WellSpan Evangelical Community Hospital
1 Hospital Drive, Lewisburg, PA · Wellspan · · NPI 1124076039
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 |
|---|---|---|---|---|
| Blood Count (CBC) Test CPT 85025 | $15.00 | $138.25 | $6.60 – $45.17 | 27 |
| Blood Count (CBC) Test (without differential) CPT 85027 | $15.00 | $135.50 | $6.41 – $37.61 | 27 |
| Blood Culture Test CPT 87040 | $582.20 | $727.75 | $10.22 – $59.98 | 27 |
| Blood draw capillary 36416 CPT 36416 | $32.00 | $40.00 | $16.90 – $26.52 | 2 |
| Blood gases o2 saturation direct measurement CPT 82805 | $264.00 | $330.00 | $42.75 – $381.96 | 27 |
| Blood gases ph venous CPT 82800 | $320.00 | $400.00 | $10.89 – $53.34 | 27 |
| Blood occult fecal hemoglobin immunoassay qualitative 1-3 simultaneous determinations diagnostic CPT 82274 | $36.00 | $240.25 | $3.64 – $92.42 | 27 |
| Blood occult feces colorectal neoplasm screening qualitative CPT 82270 | $15.00 | $22.00 | $3.82 – $21.24 | 27 |
| Blood typing abo CPT 86900 | $46.25 | $46.25 | $4.53 – $124.49 | 27 |
| Blood typing ag donor ea ag CPT 86902 | $122.60 | $153.25 | $3.10 – $347.42 | 27 |
| Blood typing rbc ag non abo/rh ea CPT 86905 | $133.00 | $166.25 | $3.61 – $347.42 | 27 |
| Blood typing rh (d) CPT 86901 | $43.00 | $81.25 | $4.59 – $37.91 | 27 |
| Bone Density Scan (DEXA) CPT 77080 | $237.00 | $689.75 | $66.12 – $602.31 | 27 |
| Borrelia burgdorferi (lyme disease) antibody nonspecific CPT 86618 | $56.40 | $70.50 | $16.86 – $98.98 | 27 |
| Borrelia miyamotoi amp prb CPT 87478 | $162.40 | $203.00 | $30.88 – $170.15 | 27 |
| Brain MRA (blood vessel MRI, without contrast) CPT 70544 | $473.50 | $3,929.25 | $232.54 – $1,810.29 | 27 |
| Brain MRI (with and without contrast) CPT 70553 | $701.50 | $6,651.00 | $343.57 – $2,812.46 | 27 |
| Brain MRI (with contrast) CPT 70552 | $635.50 | $4,768.75 | $343.57 – $2,225.60 | 27 |
| Brain MRI (without contrast) CPT 70551 | $455.00 | $4,194.75 | $232.54 – $1,813.42 | 27 |
| Breast Biopsy (ultrasound-guided, percutaneous) CPT 19083 | $5,202.40 | $6,503.00 | $152.78 – $180.56 | 7 |
| Breast punct aspir cyst, bil CPT 19000 | $2,043.60 | $2,554.50 | $40.15 – $679.53 | 25 |
| Bumetanide in d5w IV syringe 0.04 mg/ml (neo/ped) - cnr HCPCS J1939 | $18.40 | $23.00 | $0.56 – $9.76 | 25 |
| Bundled special stain group 1 microorganisms CPT 88312 | $164.40 | $205.50 | $51.40 – $263.12 | 27 |
| Bundled special stain group 2 CPT 88313 | $192.40 | $240.50 | $42.92 – $220.65 | 27 |
| Bupivacaine 0.1 % epidural pca - 1 hour dose limit HCPCS J0665 | $10.20 | $12.75 | $0.01 – $0.03 | 7 |
| Bx breast 1st lesion mr imag CPT 19085 | $4,769.60 | $5,962.00 | $178.31 – $210.73 | 7 |
| Bx breast add lesion Ultrasound imag CPT 19084 | $5,202.40 | $6,503.00 | $72.73 – $85.96 | 7 |
| Bx breast pq tomo guide CPT 19499 | $9,758.40 | $12,198.00 | $86.34 – $86.34 | 1 |
| C1 esterase inhibitor func - sendout CPT 86161 | $358.60 | $448.25 | $11.88 – $69.77 | 27 |
| Calcium 24 hour urine CPT 82340 | $88.20 | $110.25 | $5.97 – $35.06 | 27 |
| Calcium ionized CPT 82330 | $132.60 | $165.75 | $9.74 – $79.40 | 27 |
| Calcium total CPT 82310 | $52.60 | $65.75 | $5.11 – $29.97 | 27 |
| Calprotectin fecal CPT 83993 | $545.20 | $681.50 | $19.43 – $114.07 | 27 |
| Carbamazepine free CPT 80157 | $415.80 | $519.75 | $12.09 – $77.05 | 27 |
| Carbamazepine total therapeutic drug level CPT 80156 | $312.00 | $390.00 | $14.42 – $84.62 | 27 |
| Carbon dioxide CPT 82374 | $20.00 | $25.00 | $4.83 – $28.42 | 27 |
| Carboxyhemoglobin quantitative CPT 82375 | $279.20 | $349.00 | $6.16 – $59.74 | 27 |
| Carcinoembryonic ag (cea) CPT 82378 | $65.00 | $516.25 | $18.70 – $110.25 | 27 |
| Cardiac rehabilitation op phase 2 w/continous ecg monitoring CPT 93798 | $277.40 | $346.75 | $50.00 – $228.52 | 23 |
| Cardiolipin antibody iga CPT 86147 | $285.60 | $357.00 | $25.20 – $147.82 | 27 |
| Cardioversion elective electrical conversion arrhythmia external CPT 92960 | $1,863.20 | $2,329.00 | $95.70 – $632.00 | 25 |
| Carotid Artery Ultrasound (Duplex) CPT 93880 | $1,843.20 | $2,304.00 | $162.65 – $233.45 | 25 |
| Carpal Tunnel Release Surgery CPT 64721 | not published | not published | $853.60 – $1,008.80 | 7 |
| Cath bi-dir df smarttouch HCPCS C1732 | $10,598.62 | $13,248.27 | $16,618.12 – $16,618.12 | 1 |
| Cath combo lt&rt heart w/inj/s CPT 93453 | $6,734.20 | $8,417.75 | $3,216.41 – $8,978.01 | 2 |
| Cath hawkone s directional HCPCS C1714 | $9,551.28 | $11,939.10 | $13,997.91 – $13,997.91 | 1 |
| Cath plc art/angio/rt hrt cath CPT 93456 | $8,399.80 | $10,499.75 | $3,216.41 – $12,598.53 | 2 |
| Cath/saline/contrast/sis/hysteosal 58340 CPT 58340 | $305.60 | $382.00 | $57.20 – $67.60 | 7 |
| Cauterization chemical granulation tissue CPT 17250 | $877.80 | $1,097.25 | $28.40 – $191.90 | 25 |
| Cefazolin 10 mg/10 ml (dilution #2) IV desensitization - cnr HCPCS J0690 | $7.40 | $9.25 | $0.61 – $2.69 | 7 |
| Cell count body fluid CPT 89050 | $20.00 | $25.00 | $4.67 – $27.46 | 27 |
| Cell count w differential body fluid CPT 89051 | $548.80 | $686.00 | $5.54 – $32.00 | 27 |
| Change cystostomy tube simple CPT 51705 | $717.80 | $897.25 | $30.80 – $234.89 | 25 |
| Chest CT scan (with and without contrast) CPT 71270 | $562.00 | $4,783.25 | $171.26 – $1,777.05 | 27 |
| Chest CT scan (with contrast) CPT 71260 | $470.00 | $4,476.50 | $159.67 – $1,452.17 | 27 |
| Chest CT scan (without contrast) CPT 71250 | $285.00 | $3,769.00 | $102.30 – $1,012.95 | 27 |
| Chest X-ray CPT 71046 | $537.60 | $672.00 | $26.00 – $497.84 | 27 |
| Chest X-ray (single view) CPT 71045 | $475.20 | $594.00 | $17.03 – $497.84 | 27 |
| Chloride CPT 82435 | $71.20 | $89.00 | $4.55 – $26.67 | 27 |
| Chloride 24 hour urine CPT 82436 | $52.00 | $65.00 | $5.69 – $29.21 | 27 |
| Cholangiography and/or pancreatography intraoperative supervision & interpretation CPT 74300 | $1,195.80 | $1,494.75 | $170.59 – $305.24 | 2 |
| Cholesterol CPT 82465 | $62.20 | $77.75 | $4.31 – $25.31 | 27 |
| Cholesterol (Lipid) Test CPT 80061 | $40.00 | $349.75 | $13.26 – $77.89 | 27 |
| Chromosome analysis 15-20 cell count CPT 88262 | $2,698.20 | $3,372.75 | $124.24 – $724.29 | 27 |
| Circumcision (newborn) CPT 54150 | $717.40 | $896.75 | $86.90 – $102.70 | 7 |
| Clamp isol transpolr 5mmx6.5cm transpolar HCPCS C1733 | $3,286.38 | $4,107.97 | $7,647.28 – $7,647.28 | 1 |
| Closed tx humerus fx without manip 23600 CPT 23600 | $952.80 | $1,191.00 | $128.15 – $231.68 | 25 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $1,197.80 | $1,497.25 | $108.90 – $231.68 | 25 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $885.60 | $1,107.00 | $58.30 – $231.68 | 25 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $5,969.40 | $7,461.75 | $182.60 – $215.80 | 7 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $685.00 | $856.25 | $116.60 – $231.68 | 25 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $797.60 | $997.00 | $112.20 – $231.68 | 25 |
| Cmv pcr-sendout CPT 87496 | $300.40 | $375.50 | $34.74 – $203.98 | 27 |
| Coagulation time activated teg CPT 85347 | $68.00 | $85.00 | $4.24 – $24.76 | 27 |
| Collection blood specimen from completely implantable venous access device CPT 36591 | $100.00 | $287.00 | $124.00 – $221.24 | 19 |
| Collection blood specimen using established central/peripheral catheter venous nos CPT 36592 | $100.00 | $256.75 | $124.00 – $252.79 | 19 |
| Collection of venous blood by venipuncture CPT 36415 | $5.00 | $40.00 | $9.00 – $44.08 | 20 |
| Colonoscopy (diagnostic) CPT 45378 | not published | not published | $853.60 – $3,367.11 | 25 |
| Colonoscopy (with biopsy) CPT 45380 | not published | not published | $853.60 – $4,354.58 | 25 |
| Colonoscopy (with polyp removal) CPT 45385 | not published | not published | $853.60 – $4,354.58 | 25 |
| Compatibility test each unit antiglobulin technique CPT 86922 | $714.80 | $893.50 | $23.10 – $488.22 | 26 |
| Compatibility test each unit electronic CPT 86923 | $528.00 | $660.00 | $23.10 – $488.22 | 26 |
| Compatibility test each unit immediate spin technique CPT 86920 | $528.00 | $660.00 | $23.10 – $488.22 | 26 |
| Complement antigen each component c3 CPT 86160 | $167.40 | $209.25 | $11.88 – $69.77 | 27 |
| Concentration infection agents any type CPT 87015 | $116.60 | $145.75 | $6.61 – $38.81 | 27 |
| Contrast exam abdominl aorta 75625-26 CPT 75625 | $4,233.00 | $5,291.25 | $42.90 – $1,129.25 | 8 |
| Control of nosebleed ant comp 30903 CPT 30903 | $684.80 | $856.00 | $44.55 – $124.49 | 25 |
| Control of nosebleedantersmpl 30901 CPT 30901 | $1,338.60 | $1,673.25 | $29.70 – $124.49 | 25 |
| Coombs direct CPT 86880 | $124.20 | $155.25 | $8.17 – $57.37 | 27 |
| Coronary angio/lv gram/lt heart CPT 93458 | $6,734.20 | $8,417.75 | $3,216.41 – $9,121.01 | 2 |
| Coronary angio/lv gram/rt< heart CPT 93460 | $6,734.20 | $8,417.75 | $3,216.41 – $11,130.95 | 2 |
| Coronary art/grft angio s&i CPT 93455 | $6,734.20 | $8,417.75 | $3,216.41 – $7,260.09 | 2 |
| Coronary catheterization w/angiography supervision & interpretation CPT 93454 | $6,734.20 | $8,417.75 | $3,216.41 – $6,101.22 | 2 |
| Cortisol acth stimulation test - sendout CPT 80400 | $1,393.20 | $1,741.50 | $32.29 – $189.53 | 27 |
| Cortisol total am CPT 82533 | $204.60 | $255.75 | $13.20 – $94.77 | 27 |
| C-peptide CPT 84681 | $232.80 | $291.00 | $20.60 – $120.91 | 27 |
| C-reactive protein CPT 86140 | $20.00 | $305.25 | $3.30 – $30.09 | 27 |
| C-reactive protein high sensitivity CPT 86141 | $92.80 | $116.00 | $11.58 – $75.26 | 27 |
| Create eardrum opening CPT 69436 | not published | not published | $853.60 – $1,008.80 | 7 |
| Creatine kinase CPT 82550 | $158.80 | $198.50 | $6.44 – $37.85 | 27 |
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.