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 |
|---|---|---|---|---|
| Injection, casimersen, 10 mg HCPCS J1426 | not published | not published | $311.06 – $497.49 | 3 |
| Injection, cimetidine hydroc HCPCS S0023 | not published | not published | $4.65 – $4.65 | 1 |
| Injection, daratumumab 10 mg HCPCS J9145 | not published | not published | $124.50 – $213.52 | 3 |
| Injection, delafloxacin HCPCS C9462 | not published | not published | $0.91 – $0.91 | 1 |
| Injection, doxercalciferol HCPCS J1270 | not published | not published | $0.72 – $0.72 | 1 |
| Injection during cath supravalvular aortography CPT 93567 | $1,783.08 | $4,572.00 | $2,665.00 – $2,665.00 | 1 |
| Injection, edaravone, 1 mg HCPCS J1301 | not published | not published | $41.32 – $75.50 | 3 |
| Injection epidural blood patch or clot CPT 62273 | $1,987.44 | $5,096.00 | $1,308.00 – $4,066.00 | 5 |
| Injection estrone per 1 mg HCPCS J1435 | not published | not published | $0.46 – $0.46 | 1 |
| Injection eye drug CPT 67028 | $709.80 | $1,820.00 | $955.94 – $3,391.00 | 4 |
| Injection, famotidine, 20 mg HCPCS S0028 | not published | not published | $1.73 – $1.73 | 1 |
| Injection for arthrography wrist (both sides) CPT 25246 | $588.12 | $1,508.00 | $2,665.00 – $3,391.00 | 2 |
| Injection for bladder x-ray CPT 51600 | $890.37 | $2,283.00 | $1,308.00 – $5,063.00 | 3 |
| Injection for hip x-ray CPT 27095 | $1,529.58 | $3,922.00 | $2,665.00 – $3,391.00 | 2 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $591.63 | $1,517.00 | $2,665.00 – $3,391.00 | 2 |
| Injection for spleen x-ray CPT 38200 | not published | not published | $2,665.00 – $3,391.00 | 2 |
| Injection for tear sac x-ray CPT 68850 | $504.27 | $1,293.00 | $2,665.00 – $3,391.00 | 2 |
| Injection for ureter x-ray CPT 50684 | $219.18 | $562.00 | $1,308.00 – $3,391.00 | 3 |
| Injection for ureter x-ray CPT 50690 | $742.17 | $1,903.00 | $1,308.00 – $3,391.00 | 3 |
| Injection, fosphenytoin sodi HCPCS S0078 | not published | not published | $71.76 – $71.76 | 1 |
| Injection, fulvestrant HCPCS J9395 | not published | not published | $12.69 – $30.77 | 3 |
| Injection glatiramer acetate HCPCS J1595 | not published | not published | $111.79 – $517.42 | 3 |
| Injection, glucarpidase HCPCS C9293 | not published | not published | $800.48 – $800.48 | 1 |
| Injection, inclisiran, 1 mg HCPCS J1306 | not published | not published | $23.41 – $41.97 | 2 |
| Injection into brain canal CPT 61026 | not published | not published | $1,308.00 – $4,066.00 | 5 |
| Injection into brain canal CPT 61055 | $1,266.72 | $3,248.00 | $836.02 – $3,391.00 | 5 |
| Injection into hemorrhoid(s) CPT 46500 | not published | not published | $2,579.78 – $5,063.00 | 3 |
| Injection into spinal artery CPT 62294 | not published | not published | $1,937.00 – $5,809.00 | 5 |
| Injection into vocal cord CPT 31513 | not published | not published | $1,152.56 – $4,714.00 | 5 |
| Injection intraop add-on CPT 48400 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Injection, isavuconazonium HCPCS J1833 | not published | not published | $2.00 – $2.93 | 3 |
| Injection jaw joint x-ray CPT 21116 | $451.23 | $1,157.00 | $2,665.00 – $3,391.00 | 2 |
| Injection jugular CPT 36299 | $1,134.12 | $2,908.00 | $2,665.00 – $5,063.00 | 2 |
| Injection, khapzory, 0.5 mg HCPCS J0642 | not published | not published | $2.57 – $5.29 | 3 |
| Injection, necitumumab, 1 mg HCPCS J9295 | not published | not published | $10.92 – $19.86 | 3 |
| Injection of HIV prep drug HCPCS G0012 | not published | not published | $198.84 – $198.84 | 1 |
| Injection of sinus tract CPT 20500 | $2,436.33 | $6,247.00 | $3,391.00 – $5,272.00 | 3 |
| Injection,onabotulinumtoxina HCPCS J0585 | $131.04 | $336.00 | $11.87 – $21.90 | 3 |
| Injection, pentamidine iseth HCPCS S0080 | not published | not published | $189.93 – $189.93 | 1 |
| Injection, peramivir HCPCS J2547 | not published | not published | $3.09 – $5.02 | 3 |
| Injection, piperacillin sodi HCPCS S0081 | not published | not published | $3.39 – $3.39 | 1 |
| Injection px peyronie ds CPT 54200 | $471.51 | $1,209.00 | $697.61 – $5,063.00 | 4 |
| Injection radioactive tracer sentinel node (both sides) CPT 38792 | $1,164.93 | $2,987.00 | $1,164.18 – $3,391.00 | 4 |
| Injection, renflexis HCPCS Q5104 | not published | not published | $50.05 – $161.92 | 3 |
| Injection, ruconest HCPCS J0596 | not published | not published | $66.08 – $115.94 | 3 |
| Injection sacroiliac joint anesthesia/steroid without or w/arthrography (both sides) HCPCS G0260 | $1,895.01 | $4,859.00 | $1,308.00 – $4,066.00 | 5 |
| Injection(s) anesthetic agent(s) and/or steroid femoral nerve left CPT 64447 | $2,867.67 | $7,353.00 | $1,952.00 – $5,063.00 | 4 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $2,049.06 | $5,254.00 | $1,308.00 – $4,066.00 | 5 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $4,175.73 | $10,707.00 | $1,308.00 – $4,066.00 | 5 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $1,346.28 | $3,452.00 | $2,665.00 – $3,391.00 | 2 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $2,719.08 | $6,972.00 | $2,572.00 – $4,066.00 | 4 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $1,346.28 | $3,452.00 | $2,665.00 – $3,391.00 | 2 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $3,041.22 | $7,798.00 | $2,572.00 – $4,066.00 | 4 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $6,020.82 | $15,438.00 | $1,952.00 – $4,066.00 | 4 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,758.12 | $4,508.00 | $1,952.00 – $4,066.00 | 4 |
| Injection, siltuximab HCPCS J2860 | not published | not published | $297.28 – $515.33 | 3 |
| Injection(s) tendon sheath/ligament aponeurosis single (both sides) CPT 20550 | $1,396.20 | $3,580.00 | $836.02 – $3,391.00 | 5 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $1,210.56 | $3,104.00 | $836.02 – $3,391.00 | 4 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $1,248.00 | $3,200.00 | $836.02 – $3,391.00 | 4 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $164.96 | $422.98 | not published | 0 |
| Injection, ticarcillin disod HCPCS S0040 | not published | not published | $25.92 – $25.92 | 1 |
| Injection torsemide 10 mg/ml HCPCS J3265 | not published | not published | $4.17 – $4.17 | 1 |
| Injection treatment of eye CPT 66020 | $2,601.69 | $6,671.00 | $1,308.00 – $6,577.81 | 5 |
| Injection treatment of eye CPT 66030 | $1,022.19 | $2,621.00 | $1,308.00 – $6,577.81 | 5 |
| Injection treatment of nerve CPT 64605 | $4,535.70 | $11,630.00 | $1,308.00 – $6,179.00 | 5 |
| Injection treatment of nerve CPT 64610 | $4,535.70 | $11,630.00 | $1,308.00 – $6,179.00 | 5 |
| Injection treatment of nerve CPT 64681 | not published | not published | $1,694.00 – $4,714.00 | 5 |
| Injection treatment of nose CPT 30200 | not published | not published | $1,553.04 – $5,063.00 | 4 |
| Inject sacroiliac joint CPT 27096 | not published | not published | $2,665.00 – $3,391.00 | 2 |
| Inject/treat eye socket CPT 67500 | $282.36 | $724.00 | $822.27 – $5,063.00 | 3 |
| Inject/treat eye socket CPT 67505 | not published | not published | $822.27 – $3,391.00 | 4 |
| Inject/treat eye socket CPT 67515 | $670.02 | $1,718.00 | $822.27 – $3,391.00 | 4 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | not published | not published | $63.09 – $111.55 | 2 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $42.20 – $102.69 | 2 |
| Inj., emapalumab-lzsg, 1 mg HCPCS J9210 | not published | not published | $717.74 – $1,299.78 | 3 |
| Inj., emicizumab-kxwh 0.5 mg HCPCS J7170 | not published | not published | $99.15 – $175.25 | 3 |
| Inj epidural sgl cerv-thor without img CPT 62320 | $1,895.01 | $4,859.00 | $1,952.00 – $4,066.00 | 4 |
| Inj epidural sgl lumb-sacral without img CPT 62322 | $1,740.18 | $4,462.00 | $2,572.00 – $4,066.00 | 4 |
| Inj, epinephrine (belcher) HCPCS J0173 | not published | not published | $4.54 – $6.19 | 2 |
| Inj., eravacycline, 1 mg HCPCS J0122 | not published | not published | $2.34 – $3.91 | 2 |
| Inj, etelcalcetide, 0.1 mg HCPCS J0606 | not published | not published | $7.64 – $7.68 | 2 |
| Inj, eteplirsen, 10 mg HCPCS J1428 | not published | not published | $311.06 – $311.06 | 1 |
| Inj, evinacumab-dgnb, 5mg HCPCS J1305 | not published | not published | $355.11 – $619.82 | 3 |
| Inj., evomela, 1 mg HCPCS J9246 | not published | not published | $34.31 – $57.06 | 3 |
| Inj, factor x, (human), 1iu HCPCS J7175 | not published | not published | $18.16 – $31.52 | 3 |
| Inj, faricimab-svoa, 0.1mg HCPCS J2777 | not published | not published | $67.19 – $124.87 | 2 |
| Inj fe-based mr contrast,1ml HCPCS Q9953 | not published | not published | $118.27 – $118.27 | 1 |
| Inj. fe derisomaltose 10 mg HCPCS J1437 | not published | not published | $39.59 – $65.26 | 3 |
| Inj fensolvi 0.25 mg HCPCS J1951 | not published | not published | $260.13 – $456.10 | 3 |
| Inj ferric pyrophosphate cit HCPCS J1443 | not published | not published | $0.06 – $0.06 | 1 |
| Inj., fibryga, 1 mg HCPCS J7177 | not published | not published | $2.12 – $3.81 | 2 |
| Inj fluphenazine hcl 1.25 mg HCPCS J2679 | not published | not published | $14.66 – $14.66 | 1 |
| Inj, focinvez, 1mg HCPCS J1434 | not published | not published | $5.93 – $9.40 | 2 |
| Inj follitropin alfa 75 iu HCPCS S0126 | not published | not published | $469.52 – $469.52 | 1 |
| Inj follitropin beta 75 iu HCPCS S0128 | not published | not published | $422.85 – $422.85 | 1 |
| Inj for ext venography CPT 36005 | $394.29 | $1,011.00 | $2,665.00 – $3,391.00 | 2 |
| Inj for mammo ductogram CPT 19030 | $1,127.49 | $2,891.00 | $2,665.00 – $3,391.00 | 2 |
| Inj, fosaprepitant (teva) HCPCS J1456 | not published | not published | $0.84 – $1.52 | 2 |
| Inj fosnetupitant, palonoset HCPCS J1454 | not published | not published | $1,230.61 – $2,401.86 | 3 |
| Inj., fremanezumab-vfrm 1 mg HCPCS J3031 | not published | not published | $5.53 – $6.33 | 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.