WellSpan Good Samaritan Hospital prices. From its own published file.

WellSpan Good Samaritan Hospital in Lebanon, PA publishes its standard charges as required by federal rule. Here's what it lists for common services, and how to check your bill against it.

2,316prices published

Jan 2026file last updated

$438cash price for ct abdomen and pelvis with contrast (list $3,012)

Common services

Service	Cash price	List price	Insurers pay
Emergency visit, moderate (level 3) `99283`	$1,226	$1,533	$98.75–$1,836
Emergency visit, high (level 4) `99284`	$1,810	$2,263	$154–$3,223
Emergency visit, highest (level 5) `99285`	$1,845	$2,306	$241–$4,869
Comprehensive metabolic panel `80053`	$25.00	$57.00	$10.56–$522
Basic metabolic panel `80048`	$20.00	$46.00	$8.46–$522
Complete blood count (CBC) `85025`	$15.00	$74.00	$7.50–$522
Blood draw (venipuncture) `36415`	$5.00	$15.00	$2.70–$522
Urinalysis `81001`	$10.00	$21.00	$3.17–$522
Troponin (heart test) `84484`	$62.40	$78.00	$12.34–$522
EKG tracing `93005`	$314	$393	$13.08–$369
Chest X-ray, 2 views `71046`	$322	$403	$18.57–$498
CT head without contrast `70450`	$296	$1,610	$105–$1,288
CT abdomen and pelvis with contrast `74177`	$438	$3,012	$241–$2,410
MRI lower back without contrast `72148`	$454	$2,225	$239–$2,128
Ultrasound, abdomen `76700`	$1,754	$2,192	$88.36–$1,957
IV push, single drug `96374`	$421	$526	$38.78–$758
IV fluids, first hour `96360`	$664	$830	$39.54–$779
Ketorolac injection, 15 mg `J1885`	$30.00	$37.50	$0.23–$522
Ondansetron injection `J2405`	$19.40	$59.12	$0.10–$522

Cash price: the discounted price for self-pay patients. List price: the hospital's gross charge. Insurers pay: the lowest and highest rates it lists for insurance plans. Source: WellSpan Good Samaritan Hospital price transparency page.

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Common billing problems to look for

Billed above the posted cash priceIf you're paying yourself, ask the hospital to apply its published cash price.
Panels billed inside panelsA basic metabolic panel (80048) billed with a comprehensive one (80053) on the same day.
Duplicate linesThe same service billed twice without explanation.
No itemized billYou can ask for every line with its code, date and amount.