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 |
|---|---|---|---|---|
| Cystoscopy and treatment CPT 52214 | $3,970.98 | $10,182.00 | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52224 | $3,970.98 | $10,182.00 | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52234 | $6,766.11 | $17,349.00 | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52235 | $6,766.11 | $17,349.00 | $1,937.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52240 | not published | not published | $1,937.00 – $14,605.40 | 5 |
| Cystoscopy and treatment CPT 52260 | not published | not published | $1,694.00 – $5,749.22 | 5 |
| Cystoscopy and treatment CPT 52265 | $3,970.98 | $10,182.00 | $2,572.00 – $5,749.22 | 4 |
| Cystoscopy and treatment CPT 52276 | not published | not published | $1,937.00 – $6,179.00 | 5 |
| Cystoscopy and treatment CPT 52277 | not published | not published | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52283 | not published | not published | $1,694.00 – $6,179.00 | 5 |
| Cystoscopy and treatment CPT 52285 | not published | not published | $1,694.00 – $5,272.00 | 5 |
| Cystoscopy and treatment CPT 52290 | not published | not published | $1,694.00 – $6,179.00 | 5 |
| Cystoscopy and treatment CPT 52300 | not published | not published | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52301 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52305 | not published | not published | $1,694.00 – $14,605.40 | 5 |
| Cystoscopy and treatment CPT 52310 | $4,142.19 | $10,621.00 | $1,694.00 – $5,749.22 | 5 |
| Cystoscopy and treatment CPT 52315 | $4,772.04 | $12,236.00 | $1,694.00 – $6,179.00 | 5 |
| Cystoscopy and treatment CPT 52320 | $3,970.98 | $10,182.00 | $2,664.00 – $9,840.21 | 5 |
| Cystoscopy and treatment CPT 52330 | not published | not published | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy (Bladder Scope) CPT 52000 | $1,619.67 | $4,153.00 | $1,308.00 – $4,066.00 | 5 |
| Cystoscopy chemodenervation CPT 52287 | $3,970.98 | $10,182.00 | $4,714.00 – $5,749.22 | 4 |
| Cystoscopy & duct catheter CPT 52010 | not published | not published | $1,694.00 – $4,714.00 | 5 |
| Cystoscopy implant stent CPT 52282 | not published | not published | $5,809.00 – $9,840.21 | 5 |
| Cystoscopy inject material CPT 52327 | not published | not published | $1,694.00 – $14,605.40 | 5 |
| Cystoscopy prostatic imp 1-3 HCPCS C9739 | not published | not published | $6,179.00 – $14,605.40 | 4 |
| Cystoscopy removal of clots CPT 52001 | $3,970.98 | $10,182.00 | $1,694.00 – $9,840.21 | 5 |
| Cystoscopy & revise urethra CPT 52270 | not published | not published | $1,694.00 – $5,749.22 | 5 |
| Cystoscopy & revise urethra CPT 52275 | not published | not published | $1,694.00 – $6,179.00 | 5 |
| Cystoscopy stone removal CPT 52325 | not published | not published | $2,323.00 – $14,605.40 | 5 |
| Cystoscopy & ureter catheter CPT 52005 | $3,970.98 | $10,182.00 | $1,694.00 – $6,179.00 | 5 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | not published | not published | $2,323.00 – $6,389.00 | 5 |
| Cystotomy/cystostomy fulg+/insj radact matrl 51020 CPT 51020 | not published | not published | $2,323.00 – $9,840.21 | 5 |
| Cystotomy excise/incise/repair 51535 CPT 51535 | not published | not published | $5,063.00 – $9,840.21 | 3 |
| Cystouretero & or pyeloscope CPT 52351 | $4,376.19 | $11,221.00 | $1,937.00 – $9,840.21 | 5 |
| Cysto/uretero stricture tx CPT 52344 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cystouretero w/biopsy CPT 52354 | not published | not published | $2,323.00 – $14,605.40 | 5 |
| Cystouretero w/excise tumor CPT 52355 | not published | not published | $2,323.00 – $14,605.40 | 5 |
| Cysto/uretero w/lithotripsy CPT 52356 | not published | not published | $6,389.00 – $14,605.40 | 4 |
| Cystouretero w/lithotripsy CPT 52353 | $7,873.71 | $20,189.00 | $2,323.00 – $14,605.40 | 5 |
| Cystouretero w/renal strict CPT 52346 | not published | not published | $1,937.00 – $14,605.40 | 5 |
| Cystouretero w/stone remove CPT 52352 | $4,724.46 | $12,114.00 | $2,323.00 – $9,840.21 | 5 |
| Cysto/uretero w/up stricture CPT 52345 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cystourethro cut ejacul duct CPT 52402 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | $2,325.96 | $5,964.00 | $1,694.00 – $5,749.22 | 5 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | $3,970.98 | $10,182.00 | $1,694.00 – $6,179.00 | 5 |
| Cystourethro w/addl implant 52442 CPT 52442 | not published | not published | $2,665.00 – $3,391.00 | 2 |
| Cystourethro w/implant CPT 52441 | not published | not published | $2,665.00 – $5,809.00 | 2 |
| Cysto with bx(s) with blue light HCPCS C7550 | not published | not published | $4,714.00 – $6,859.00 | 2 |
| Cysto w/renal stricture tx CPT 52343 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cysto w/up stricture tx CPT 52342 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cysto w/ureter stricture tx CPT 52341 | not published | not published | $1,937.00 – $9,840.21 | 5 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | not published | not published | $1.51 – $1.51 | 1 |
| Cytarabine liposome inj HCPCS J9098 | not published | not published | $1,197.67 – $1,197.67 | 1 |
| Cytog alys chrml abnr lw-ps CPT 81349 | not published | not published | $4,144.87 – $4,144.87 | 1 |
| Cytogenetics 25-99 CPT 88274 | $216.84 | $556.00 | $60.98 – $146.63 | 4 |
| Cytogenetics 3-5 CPT 88272 | not published | not published | $46.91 – $140.82 | 4 |
| Cytogenomic neo microra alys CPT 81277 | $1,911.78 | $4,902.00 | $1,392.00 – $4,013.60 | 2 |
| Cytogenom microarray copy nmbr var CPT 81228 | $1,564.68 | $4,012.00 | $914.02 – $3,114.00 | 3 |
| Cytomegalovirus ag ia CPT 87332 | not published | not published | $21.02 – $41.45 | 4 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $120.12 | $308.00 | $25.22 – $49.79 | 4 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $153.66 | $394.00 | $29.52 – $58.30 | 4 |
| Cytomegalovirus dfa CPT 87271 | not published | not published | $21.02 – $46.43 | 4 |
| Cytomegalovirus imm IV /vial HCPCS J0850 | not published | not published | $3,457.69 – $6,255.23 | 3 |
| Cytomeg dna dir probe CPT 87495 | not published | not published | $35.12 – $103.90 | 4 |
| Cyto/molecular report CPT 88291 | $91.65 | $235.00 | $35.48 – $48.80 | 3 |
| Cytopath c/v auto in fluid CPT 88174 | $106.47 | $273.00 | $37.43 – $87.78 | 4 |
| Cytopath c/v automated CPT 88147 | not published | not published | $19.94 – $174.94 | 4 |
| Cytopath c/v auto redo CPT 88152 | not published | not published | $18.50 – $95.63 | 4 |
| Cytopath c/v auto rescreen CPT 88148 | not published | not published | $26.63 – $61.45 | 4 |
| Cytopath c/v index add-on CPT 88155 | not published | not published | $10.50 – $50.69 | 4 |
| Cytopath c/v manual CPT 88150 | $8.97 | $23.00 | $18.50 – $61.45 | 4 |
| Cytopath c/v redo CPT 88153 | not published | not published | $18.50 – $83.14 | 4 |
| Cytopath c/v thin layer redo CPT 88143 | not published | not published | $35.50 – $79.72 | 4 |
| Cytopath fl nongyn filter CPT 88106 | not published | not published | $19.80 – $101.32 | 4 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $153.66 | $394.00 | $41.46 – $152.95 | 4 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $117.00 | $300.00 | $46.42 – $92.07 | 4 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | $168.87 | $433.00 | $35.50 – $70.10 | 4 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $125.97 | $323.00 | $19.80 – $113.20 | 4 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $221.13 | $567.00 | $19.80 – $113.20 | 4 |
| Cytopathology fna adequacy evaluation each separate additional episode same site CPT 88177 | $43.68 | $112.00 | $10.22 – $17.15 | 3 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $168.87 | $433.00 | $25.36 – $482.12 | 4 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $463.32 | $1,188.00 | $41.46 – $185.49 | 4 |
| Cytopath smear other source CPT 88160 | $78.39 | $201.00 | $19.80 – $105.41 | 4 |
| Cytopath smear other source CPT 88162 | $792.09 | $2,031.00 | $19.80 – $152.95 | 4 |
| Cytopath smear oth prep screen & interp CPT 88161 | not published | not published | $19.80 – $91.51 | 4 |
| Cytopath tbs c/v auto redo CPT 88166 | not published | not published | $18.50 – $61.45 | 4 |
| Cytopath tbs c/v manual CPT 88164 | not published | not published | $18.50 – $61.45 | 4 |
| Cytopath tbs c/v redo CPT 88165 | not published | not published | $18.50 – $146.08 | 4 |
| Cytopath tbs c/v select CPT 88167 | not published | not published | $18.50 – $61.45 | 4 |
| Cytotoxic antibody screening CPT 86807 | not published | not published | $69.32 – $272.13 | 4 |
| Cytotoxic antibody screening CPT 86808 | not published | not published | $52.00 – $102.69 | 4 |
| Cytp urine 3-5 probes cmptr CPT 88121 | $859.95 | $2,205.00 | $67.70 – $1,142.22 | 4 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | not published | not published | $7.95 – $7.95 | 1 |
| Dactinomycin 0.5 mg intravenous solution HCPCS J9120 | not published | not published | $619.07 – $2,314.39 | 3 |
| Dalbavancin 500 mg intravenous solution HCPCS J0875 | not published | not published | $29.73 – $52.90 | 3 |
| Dalteparin sodium HCPCS J1645 | not published | not published | $26.42 – $26.42 | 1 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | not published | not published | $0.08 – $0.08 | 1 |
| Daptomycin (xellia) unrefrig HCPCS J0872 | not published | not published | $0.08 – $0.08 | 1 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | not published | not published | $97.95 – $169.71 | 3 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | not published | not published | $5.51 – $10.14 | 3 |
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.