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 |
|---|---|---|---|---|
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | not published | not published | $16.81 – $16.81 | 1 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | not published | not published | $9,663.38 – $16,529.94 | 3 |
| Digoxin total therapeutic drug level CPT 80162 | $124.80 | $320.00 | $23.27 – $45.95 | 4 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | not published | not published | $78.22 – $78.22 | 1 |
| Dilate biliary duct/ampulla CPT 47542 | $1,156.74 | $2,966.00 | $2,665.00 – $3,391.00 | 2 |
| Dilate esophagus CPT 43453 | $2,003.04 | $5,136.00 | $1,308.00 – $5,371.00 | 5 |
| Dilate esophagus 1/mult pass CPT 43450 | not published | not published | $1,308.00 – $5,272.00 | 5 |
| Dilate ic vasospasm ea add vsl diff territory CPT 61642 | $5,382.39 | $13,801.00 | $3,437.00 – $6,859.00 | 3 |
| Dilate ic vasospasm ea add vsl same territory CPT 61641 | $3,589.17 | $9,203.00 | $3,437.00 – $6,859.00 | 3 |
| Dilate ic vasospasm init CPT 61640 | $6,280.95 | $16,105.00 | $4,220.00 – $6,859.00 | 3 |
| Dilate tear duct opening CPT 68801 | $80.73 | $207.00 | $1,124.66 – $5,063.00 | 3 |
| Dilate urethra stricture CPT 53600 | $1,503.84 | $3,856.00 | $697.61 – $3,391.00 | 4 |
| Dilate urethra stricture CPT 53601 | not published | not published | $360.57 – $3,391.00 | 4 |
| Dilate urethra stricture CPT 53605 | $1,368.12 | $3,508.00 | $1,694.00 – $9,840.21 | 5 |
| Dilate urethra stricture CPT 53621 | not published | not published | $697.61 – $3,391.00 | 5 |
| Dilation/female urethra/initial 53660 CPT 53660 | $714.87 | $1,833.00 | $440.91 – $3,391.00 | 3 |
| Dilation of anal sphincter CPT 45905 | not published | not published | $1,308.00 – $5,272.00 | 5 |
| Dilation of cervical canal 57800 CPT 57800 | not published | not published | $1,308.00 – $8,824.63 | 5 |
| Dilation of rectal stricture 45910 CPT 45910 | not published | not published | $1,308.00 – $5,272.00 | 5 |
| Dilation of salivary duct CPT 42660 | not published | not published | $1,553.04 – $3,391.00 | 3 |
| Dilation of urethra CPT 53661 | not published | not published | $360.57 – $5,063.00 | 3 |
| Dilation of urethra CPT 53665 | $2,507.31 | $6,429.00 | $1,308.00 – $6,179.00 | 5 |
| Dilation of vagina CPT 57400 | not published | not published | $1,694.00 – $8,824.63 | 5 |
| Dilation salivary duct 42650 CPT 42650 | not published | not published | $2,572.00 – $5,272.00 | 4 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $2,507.31 | $6,429.00 | $1,928.18 – $4,066.00 | 3 |
| Dilator fascial 10fx20cm HCPCS C2627 | $286.59 | $734.85 | not published | 0 |
| Dilat xst trc ndurlgc px CPT 50436 | $4,820.40 | $12,360.00 | $3,391.00 – $9,840.21 | 4 |
| Dilat xst trc new access rcs CPT 50437 | $8,110.83 | $20,797.00 | $4,714.00 – $9,840.21 | 3 |
| Dimecaprol injection HCPCS J0470 | not published | not published | $103.97 – $179.00 | 2 |
| Dimenhydrinate injection HCPCS J1240 | not published | not published | $16.53 – $16.53 | 1 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | not published | not published | $1,363.53 – $2,355.64 | 3 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | not published | not published | $0.04 – $0.04 | 1 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | not published | not published | $1.39 – $1.39 | 1 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | not published | not published | $141.08 – $141.08 | 1 |
| Dipyridamole injection HCPCS J1245 | not published | not published | $7.38 – $7.38 | 1 |
| Disability dlco CPT 94727 | $574.86 | $1,474.00 | $440.91 – $440.91 | 1 |
| Disaccharidases CPT 82657 | $249.21 | $639.00 | $31.64 – $76.71 | 4 |
| Disarticulation sho sec clsr CPT 23921 | not published | not published | $1,937.00 – $5,809.00 | 5 |
| Disarticulation shoulder CPT 23920 | not published | not published | $5,063.00 – $15,026.00 | 2 |
| Discectomy ant dcmprn cord thoracic 1 ntrspc 63077 CPT 63077 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Discectomy ant dcmprn cord thoracic ea ntrsp 63078 CPT 63078 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Discography cerv/thor spine CPT 72285 | $1,921.92 | $4,928.00 | $120.11 – $5,449.92 | 4 |
| Dise eval slp do brth flx dx CPT 42975 | not published | not published | $2,665.00 – $4,790.79 | 3 |
| Dissect brain w/scope CPT 62161 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Dissolve clot heart vessel CPT 92975 | $3,256.89 | $8,351.00 | $6,859.00 – $6,859.00 | 1 |
| Dist revas ligation hemo CPT 36838 | not published | not published | $6,389.00 – $15,511.46 | 3 |
| Div aberrant vsl w/reanast CPT 33803 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | not published | not published | $6,760.00 – $16,529.94 | 3 |
| Division of fallopian tube 58605 CPT 58605 | not published | not published | $4,714.00 – $5,272.00 | 2 |
| #d/lmeth-l-methamphetamine CPT 80374 | not published | not published | $25.44 – $25.44 | 1 |
| Dlyd plmt xtn prosth ea addl CPT 34711 | not published | not published | $3,391.00 – $6,859.00 | 2 |
| Dmd dup/delet analysis CPT 81161 | not published | not published | $168.17 – $965.34 | 3 |
| Dmpk gene charac alleles CPT 81239 | $452.40 | $1,160.00 | $329.80 – $950.91 | 3 |
| Dmpk gene detc abnor allele CPT 81234 | $318.75 | $817.30 | $164.40 – $474.02 | 3 |
| Dna antibody native/double stranded CPT 86225 | $160.68 | $412.00 | $24.07 – $47.54 | 4 |
| Dna gardnerella CPT 87510 | $86.58 | $222.00 | $35.12 – $69.37 | 4 |
| Dna probe chlamydia CPT 87490 | $271.05 | $695.00 | $35.12 – $78.72 | 4 |
| Dna probe gc CPT 87590 | not published | not published | $35.12 – $93.00 | 4 |
| Dna trichomonas CPT 87660 | $76.44 | $196.00 | $35.12 – $69.37 | 4 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $20.94 | $53.70 | $14.09 – $14.09 | 1 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | not published | not published | $1.35 – $1.35 | 1 |
| Docetaxel (docivyx), 1 mg HCPCS J9172 | not published | not published | $99.51 – $152.59 | 2 |
| Dolasetron mesylate HCPCS J1260 | not published | not published | $11.76 – $11.76 | 1 |
| Dolasetron mesylate oral HCPCS Q0180 | not published | not published | $117.26 – $117.26 | 1 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | not published | not published | $1.47 – $1.47 | 1 |
| Doppler echo complete CPT 93320 | $389.61 | $999.00 | $95.41 – $123.08 | 2 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $1,238.64 | $3,176.00 | $2,665.00 – $2,665.00 | 1 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $486.33 | $1,247.00 | $266.37 – $570.57 | 3 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $798.33 | $2,047.00 | $175.67 – $377.23 | 3 |
| Doripenem 50 mg/ml inj 10 ml HCPCS J1267 | not published | not published | $1.68 – $1.68 | 1 |
| Dornase alfa non-comp unit HCPCS J7639 | not published | not published | $102.14 – $102.14 | 1 |
| Dornhoffer fixed part w/window HCPCS L8614 | $48,793.00 | $125,110.26 | $1,308.00 – $1,308.00 | 1 |
| Dostarlimab-gxly 50 mg/ml intravenous solution HCPCS J9272 | not published | not published | $457.55 – $807.08 | 3 |
| Double transfer toe-hand CPT 26554 | not published | not published | $1,694.00 – $11,889.00 | 3 |
| Doxorubicin 2 mg/ml intravenous solution (wrapper) HCPCS J9000 | not published | not published | $6.33 – $6.33 | 1 |
| Doxorubicin, pegylated liposomal 2 mg/ml intravenous suspension HCPCS Q2050 | not published | not published | $259.31 – $473.87 | 3 |
| Dpyd gene common variants CPT 81232 | $453.57 | $1,163.00 | $209.77 – $604.84 | 4 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $794.82 | $2,038.00 | $1,985.95 – $5,063.00 | 3 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $710.58 | $1,822.00 | $1,985.95 – $4,066.00 | 3 |
| Drainage external ear complex 69005 CPT 69005 | $9,703.59 | $24,881.00 | $1,694.00 – $5,272.00 | 4 |
| Drainage external ear simple 69000 CPT 69000 | $794.82 | $2,038.00 | $1,985.95 – $4,066.00 | 3 |
| Drainage lymph node lesion 38300 CPT 38300 | not published | not published | $1,308.00 – $8,020.55 | 5 |
| Drainage lymph node lesion 38305 CPT 38305 | not published | not published | $1,694.00 – $8,020.55 | 5 |
| Drainage mouth roof lesion CPT 42000 | $1,661.79 | $4,261.00 | $689.46 – $4,714.00 | 5 |
| Drainage of abdomen CPT 48000 | $6,075.03 | $15,577.00 | $5,063.00 – $6,859.00 | 2 |
| Drainage of arm bursa 23931 CPT 23931 | $4,476.81 | $11,479.00 | $1,694.00 – $5,272.00 | 5 |
| Drainage of bladder abscess CPT 51080 | not published | not published | $1,308.00 – $8,020.55 | 5 |
| Drainage of bone lesion CPT 26992 | not published | not published | $1,694.00 – $11,889.00 | 3 |
| Drainage of bone lesion CPT 27303 | not published | not published | $1,694.00 – $11,889.00 | 3 |
| Drainage of eye CPT 65800 | $1,726.53 | $4,427.00 | $1,308.00 – $6,577.81 | 5 |
| Drainage of eye CPT 65810 | not published | not published | $1,937.00 – $6,577.81 | 5 |
| Drainage of eye CPT 65815 | not published | not published | $1,694.00 – $6,577.81 | 5 |
| Drainage of forearm bursa CPT 25031 | not published | not published | $1,694.00 – $6,179.00 | 5 |
| Drainage of kidney lesion CPT 50390 | $3,883.62 | $9,958.00 | $1,308.00 – $4,066.00 | 5 |
| Drainage of mouth lesion CPT 41005 | $284.70 | $730.00 | $689.46 – $3,391.00 | 5 |
| Drainage of mouth lesion CPT 41006 | not published | not published | $1,308.00 – $5,272.00 | 5 |
| Drainage of mouth lesion CPT 41007 | not published | not published | $1,308.00 – $5,272.00 | 5 |
| Drainage of mouth lesion CPT 41008 | $7,569.90 | $19,410.00 | $1,308.00 – $9,087.85 | 5 |
| Drainage of mouth lesion CPT 41009 | $1,416.48 | $3,632.00 | $1,308.00 – $3,391.00 | 5 |
| Drainage of mouth lesion CPT 41015 | not published | not published | $1,308.00 – $3,391.00 | 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.