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 |
|---|---|---|---|---|
| Injection anesthetic agent(s) and/or steroid genicular nerve branches w/guidance (both sides) CPT 64454 | $2,397.80 | $2,997.25 | $666.22 – $2,800.07 | 20 |
| Injection arthrography hip without anesthesia (both sides) CPT 27093 | $750.40 | $938.00 | $52.80 – $62.40 | 7 |
| Injection for shoulder arthrogram or enhanced ct/mri shoulder arthography (both sides) CPT 23350 | $581.80 | $727.25 | $36.30 – $42.90 | 7 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $3,434.40 | $4,293.00 | $23.10 – $668.84 | 25 |
| Injection(s) anesthetic agent(s)/steroid lumb/s transforaminal epidural w/img single (both sides) CPT 64483 | $3,272.00 | $4,090.00 | $104.54 – $859.84 | 25 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic 2nd level CPT 64491 | $1,199.00 | $1,498.75 | $53.64 – $63.39 | 7 |
| Injection(s) diagnostic/therapeutic agent facet cervical/thoracic single level CPT 64490 | $3,596.80 | $4,496.00 | $94.12 – $859.84 | 25 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral 2nd level w/image guidance CPT 64494 | $1,586.60 | $1,983.25 | $45.74 – $54.05 | 7 |
| Injection(s) diagnostic/therapeutic agent facet lumbar/sacral single level CPT 64493 | $4,737.20 | $5,921.50 | $79.21 – $859.84 | 25 |
| Injection(s) epidural/subarachnoid cervical/thoracic needle placement w/guidance CPT 62321 | $4,834.00 | $6,042.50 | $98.12 – $668.84 | 25 |
| Injection(s) epidural/subarachnoid lumbar/sacral needle placement w/guidance CPT 62323 | $1,843.20 | $2,304.00 | $89.45 – $5,032.00 | 26 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $1,605.20 | $2,006.50 | $34.17 – $285.09 | 25 |
| Injection(s) trigger point(s) single/multiple >= 3 muscle(s) CPT 20553 | $1,605.20 | $2,006.50 | $37.92 – $285.09 | 25 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push new substance/drug CPT 96375 | $239.80 | $299.75 | $14.31 – $44.56 | 25 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $239.80 | $299.75 | $227.70 – $227.70 | 1 |
| Injection therapeutic/prophylactic/diagnostic IV push single/initial substance/drug CPT 96374 | $239.80 | $299.75 | $34.12 – $203.48 | 25 |
| Injection therapeutic/prophylactic/diagnostic subcutaneous/im CPT 96372 | $183.00 | $228.75 | $13.97 – $68.74 | 25 |
| Inject sacroiliac joint CPT 27096 | $2,364.80 | $2,956.00 | $67.31 – $2,718.13 | 25 |
| Inj, lidocaine w epinephrine HCPCS J2004 | $5.60 | $7.00 | $0.48 – $4.35 | 2 |
| Inj., tildrakizumab, 1 mg HCPCS J3245 | $73,040.40 | $91,300.50 | $9,678.90 – $40,396.80 | 25 |
| Ins cerv dilator (sep proc) CPT 59200 | $1,465.20 | $1,831.50 | $152.10 – $293.79 | 20 |
| Insert cath pleura with image CPT 32557 | $900.80 | $1,126.00 | $145.86 – $172.38 | 7 |
| Insertion catheter bladder non indwelling CPT 51701 | $356.40 | $445.50 | $28.00 – $124.49 | 25 |
| Insertion catheter bladder temporary simple CPT 51702 | $355.80 | $444.75 | $30.26 – $124.49 | 25 |
| Insertion intra aortic balloon assist device percutaneous CPT 33967 | $1,777.40 | $2,221.75 | $238.95 – $1,769.95 | 17 |
| Insertion picc without port or pump with imaging guidance=>5y CPT 36573 | $4,020.80 | $5,026.00 | $76.74 – $90.69 | 7 |
| Insertion/replacement temporary single chamber electrode/pacemaker catheter CPT 33210 | $7,439.20 | $9,299.00 | $181.39 – $214.37 | 7 |
| Insertion subcutaneous cardiac rhythm monitor CPT 33285 | $23,846.40 | $29,808.00 | $92.15 – $12,937.78 | 3 |
| Insertion tunneled centrally inserted central venous access device with port >= 5 years old (both sides) CPT 36561 | not published | not published | $853.60 – $1,008.80 | 7 |
| Instillation anticarcinogenic agent bladder CPT 51720 | $1,040.80 | $1,301.00 | $73.63 – $87.02 | 7 |
| Ins tun cv cath wo subq prt/pm CPT 36558 | $11,785.40 | $14,731.75 | $292.05 – $345.15 | 7 |
| Insulin total CPT 83525 | $204.00 | $255.00 | $11.32 – $66.43 | 27 |
| Intrinsic factor antibody CPT 86340 | $300.80 | $376.00 | $14.93 – $87.60 | 27 |
| Intro cath dialysis circuit w/pta CPT 36902 | $12,076.40 | $15,095.50 | $195.43 – $230.96 | 7 |
| Intubation endotracheal emergency procedure CPT 31500 | $850.40 | $1,063.00 | $79.20 – $224.28 | 25 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $5.40 | $6.75 | $0.45 – $1.44 | 5 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $2.60 | $3.25 | $0.15 – $0.76 | 5 |
| Iron CPT 83540 | $20.00 | $76.00 | $6.41 – $37.65 | 27 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $100.00 | $265.00 | $21.43 – $57.37 | 25 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $287.20 | $359.00 | $21.16 – $68.74 | 25 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $299.60 | $374.50 | $12.57 – $14.86 | 7 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $318.00 | $397.50 | $13.52 – $44.56 | 25 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $1,100.00 | $1,375.00 | $43.23 – $203.48 | 25 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $73.20 | $91.50 | $5.50 – $41.75 | 27 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $17.41 | $21.76 | $0.23 – $1.12 | 25 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $898.20 | $1,122.75 | $89.65 – $602.31 | 27 |
| Kit lead specify 5-6-5 HCPCS C1778 | $30,619.80 | $38,274.75 | $24,090.55 – $24,090.55 | 1 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | not published | not published | $853.60 – $1,008.80 | 7 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $853.60 – $11,091.00 | 8 |
| Knee MRI (with and without contrast) CPT 73723 | $712.50 | $6,750.75 | $343.57 – $2,802.41 | 27 |
| Knee MRI (with contrast) CPT 73722 | $645.00 | $4,980.50 | $421.30 – $4,386.56 | 27 |
| Knee MRI (without contrast) CPT 73721 | $462.00 | $4,562.00 | $232.54 – $1,807.44 | 27 |
| Knee X-ray CPT 73564 | $696.80 | $871.00 | $35.70 – $602.31 | 27 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $20.20 | $25.25 | $0.26 – $1.25 | 7 |
| Lactate dehydrogenase (ldh) CPT 83615 | $25.00 | $86.50 | $5.98 – $35.06 | 27 |
| Lactic acid CPT 83605 | $149.40 | $186.75 | $8.80 – $62.05 | 27 |
| Lactoferrin fecal qualitative CPT 83630 | $62.00 | $77.50 | $13.54 – $114.07 | 27 |
| Lap ing hernia repair init CPT 49650 | not published | not published | $853.60 – $18,724.00 | 8 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | $853.60 – $18,724.00 | 8 |
| Lap paraesophag hern repair CPT 43281 | not published | not published | $853.60 – $34,157.00 | 8 |
| Lap sleeve gastrectomy CPT 43775 | not published | not published | $853.60 – $34,157.00 | 26 |
| Laryngoscopy telescopic CPT 31579 | $2,076.20 | $2,595.25 | $82.50 – $375.03 | 25 |
| Lead capillary CPT 83655 | $187.20 | $234.00 | $11.00 – $70.33 | 27 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $2,140.60 | $2,675.75 | $161.33 – $233.45 | 25 |
| Levetiracetam therapeutic drug level CPT 80177 | $426.20 | $532.75 | $13.12 – $72.00 | 27 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $5.20 | $6.50 | $0.02 – $0.19 | 2 |
| Lipase CPT 83690 | $174.20 | $217.75 | $5.50 – $40.04 | 27 |
| Lipoprotein direct measurement hdl CPT 83718 | $81.00 | $101.25 | $7.70 – $47.60 | 27 |
| Lipoprotein direct measurement ldl CPT 83721 | $205.00 | $256.25 | $10.40 – $55.44 | 27 |
| Lithium therapeutic drug level CPT 80178 | $127.80 | $159.75 | $6.54 – $38.41 | 27 |
| Liver Function Test CPT 80076 | $25.00 | $358.00 | $8.09 – $47.48 | 27 |
| Low back disk surgery CPT 63030 | not published | not published | $853.60 – $18,724.00 | 8 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $472.00 | $3,999.00 | $165.61 – $2,106.92 | 27 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $286.00 | $3,445.50 | $102.30 – $1,012.95 | 27 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $700.50 | $7,222.00 | $343.57 – $2,814.97 | 27 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $635.50 | $5,874.75 | $343.57 – $2,225.60 | 27 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $454.00 | $4,527.25 | $232.54 – $1,813.75 | 27 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $563.60 | $704.50 | $35.78 – $602.31 | 27 |
| Lsh w/t/o ut 250 g or less CPT 58542 | not published | not published | $853.60 – $24,338.00 | 8 |
| Lung perfusion imaging CPT 78580 | $1,850.20 | $2,312.75 | $86.90 – $2,259.58 | 27 |
| Lysis penil circumic lesion CPT 54162 | not published | not published | $853.60 – $9,100.00 | 8 |
| Magnesium CPT 83735 | $30.00 | $85.50 | $6.63 – $38.92 | 27 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $29.20 | $36.50 | $0.36 – $3.20 | 7 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $157.80 | $197.25 | $64.45 – $190.31 | 21 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $369.20 | $461.50 | $124.00 – $219.09 | 20 |
| Mastectomy partial CPT 19301 | not published | not published | $853.60 – $9,100.00 | 8 |
| Mayo a1app alpha 1 antitrypsin phenotype CPT 82104 | $388.40 | $485.50 | $14.32 – $84.02 | 27 |
| Mayo aathr protein s free CPT 85306 | $322.60 | $403.25 | $15.17 – $89.03 | 27 |
| Mayo alkaline phosphatase isoenzyme CPT 84080 | $168.40 | $210.50 | $7.39 – $133.67 | 23 |
| Mayo alpha 1 antitrypsin CPT 82103 | $301.40 | $376.75 | $13.31 – $78.05 | 27 |
| Mayo androstenedione CPT 82157 | $330.40 | $413.00 | $27.50 – $170.11 | 27 |
| Mayo angiotensin 1 converting enzyme (ace) csf CPT 82164 | $174.60 | $218.25 | $14.45 – $84.82 | 27 |
| Mayo aspergillus fumigatus antibody CPT 86606 | $154.00 | $192.50 | $14.90 – $87.48 | 27 |
| Mayo babpb infectious agent nucleic acid amplified probe babesia microti CPT 87469 | $162.40 | $203.00 | $30.88 – $170.15 | 27 |
| Mayo bart bartonella henselae antibody igg CPT 86611 | $91.00 | $113.75 | $10.08 – $59.10 | 27 |
| Mayo carnitine total and free quantitative each specimen plasma CPT 82379 | $405.80 | $507.25 | $8.44 – $250.23 | 23 |
| Mayo ceruloplasmin CPT 82390 | $228.20 | $285.25 | $10.63 – $62.41 | 27 |
| Mayo chikv chikungunya antibodies igg CPT 86790 | $267.40 | $334.25 | $12.75 – $199.12 | 22 |
| Mayo chrcb tissue culture non-neoplastic disorders lymphocyte CPT 88230 | $2,698.20 | $3,372.75 | $115.33 – $677.01 | 27 |
| Mayo cocou cortisone urine CPT 82542 | $465.80 | $582.25 | $21.20 – $116.81 | 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.