroid)

CPT 84443 · metro median $40

$40
cash
Transvaginal ultrasound

CPT 76830 · metro median $709

$709
cash
Ultrasound of the abdomen (complete)

CPT 76700 · metro median $1,754

$1,754
cash
Urinalysis with microscope

CPT 81001 · metro median $10

$10
cash
Vaginal delivery hospital stay, no complications

MS-DRG 807

—
cash
X-ray of the lower spine (4 or more views)

CPT 72110 · metro median $526

$526
cash

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.