WellSpan Chambersburg Hospital
112 N. 7th St., Chambersburg, PA · Wellspan · · NPI 1902804552
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 |
|---|---|---|---|---|
| Shoulder MRI (with and without contrast) CPT 73223 | $712.50 | $4,226.00 | $369.24 – $2,106.92 | 25 |
| Shoulder MRI (with contrast) CPT 73222 | $645.50 | $3,019.00 | $384.69 – $4,386.56 | 25 |
| Shoulder MRI (without contrast) CPT 73221 | $461.50 | $2,225.00 | $249.91 – $1,342.45 | 25 |
| Shoulder X-ray CPT 73030 | $470.40 | $588.00 | $18.91 – $497.84 | 25 |
| Sickling rbc CPT 85660 | $80.00 | $100.00 | $3.00 – $72.00 | 26 |
| Sigmoidoscopy w/resection CPT 45349 | not published | not published | $970.00 – $12,612.53 | 17 |
| Sigmoidoscopy w/tumr remove CPT 45338 | not published | not published | $970.00 – $5,422.70 | 18 |
| Signal avg ecg w or without ecg 93278 CPT 93278 | $667.20 | $834.00 | $26.91 – $3,201.00 | 24 |
| Sincalide 5 mcg solution for injection HCPCS J2805 | $335.80 | $419.75 | $133.84 – $501.41 | 6 |
| Sinus CT scan (with and without contrast) CPT 70488 | $568.00 | $2,645.00 | $125.00 – $1,006.60 | 25 |
| Sinus CT scan (with contrast) CPT 70487 | $494.00 | $2,362.00 | $100.00 – $1,006.60 | 25 |
| Sinus CT scan (without contrast) CPT 70486 | $295.00 | $1,610.00 | $96.88 – $602.31 | 25 |
| Skin Biopsy CPT 11102 | $617.60 | $772.00 | $40.28 – $913.86 | 23 |
| Sleep Study (Polysomnography) CPT 95810 | $3,935.20 | $4,919.00 | $433.20 – $4,679.08 | 23 |
| Sleeve fing rolyan med HCPCS L3933 | $316.00 | $395.00 | $67.93 – $1,015.64 | 19 |
| Sling suprapubic suburetheral HCPCS C1771 | $2,990.26 | $3,737.83 | $1,608.55 – $1,608.55 | 1 |
| Slitting of prepuce CPT 54001 | not published | not published | $970.00 – $9,421.28 | 17 |
| Small bowel endoscopy CPT 44369 | not published | not published | $970.00 – $8,724.45 | 17 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $26.40 | $33.00 | $3.00 – $23.98 | 26 |
| Smear gram stain CPT 87205 | $21.60 | $27.00 | $4.27 – $19.44 | 26 |
| Smear nasal eosinophil CPT 89190 | $24.00 | $30.00 | $5.79 – $25.76 | 26 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $29.60 | $37.00 | $4.50 – $26.65 | 26 |
| Sodium 24 hour urine CPT 84300 | $20.80 | $26.00 | $5.06 – $22.51 | 26 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $18.20 | $22.75 | $2.11 – $16.38 | 5 |
| Sodium serum/plasma/whole blood CPT 84295 | $25.60 | $32.00 | $4.81 – $23.04 | 26 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $316.80 | $396.00 | $0.77 – $372.00 | 4 |
| Sp bone algrft morsel add-on CPT 20930 | not published | not published | $970.00 – $19,964.14 | 8 |
| Spinal bone allograftstructural 20931 CPT 20931 | not published | not published | $970.00 – $13,968.16 | 8 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,758.40 | $2,198.00 | $91.73 – $3,184.98 | 23 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $841.60 | $1,052.00 | $14.25 – $1,432.17 | 23 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $552.00 | $690.00 | $312.50 – $2,096.22 | 19 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $67.20 | $84.00 | $39.65 – $246.44 | 19 |
| Splint finger frog med HCPCS L3927 | $79.20 | $99.00 | $28.13 – $166.46 | 19 |
| Splint func pos polyflex ii med HCPCS L3999 | $13.60 | $17.00 | $12.24 – $12.24 | 1 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $102.40 | $128.00 | $25.99 – $459.51 | 19 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | not published | not published | $970.00 – $16,837.17 | 18 |
| Split blood or products CPT 86985 | $653.60 | $817.00 | $128.52 – $788.11 | 19 |
| Srs linear based CPT 77372 | $2,193.60 | $2,742.00 | $749.03 – $35,157.76 | 23 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $383.20 | $479.00 | $50.00 – $344.88 | 8 |
| Staph a dna amp probe CPT 87640 | $175.20 | $219.00 | $35.09 – $157.68 | 26 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $424.80 | $531.00 | $50.00 – $344.88 | 8 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $12,508.65 | $15,635.81 | $189.15 – $189.15 | 1 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $488.32 | $610.40 | $16.63 – $16.63 | 1 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $1,801.80 | $2,252.25 | $712.80 – $712.80 | 1 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $15,972.00 | $19,965.00 | $531.88 – $52,156.41 | 23 |
| Stent/tib/peroneal/unilat/initial 37230 CPT 37230 | not published | not published | $970.00 – $82,584.69 | 17 |
| Sterile water/saline, 10 ml HCPCS A4216 | $36.80 | $46.00 | $33.12 – $33.12 | 1 |
| St evaluate speech sound production CPT 92522 | $380.00 | $475.00 | $50.00 – $342.00 | 8 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $380.00 | $475.00 | $50.00 – $342.00 | 8 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $429.60 | $537.00 | $52.90 – $386.64 | 24 |
| St evaluation swallow function CPT 92610 | $380.00 | $475.00 | $50.00 – $357.78 | 24 |
| Strapping of toes 29550 CPT 29550 | $116.80 | $146.00 | $25.00 – $273.17 | 23 |
| Stress test pulmonary CPT 94618 | $455.20 | $569.00 | $10.83 – $592.82 | 23 |
| St treatment speech individual CPT 92507 | $304.80 | $381.00 | $27.13 – $325.00 | 8 |
| St treatment swallow dysfunction/oral CPT 92526 | $296.80 | $371.00 | $50.00 – $325.00 | 8 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $25.20 | $31.50 | $0.05 – $25.60 | 10 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $5.60 | $7.00 | $5.04 – $524.03 | 4 |
| Surgical pathology level 1 gross examination only CPT 88300 | $126.40 | $158.00 | $1.88 – $113.76 | 26 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $126.40 | $158.00 | $6.25 – $180.51 | 26 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $252.80 | $316.00 | $8.13 – $245.72 | 26 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $218.40 | $273.00 | $11.25 – $283.70 | 26 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $1,124.00 | $1,405.00 | $14.38 – $1,654.37 | 26 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,920.00 | $2,400.00 | $21.88 – $3,756.99 | 26 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $20.00 | $25.00 | $4.75 – $21.13 | 26 |
| Susceptibility mic per plate CPT 87186 | $52.80 | $66.00 | $8.00 – $47.52 | 26 |
| Suscept studies macrobroth dilution ea CPT 87188 | $27.20 | $34.00 | $6.00 – $29.54 | 26 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $18.40 | $23.00 | $4.40 – $19.57 | 26 |
| System pacing micra av HCPCS C1786 | $16,130.40 | $20,163.00 | $2,732.40 – $2,732.40 | 1 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $4,620.00 | $5,775.00 | $2,376.00 – $2,376.00 | 1 |
| T3 (triiodothyronine) free CPT 84481 | $70.40 | $88.00 | $16.94 – $75.35 | 26 |
| T3 (triiodothyronine) total CPT 84480 | $59.20 | $74.00 | $8.00 – $63.08 | 26 |
| T4 (thyroxine) free CPT 84439 | $35.00 | $69.00 | $8.00 – $40.12 | 26 |
| T4 (thyroxine) total CPT 84436 | $28.00 | $35.00 | $6.87 – $30.56 | 26 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $2.20 | $2.75 | $0.16 – $1.44 | 6 |
| Tacrolimus therapeutic drug level CPT 80197 | $50.00 | $72.00 | $13.73 – $61.08 | 26 |
| Target gsa panel hmtlmph neop CPT 81450 | $3,160.00 | $3,950.00 | $607.62 – $3,378.62 | 26 |
| Target gsa panel organ neop CPT 81445 | $2,392.00 | $2,990.00 | $478.33 – $2,659.68 | 26 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $327.60 | $409.50 | $0.30 – $388.50 | 26 |
| Tbs techl calculation only CPT 77091 | $398.40 | $498.00 | $26.95 – $497.84 | 21 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $309.60 | $387.00 | $61.98 – $278.64 | 26 |
| Tc-99m labeled rbc HCPCS A9560 | $363.20 | $454.00 | $326.88 – $337.44 | 3 |
| Tc-99m maa HCPCS A9540 | $320.80 | $401.00 | $94.21 – $288.72 | 3 |
| Tc-99m mebrofenin HCPCS A9537 | $94.40 | $118.00 | $84.96 – $363.07 | 3 |
| Tc-99m medronate HCPCS A9503 | $52.80 | $66.00 | $46.41 – $189.41 | 3 |
| Tc-99m mertiatide HCPCS A9562 | $824.80 | $1,031.00 | $742.32 – $2,458.34 | 2 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $17.60 | $22.00 | $7.50 – $44.48 | 19 |
| Tc-99m oxidronate HCPCS A9561 | $115.20 | $144.00 | $103.68 – $161.47 | 3 |
| Tc-99m pentetate dtpa HCPCS A9539 | $273.60 | $342.00 | $89.02 – $246.24 | 3 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $321.60 | $402.00 | $60.62 – $289.44 | 3 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $294.40 | $368.00 | $130.43 – $264.96 | 3 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $94.40 | $118.00 | $84.96 – $1,441.86 | 3 |
| Tc-99m sulfur colloid HCPCS A9541 | $324.80 | $406.00 | $131.76 – $2,404.48 | 3 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $739.20 | $924.00 | $304.43 – $665.28 | 3 |
| Tc-99m tilmanocept diag HCPCS A9520 | $3,187.20 | $3,984.00 | $2,361.84 – $2,868.48 | 2 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $195.20 | $244.00 | $46.98 – $208.98 | 26 |
| T cells absolute cd 4 count CPT 86361 | $111.20 | $139.00 | $26.78 – $119.13 | 26 |
| T cells total count CPT 86359 | $157.60 | $197.00 | $37.73 – $167.83 | 26 |
| Telehealth original site facility fee HCPCS Q3014 | $42.40 | $53.00 | $21.20 – $38.16 | 2 |
| Telethx isodose plan cplx CPT 77307 | $1,484.00 | $1,855.00 | $124.95 – $1,683.59 | 24 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $26,651.20 | $33,314.00 | $186.84 – $38,304.53 | 26 |
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.