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 |
|---|---|---|---|---|
| Liver ds alys 3 bmrk srm alg CPT 81517 | not published | not published | $609.62 – $609.62 | 1 |
| Liver elastography 91200 CPT 91200 | $258.18 | $662.00 | $440.91 – $440.91 | 1 |
| Liver Function Test CPT 80076 | $115.44 | $296.00 | $14.32 – $28.27 | 4 |
| Liver hem/re-expl wnd/remove pack 47362 CPT 47362 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Liver image (3d) with flow CPT 78206 | not published | not published | $709.23 – $1,396.72 | 2 |
| Liver imaging CPT 78201 | $453.96 | $1,164.00 | $402.01 – $1,525.66 | 4 |
| Liver imaging (3d) CPT 78205 | not published | not published | $425.71 – $850.99 | 2 |
| Liver imag w/vasclr flow CPT 78202 | $904.41 | $2,319.00 | $423.25 – $1,525.66 | 4 |
| Liver/spleen imag static only CPT 78215 | $638.43 | $1,637.00 | $407.73 – $1,164.18 | 4 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $727.35 | $1,865.00 | $238.61 – $1,164.18 | 4 |
| Lmtd oph exam general anes CPT 92019 | not published | not published | $1,308.00 – $6,595.97 | 3 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | not published | not published | $1,937.00 – $9,136.47 | 5 |
| Locm 100-199mg/ml iodine,1ml HCPCS Q9965 | $171.60 | $440.00 | $2.29 – $2.29 | 1 |
| Lomustine 10 mg HCPCS S0178 | not published | not published | $218.69 – $218.69 | 1 |
| Loncastuximab tesirine-lpyl 10 mg intravenous solution HCPCS J9359 | not published | not published | $404.30 – $694.18 | 3 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | not published | not published | $2.57 – $2.57 | 1 |
| Loudness balance test CPT 92562 | not published | not published | $885.97 – $885.97 | 1 |
| Low back disk surgery CPT 63030 | not published | not published | $3,099.00 – $20,193.44 | 4 |
| Low cost skin substitute app HCPCS C5271 | $1,533.48 | $3,932.00 | $1,772.77 – $4,714.00 | 4 |
| Low cost skin substitute app HCPCS C5273 | $1,533.48 | $3,932.00 | $4,714.00 – $9,032.00 | 4 |
| Low cost skin substitute app HCPCS C5275 | $1,533.48 | $3,932.00 | $1,772.77 – $4,714.00 | 4 |
| Low cost skin substitute app HCPCS C5277 | $1,533.48 | $3,932.00 | $1,772.77 – $4,714.00 | 4 |
| Low cost skin substitute app HCPCS C5272 | $652.86 | $1,674.00 | $2,665.00 – $3,391.00 | 2 |
| Low cost skin substitute app HCPCS C5274 | $652.86 | $1,674.00 | $2,665.00 – $3,391.00 | 2 |
| Low cost skin substitute app HCPCS C5276 | $702.00 | $1,800.00 | $2,665.00 – $3,391.00 | 2 |
| Low cost skin substitute app HCPCS C5278 | $652.86 | $1,674.00 | $2,665.00 – $3,391.00 | 2 |
| Low-Dose Lung Cancer Screening CT Scan CPT 71271 | $331.50 | $850.00 | $310.32 – $310.32 | 1 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,958.19 | $5,021.00 | $473.88 – $539.50 | 3 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $1,705.08 | $4,372.00 | $384.01 – $1,085.52 | 3 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $1,610.70 | $4,130.00 | $298.22 – $344.93 | 3 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $2,370.03 | $6,077.00 | $605.44 – $1,085.52 | 3 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $2,045.55 | $5,245.00 | $532.72 – $1,085.52 | 3 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $1,775.67 | $4,553.00 | $342.35 – $730.45 | 3 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $341.64 | $876.00 | $38.82 – $310.32 | 4 |
| Lower Back (Lumbar Spine) X-ray (4 or more views) CPT 72110 | $505.83 | $1,297.00 | $52.80 – $310.32 | 4 |
| Lower Back (Lumbar Spine) X-ray (with bending views) CPT 72114 | $513.63 | $1,317.00 | $75.08 – $310.32 | 4 |
| Lower jaw bone graft CPT 21215 | not published | not published | $3,721.00 – $16,529.94 | 5 |
| Lower Leg (Shin) X-ray (both sides) CPT 73590 | $238.68 | $612.00 | $46.58 – $256.49 | 4 |
| Low frequency non-thermal Ultrasound CPT 97610 | $272.22 | $698.00 | $565.10 – $565.10 | 1 |
| Loxapine for inhalation 1 mg HCPCS J2062 | not published | not published | $29.16 – $29.16 | 1 |
| Lsh uterus 250 g or less CPT 58541 | not published | not published | $6,760.00 – $29,055.57 | 4 |
| Lsh uterus above 250 g CPT 58543 | not published | not published | $6,760.00 – $29,055.57 | 4 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $6,760.00 – $29,055.57 | 4 |
| Lsh w/t/o uterus above 250 g CPT 58544 | not published | not published | $6,760.00 – $29,055.57 | 4 |
| L/s ratio fetal lung CPT 83661 | $476.19 | $1,221.00 | $38.51 – $76.09 | 4 |
| Lumbar diskogram s&i CPT 72295 | $667.29 | $1,711.00 | $125.02 – $5,449.92 | 4 |
| Lumbar Spinal Fusion (single level) CPT 22612 | not published | not published | $8,245.00 – $52,603.13 | 3 |
| Lumizyme injection HCPCS J0221 | not published | not published | $384.33 – $682.59 | 3 |
| Lung Function Test Before and After an Inhaler CPT 94060 | $731.64 | $1,876.00 | $885.97 – $885.97 | 1 |
| Lung function test (mbc/mvv) CPT 94200 | $182.91 | $469.00 | $172.66 – $172.66 | 1 |
| Lung Function Test (Spirometry) CPT 94010 | $415.35 | $1,065.00 | $440.91 – $440.91 | 1 |
| Lung perfusion imaging CPT 78580 | $650.52 | $1,668.00 | $486.17 – $1,164.18 | 4 |
| Lung transplant double CPT 32853 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Lung transplant single CPT 32851 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Lung transplant with bypass CPT 32852 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Lung transplant with bypass CPT 32854 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Lung volume reduction 32491 CPT 32491 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Lurbinectedin 4 mg intravenous solution HCPCS J9223 | not published | not published | $390.54 – $692.03 | 3 |
| Luspatercept-aamt 25 mg subcutaneous solution HCPCS J0896 | not published | not published | $78.68 – $138.30 | 3 |
| Lutetium lu 177 dotatat ther HCPCS A9513 | $26,421.41 | $67,747.20 | $570.50 – $886.63 | 3 |
| Lutetium lu 177 vipivotide HCPCS A9607 | $2,737.80 | $7,020.00 | $462.36 – $722.00 | 2 |
| Lvad shower bag heartmate HCPCS Q0501 | $542.77 | $1,391.73 | not published | 0 |
| Lw ntsty Ultrasound stimj bone healg CPT 20979 | not published | not published | $84.05 – $5,063.00 | 3 |
| Lyme dis dna dir probe CPT 87475 | not published | not published | $35.12 – $69.37 | 4 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | not published | not published | $5,063.00 – $15,026.00 | 2 |
| Lymphatics/lymph node imaging CPT 78195 | $920.79 | $2,361.00 | $714.12 – $1,525.66 | 4 |
| Lymphocyte culture mixed CPT 86821 | not published | not published | $98.93 – $176.47 | 4 |
| Lymphocyte transformation mitogen CPT 86353 | $235.56 | $604.00 | $85.90 – $169.64 | 4 |
| Lymphocytotoxicity assay CPT 86805 | not published | not published | $91.61 – $655.70 | 4 |
| Lymphocytotoxicity assay CPT 86806 | not published | not published | $83.38 – $164.66 | 4 |
| Lymph vessel x-ray arm/leg CPT 75801 | $687.96 | $1,764.00 | $506.93 – $1,773.21 | 4 |
| Lymph vessel x-ray arms/legs CPT 75803 | $2,229.24 | $5,716.00 | $501.21 – $4,520.58 | 4 |
| Lymph vessel x-ray trunk CPT 75805 | $2,542.41 | $6,519.00 | $537.19 – $8,997.17 | 4 |
| Lymph vessel x-ray trunk CPT 75807 | $1,775.28 | $4,552.00 | $549.45 – $8,997.17 | 4 |
| Lysis intranasal synechia 30560 CPT 30560 | not published | not published | $1,553.04 – $4,714.00 | 5 |
| Lysis of labial adhesions CPT 56441 | $6,276.66 | $16,094.00 | $1,308.00 – $8,824.63 | 5 |
| Lysis penil circumic lesion CPT 54162 | $4,673.37 | $11,983.00 | $1,694.00 – $6,179.00 | 5 |
| Lyumjev for insulin pump use HCPCS J1813 | not published | not published | $29.50 – $53.87 | 2 |
| Macro exam dissect molec study ea CPT 88387 | not published | not published | $7.74 – $17.16 | 3 |
| Macroscopic exam arthropod CPT 87168 | $113.88 | $292.00 | $7.48 – $14.77 | 4 |
| Macroscopic exam parasite CPT 87169 | $43.29 | $111.00 | $7.48 – $14.91 | 4 |
| Magnesium CPT 83735 | $83.85 | $215.00 | $11.74 – $23.18 | 4 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | not published | not published | $0.93 – $0.93 | 1 |
| Magnetic image bone marrow CPT 77084 | $333.06 | $854.00 | $674.39 – $869.96 | 4 |
| Makena, 10 mg HCPCS J1726 | not published | not published | $41.80 – $43.65 | 2 |
| Malaria antibody CPT 86750 | not published | not published | $23.10 – $45.64 | 4 |
| Male sling procedure CPT 53440 | not published | not published | $1,694.00 – $36,233.94 | 5 |
| Mammosite ced HCPCS C1728 | $5,848.89 | $14,997.15 | not published | 0 |
| Management of liver hemorrhage 47361 CPT 47361 | not published | not published | $5,063.00 – $6,859.00 | 2 |
| Manipulate finger w/anesth CPT 26340 | not published | not published | $2,572.00 – $4,536.58 | 4 |
| Manipulate wrist w/anesthes CPT 25259 | not published | not published | $3,391.00 – $5,272.00 | 4 |
| Manipulation of hip joint CPT 27275 | not published | not published | $1,694.00 – $5,272.00 | 5 |
| Manipulation of spine CPT 22505 | not published | not published | $1,694.00 – $5,272.00 | 5 |
| Manipulat palm cord post inj CPT 26341 | not published | not published | $665.65 – $3,391.00 | 4 |
| Mannitol 12.5 gm/50 ml inj HCPCS J2150 | not published | not published | $4.84 – $4.84 | 1 |
| Mannitol for inhaler HCPCS J7665 | not published | not published | $12.79 – $12.79 | 1 |
| Manual diff wbc count b-coat CPT 85009 | $25.74 | $66.00 | $6.52 – $17.54 | 4 |
| Mapping functional cort/subcort ea add'l hr CPT 95962 | $567.06 | $1,454.00 | not published | 0 |
| Mapping io sentinel lymph node CPT 38900 | not published | not published | $2,665.00 – $3,391.00 | 2 |
| Map tachycard site(s) CPT 93609 | $2,755.74 | $7,066.00 | $2,665.00 – $9,000.00 | 2 |
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.