Good Samaritan Hospital
Good Samaritan Hospital in Lebanon, PA publishes cash prices for 35 common procedures listed here, from its own machine-readable price file updated —. Click a procedure to compare it with other hospitals nearby.
252 S. 4th St., Lebanon, PA 17042 Collected Sep 22, 2026 Source price file
Scans and imaging
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| CT scan of abdomen and pelvis, with contrast dye CPT 74177 CT Scan of Abdomen and Pelvis With Contrast | $437.50 | $3,012.00 | 85% |
| CT scan of the head or brain, no contrast dye CPT 70450 CT Scan Head or Brain Without Contrast | $296.00 | $1,610.00 | 82% |
| CT scan of the pelvis, with contrast dye CPT 72193 CT Scan of Pelvis With Contrast | $475.50 | $2,362.00 | 80% |
| Diagnostic mammogram, both breasts CPT 77066 Diagnostic Mammography of Both Breasts | $208.00 | $564.00 | 63% |
| Diagnostic mammogram, one breast CPT 77065 Diagnostic Mammography of 1 Breast | $222.00 | $499.00 | 56% |
| MRI of knee or other lower-limb joint, no contrast dye CPT 73721 MRI Scan of Leg Joint Without Contrast | $462.00 | $2,225.00 | 79% |
| MRI of knee or other lower-limb joint, without and then with contrast dye CPT 73723 MRI Scan of Leg Joint Before and After Contrast | $712.50 | $2,805.00 | 75% |
| MRI of the brain, no contrast dye CPT 70551 MRI Scan of Brain Without Contrast | $455.00 | $2,225.00 | 80% |
| MRI of the brain, with and without contrast dye CPT 70553 MRI Scan of Brain Before and After Contrast | $701.50 | $2,390.00 | 71% |
| MRI of the lower back, no contrast dye CPT 72148 MRI Scan of Lower Spinal Canal Without Contrast | $454.00 | $2,225.00 | 80% |
| Pregnancy ultrasound after 14 weeks, one baby CPT 76805 Ultrasound Scan of Pregnant Uterus (14 Weeks or More), Single or 1st Fetus | $1,080.00 | $1,350.00 | 20% |
| Screening mammogram, both breasts CPT 77067 Screening Mammography | $225.00 | $427.00 | 47% |
| Sleep study in a lab (polysomnography) CPT 95810 Sleep Study in Sleep Lab (6 Years or Older) | $3,935.20 | $4,919.00 | 20% |
| Transvaginal pelvic ultrasound CPT 76830 Ultrasound of Uterus, Ovaries, Tubes, Cervix and Pelvic Area Through Vagina | $708.80 | $886.00 | 20% |
| Ultrasound of the abdomen, complete CPT 76700 Complete Ultrasound Scan of Abdomen | $1,753.60 | $2,192.00 | 20% |
| X-ray of the lower back, 4 or more views CPT 72110 X-Ray of Lower and Sacral Spine, Minimum of 4 Views | $526.40 | $658.00 | 20% |
Lab tests
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| Basic metabolic panel (blood test) CPT 80048 Blood Test, Basic Group of Blood Chemicals (Calcium, Total) | $20.00 | $46.00 | 57% |
| Cholesterol and triglycerides (lipid panel) blood test CPT 80061 Blood Test, Lipids (Cholesterol and Triglycerides) | $40.00 | $70.00 | 43% |
| Complete blood count (CBC) with differential CPT 85025 Complete Blood Cell Count, With Diff | $15.00 | $74.00 | 80% |
| Complete blood count (CBC), no differential CPT 85027 Complete Blood Cell Count, W/O Diff | $15.00 | $61.00 | 75% |
| Comprehensive metabolic panel (blood test) CPT 80053 Blood Test, Comprehensive Group of Blood Chemicals | $25.00 | $57.00 | 56% |
| Kidney function blood test panel CPT 80069 Kidney Function Blood Test Panel | $36.00 | $45.00 | 20% |
| Liver function blood test panel CPT 80076 Liver Function Blood Test Panel | $25.00 | $43.00 | 42% |
| Obstetric blood test panel CPT 80055 Obstetric Blood Test Panel | $190.00 | $249.00 | 24% |
| PSA (prostate-specific antigen) blood test, free CPT 84154 Psa (Prostate Specific Antigen) Measurement, Free | $45.00 | $96.00 | 53% |
| PSA (prostate-specific antigen) blood test, total CPT 84153 Psa (Prostate Specific Antigen) Measurement, Total | $45.00 | $96.00 | 53% |
| Partial thromboplastin time (PTT) clotting test CPT 85730 Coagulation Assessment Blood Test, Plasma or Whole Blood | $30.00 | $57.00 | 47% |
| Prothrombin time (PT/INR) clotting test CPT 85610 Blood Test, Clotting Time | $15.00 | $44.00 | 66% |
| Thyroid-stimulating hormone (TSH) blood test CPT 84443 Blood Test, Thyroid Stimulating Hormone (Tsh) | $40.00 | $119.00 | 66% |
| Urinalysis with microscope exam, automated CPT 81001 Manual Urinalysis Test With Examination Using Microscope, Automated | $10.00 | $21.00 | 52% |
| Urinalysis without microscope exam, automated CPT 81003 Automated Urinalysis Test | $10.00 | $11.00 | 9% |
Doctor visits and therapy
| Procedure | Cash price | List price | Off list |
|---|---|---|---|
| New patient office visit, about 30 minutes CPT 99203 Lc New Patient Visit Level 3 | $122.40 | $153.00 | 20% |
| New patient office visit, about 30 minutes CPT 99203 New Outpatient Visit Level 3 or Over 30 Minutes | $239.20 | $299.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 Lc New Patient Visit Level 4 | $175.20 | $219.00 | 20% |
| New patient office visit, about 45 minutes CPT 99204 New Outpatient Visit Level 4 or Over 45 Minutes | $388.80 | $486.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 Lc New Patient Visit Level 5 | $231.20 | $289.00 | 20% |
| New patient office visit, about 60 minutes CPT 99205 New Outpatient Visit Level 5 or Over 60 Minutes | $413.60 | $517.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Occupational Therapy, Each 15 Minutes | $204.00 | $255.00 | 20% |
| Physical therapy, therapeutic exercise (15-minute unit) CPT 97110 Physical Therapy, Each 15 Minutes | $204.00 | $255.00 | 20% |