Wellstar Sylvan Grove Hospital
1050 Mcdonough Road, Jackson, GA · Wellstar Health System · · NPI 1386664779
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 |
|---|---|---|---|---|
| Cstb gene full gene sequence CPT 81189 | $288.21 | $739.00 | $329.80 – $950.91 | 3 |
| Cstb gene known famil vrnt CPT 81190 | $304.59 | $781.00 | $222.24 – $640.79 | 3 |
| CT 3d report other modality w/workstation CPT 76377 | $613.47 | $1,573.00 | $158.27 – $204.17 | 2 |
| Cta lower extremity without & w/contrast (both sides) CPT 73706 | $1,760.46 | $4,514.00 | $518.62 – $669.95 | 3 |
| CT Angiogram of Abdomen and Pelvis CPT 74174 | $2,770.56 | $7,104.00 | $641.39 – $1,085.52 | 3 |
| CT Angiogram of the Abdomen CPT 74175 | $2,050.23 | $5,257.00 | $497.59 – $670.67 | 3 |
| CT Angiogram of the Abdomen and Both Legs CPT 75635 | $3,444.87 | $8,833.00 | $518.62 – $713.34 | 3 |
| CT Angiogram of the Chest (for blood clot) CPT 71275 | $1,347.84 | $3,456.00 | $480.44 – $664.26 | 3 |
| CT Angiogram of the Head CPT 70496 | $2,136.42 | $5,478.00 | $472.27 – $888.06 | 3 |
| CT Angiogram of the Neck CPT 70498 | $1,769.43 | $4,537.00 | $470.63 – $924.43 | 3 |
| CT angio hrt w/3d image CPT 75574 | $1,403.61 | $3,599.00 | $518.62 – $731.25 | 3 |
| CT angio pelvis CPT 72191 | $1,775.28 | $4,552.00 | $495.14 – $669.25 | 3 |
| Cta upper extremity w &/or without contrast left CPT 73206 | $1,380.60 | $3,540.00 | $518.62 – $597.26 | 3 |
| CT bone density axial CPT 77078 | not published | not published | $235.31 – $256.49 | 3 |
| CT colonography dx CPT 74261 | not published | not published | $310.32 – $893.78 | 4 |
| CT colonography dx w/dye CPT 74262 | not published | not published | $518.62 – $1,001.39 | 4 |
| CT colonography screening CPT 74263 | not published | not published | $1,094.53 – $1,473.93 | 3 |
| CT guidance for needle placement CPT 77012 | $1,776.45 | $4,555.00 | $119.86 – $154.62 | 2 |
| CT guidance for percutaneous drain w/catheter placement supervision & interpretation CPT 75989 | $1,113.84 | $2,856.00 | $113.79 – $774.00 | 2 |
| CT guid cryo ablat intramuscular CPT 20999 | $2,141.10 | $5,490.00 | $665.65 – $3,391.00 | 3 |
| CT guid parench tis ablat CPT 77013 | $1,228.50 | $3,150.00 | $561.74 – $724.64 | 2 |
| CT heart w/evaluation of calcium without contrast CPT 75571 | $1,665.30 | $4,270.00 | $165.86 – $256.49 | 3 |
| CT hrt c+ strux cgen hrt ds CPT 75573 | $1,769.43 | $4,537.00 | $518.62 – $644.30 | 3 |
| CT hrt w/3d image CPT 75572 | $2,075.58 | $5,322.00 | $452.65 – $518.62 | 3 |
| CT limited or localized follow-up study CPT 76380 | $831.87 | $2,133.00 | $196.11 – $256.49 | 4 |
| CT lwr extremity w/o&w/dye CPT 73702 | $1,419.21 | $3,639.00 | $489.41 – $569.46 | 3 |
| Ctrl nosebld postir subsq 30906 CPT 30906 | $1,117.74 | $2,866.00 | $689.46 – $3,391.00 | 5 |
| CT scan for localization CPT 77011 | $959.40 | $2,460.00 | $270.70 – $349.20 | 2 |
| CT scan for therapy guide CPT 77014 | $840.06 | $2,154.00 | $134.22 – $173.14 | 2 |
| CT Scan of Abdomen and Pelvis (with and without contrast) CPT 74178 | $3,133.65 | $8,035.00 | $580.92 – $1,085.52 | 3 |
| CT Scan of Abdomen and Pelvis (with contrast) CPT 74177 | $2,737.80 | $7,020.00 | $505.75 – $1,085.52 | 3 |
| CT Scan of Abdomen and Pelvis (without contrast) CPT 74176 | $2,224.17 | $5,703.00 | $260.64 – $691.66 | 3 |
| CT t-spine w /wo contrast CPT 72130 | $2,033.46 | $5,214.00 | $477.15 – $542.38 | 3 |
| CT uppr extremity w/o&w/dye CPT 73202 | $1,382.16 | $3,544.00 | $496.77 – $570.88 | 3 |
| Cultr oocyte/embryo <4 days CPT 89250 | not published | not published | $65.18 – $2,375.09 | 4 |
| Cultr oocyte/embryo <4 days CPT 89251 | not published | not published | $65.18 – $2,470.68 | 4 |
| Cult skin graft fnhfg 15155 CPT 15155 | not published | not published | $1,694.00 – $10,126.62 | 5 |
| Cult skin grft t/arm/leg CPT 15150 | not published | not published | $1,694.00 – $5,272.00 | 5 |
| Culture aerobic additional method definitive id each CPT 87077 | $96.72 | $248.00 | $14.16 – $27.96 | 4 |
| Culture afb any source CPT 87116 | $145.86 | $374.00 | $18.94 – $37.37 | 4 |
| Culture anaerobic additional method definitive id each CPT 87076 | $104.52 | $268.00 | $14.16 – $27.96 | 4 |
| Culture anaerobic except blood CPT 87075 | $159.90 | $410.00 | $16.57 – $32.77 | 4 |
| Culture bacteria anaerobic CPT 87073 | $132.99 | $341.00 | $16.52 – $33.42 | 4 |
| Culture bacterial urine HCPCS P7001 | not published | not published | $18.61 – $18.61 | 1 |
| Culture bact stool aero addl path ea CPT 87046 | $93.21 | $239.00 | $16.52 – $32.66 | 4 |
| Culture body fluid CPT 87070 | $159.90 | $410.00 | $15.08 – $29.83 | 4 |
| Culture fungi definitive id mold CPT 87107 | $100.62 | $258.00 | $18.08 – $35.71 | 4 |
| Culture fungi definitive id yeast CPT 87106 | $100.62 | $258.00 | $18.08 – $35.71 | 4 |
| Culture fungi other (except blood) CPT 87102 | $271.44 | $696.00 | $14.71 – $29.10 | 4 |
| Culture fungi skin/hair/nail CPT 87101 | $161.46 | $414.00 | $13.51 – $26.68 | 4 |
| Culture mycobacteria definitive id each isolate CPT 87118 | $88.14 | $226.00 | $19.18 – $50.55 | 4 |
| Culture mycoplasma any source CPT 87109 | $219.57 | $563.00 | $26.96 – $53.25 | 4 |
| Culture of specimen by kit CPT 87084 | not published | not published | $15.08 – $93.66 | 4 |
| Culture quantitative aerobic other source CPT 87071 | $159.90 | $410.00 | $16.52 – $34.22 | 4 |
| Culture screening strep group a CPT 87081 | $159.90 | $410.00 | $11.63 – $22.94 | 4 |
| Culture type pulse field gel CPT 87152 | not published | not published | $9.17 – $26.78 | 4 |
| Culture typing added method CPT 87158 | $10.92 | $28.00 | $9.17 – $26.78 | 4 |
| Culture typing glc/hplc CPT 87143 | not published | not published | $21.95 – $43.32 | 4 |
| Culture typing immunologic CPT 87147 | $44.46 | $114.00 | $9.07 – $17.92 | 4 |
| Culture typing nucleic acid probe amplified per culture/isolate 6 or more targets CPT 87154 | $306.15 | $785.00 | $261.67 – $754.49 | 2 |
| Culture typing nucleic acid probe amplified per culture/isolate each organism CPT 87150 | $159.12 | $408.00 | $60.32 – $121.41 | 4 |
| Culture urine each isolate CPT 87088 | $72.15 | $185.00 | $14.18 – $27.99 | 4 |
| Culture virus isolation CPT 87250 | $165.75 | $425.00 | $34.26 – $67.68 | 4 |
| Curette/treat cornea CPT 65435 | $1,175.85 | $3,015.00 | $2,572.00 – $5,272.00 | 4 |
| Curette/treat cornea CPT 65436 | $2,818.14 | $7,226.00 | $3,391.00 – $6,595.97 | 3 |
| Cutter lead HCPCS C1773 | $12,372.27 | $31,723.78 | not published | 0 |
| Cv line/pic reposition CPT 36597 | $2,498.73 | $6,407.00 | $2,572.00 – $4,520.58 | 4 |
| Cyanocobalamin unsat binding capacity CPT 82608 | $65.52 | $168.00 | $25.09 – $49.55 | 4 |
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | not published | not published | $2.42 – $2.42 | 1 |
| Cyclic citrullinated peptide antibody CPT 86200 | $128.70 | $330.00 | $22.69 – $44.81 | 4 |
| Cyclophosphamide 100 mg inj HCPCS J9070 | not published | not published | $63.28 – $69.72 | 2 |
| Cyclophosphamide 1 gram intravenous powder for solution HCPCS J9075 | not published | not published | $1.68 – $1.68 | 1 |
| Cyclophosphamide 25 mg capsule HCPCS J8530 | not published | not published | $1.60 – $1.60 | 1 |
| Cyclosporine 250 mg/5 ml intravenous solution HCPCS J7516 | not published | not published | $136.01 – $136.01 | 1 |
| Cyclosporine 2 hour CPT 80158 | $130.65 | $335.00 | $31.63 – $62.45 | 4 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | not published | not published | $1.58 – $1.58 | 1 |
| Cyclosporine oral 100 mg HCPCS J7502 | not published | not published | $4.19 – $4.19 | 1 |
| Cygnus matrix, per sq cm HCPCS Q4199 | not published | not published | $693.38 – $693.38 | 1 |
| Cygnus, per sq cm HCPCS Q4170 | not published | not published | $1,846.91 – $1,846.91 | 1 |
| Cylinder pump set 20cm titan zero angl HCPCS C1813 | $33,196.18 | $85,118.40 | not published | 0 |
| Cymetra injectable HCPCS Q4112 | not published | not published | $1,662.18 – $1,662.18 | 1 |
| Cyp2c19 gene com variants CPT 81225 | $290.16 | $744.00 | $350.16 – $1,008.11 | 4 |
| Cyp2c9 gene com variants CPT 81227 | $287.82 | $738.00 | $210.10 – $604.84 | 4 |
| Cyp2d6 gene com variants CPT 81226 | $644.67 | $1,653.00 | $541.91 – $1,560.15 | 4 |
| Cyp3a4 gene common variants CPT 81230 | $245.31 | $629.00 | $209.77 – $604.84 | 4 |
| Cyp3a5 gene common variants CPT 81231 | $245.31 | $629.00 | $209.77 – $604.84 | 4 |
| Cystatin c CPT 82610 | $122.46 | $314.00 | $23.82 – $64.08 | 4 |
| Cystic fibrosis cftr CPT 81223 | not published | not published | $598.80 – $1,726.54 | 3 |
| Cystine urine quantitative CPT 82131 | $459.42 | $1,178.00 | $29.56 – $79.51 | 4 |
| Cysto cgen post urtl valves CPT 52400 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cystogram >= 3 views supervision & interpretation CPT 74430 | $256.62 | $658.00 | $49.85 – $1,085.52 | 4 |
| Cysto impl 4 or more HCPCS C9740 | not published | not published | $6,760.00 – $26,003.15 | 3 |
| Cysto insj dev ischmc rmdlg CPT 53865 | not published | not published | $5,809.00 – $6,179.00 | 2 |
| Cysto, litho, vacuum kidney HCPCS C9761 | not published | not published | $6,179.00 – $26,003.15 | 3 |
| Cystometrogram w/up 51727 CPT 51727 | not published | not published | $1,928.18 – $4,066.00 | 3 |
| Cystorrhaphy wound comp 51865 CPT 51865 | not published | not published | $2,323.00 – $8,448.00 | 3 |
| Cystorrhaphy wound simple 51860 CPT 51860 | not published | not published | $4,714.00 – $26,003.15 | 3 |
| Cysto rx balo cath urtl strx CPT 52284 | not published | not published | $5,809.00 – $14,605.40 | 3 |
| Cystoscopy and biopsy CPT 52007 | not published | not published | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and radiotracer CPT 52250 | $6,600.75 | $16,925.00 | $2,323.00 – $9,840.21 | 5 |
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.