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 |
|---|---|---|---|---|
| Mayo cortisol free CPT 82530 | $387.20 | $484.00 | $16.54 – $97.15 | 27 |
| Mayo dhea (dehydroepiandrosterone) CPT 82626 | $514.60 | $643.25 | $23.10 – $146.86 | 27 |
| Mayo dihydrotestosterone CPT 82642 | $465.80 | $582.25 | $28.99 – $280.75 | 22 |
| Mayo estrone CPT 82679 | $260.80 | $326.00 | $14.30 – $145.07 | 27 |
| Mayo factor viii vw factor antigen CPT 85246 | $215.20 | $269.00 | $22.71 – $133.37 | 27 |
| Mayo factor viii vw factor multimetric analysis CPT 85247 | $452.80 | $566.00 | $22.71 – $133.37 | 27 |
| Mayo factor viii vw factor ristocetin cofactor CPT 85245 | $285.80 | $357.25 | $22.71 – $133.37 | 27 |
| Mayo hip12 infectious agent nucleic acid amplified probe hiv-1 rna qualitative CPT 87535 | $145.60 | $182.00 | $17.55 – $455.09 | 23 |
| Mayo hla typing a/b/c single antigen CPT 86812 | $107.20 | $134.00 | $13.20 – $149.97 | 27 |
| Mayo hvdip HIV 2 antibody CPT 86702 | $56.80 | $71.00 | $13.38 – $65.56 | 27 |
| Mayo hydroxyprogesterone 17-d CPT 83498 | $205.40 | $256.75 | $22.55 – $157.85 | 27 |
| Mayo immunoassay c1 esterase inhibitor antibody quantitative CPT 83520 | $300.60 | $375.75 | $8.64 – $147.09 | 23 |
| Mayo immunoassay tumor antigen quantitative ca 27.29 CPT 86300 | $85.00 | $223.50 | $20.60 – $120.91 | 27 |
| Mayo immunoassay tumor antigen quantitative chromogranin a CPT 86316 | $405.80 | $507.25 | $20.60 – $120.91 | 27 |
| Mayo infectious agent antigen immunoassay direct optical observation cryptococcus CPT 87899 | $288.00 | $360.00 | $15.91 – $137.86 | 22 |
| Mayo infectious agent antigen immunoassay ql/sq multi step aspergillus bal CPT 87305 | $179.20 | $224.00 | $11.86 – $64.00 | 27 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma genitalium urine CPT 87563 | $147.20 | $184.00 | $30.88 – $170.15 | 27 |
| Mayo infectious agent nucleic acid amplified probe mycoplasma pneumoniae CPT 87581 | $145.60 | $182.00 | $17.55 – $454.17 | 23 |
| Mayo infectious agent nucleic acid quantification cytomegalovirus CPT 87497 | $973.40 | $1,216.75 | $42.41 – $248.91 | 27 |
| Mayo infectious disease hepatitis c chronic six biochemical assays CPT 81596 | $300.00 | $375.00 | $63.53 – $350.05 | 27 |
| Mayo inhab inhibin a CPT 86336 | $475.20 | $594.00 | $7.80 – $380.52 | 23 |
| Mayo insulin antibodies CPT 86337 | $305.40 | $381.75 | $12.10 – $103.82 | 27 |
| Mayo lacosamide therapeutic drug level CPT 80235 | $426.20 | $532.75 | $13.56 – $257.60 | 23 |
| Mayo lamotrigine therapeutic drug level CPT 80175 | $426.20 | $532.75 | $13.12 – $72.00 | 27 |
| Mayo lywb borrelia burgdorferi (lyme disease) antibody igg confirmatory CPT 86617 | $226.80 | $283.50 | $15.34 – $89.99 | 27 |
| Mayo metanephrines plasma CPT 83835 | $462.60 | $578.25 | $14.30 – $98.47 | 27 |
| Mayo microsomal antibody liver-kidney CPT 86376 | $243.40 | $304.25 | $8.70 – $84.58 | 27 |
| Mayo mitotane (lysodren) therapeutic drug level CPT 80299 | $361.20 | $451.50 | $16.83 – $90.39 | 27 |
| Mayo myoglobin CPT 83874 | $558.00 | $697.50 | $12.79 – $75.06 | 27 |
| Mayo organic acid methylmalonic single quantitative CPT 83921 | $718.00 | $897.50 | $20.02 – $102.85 | 27 |
| Mayo parvs parvovirus b19 antibody igg CPT 86747 | $748.60 | $935.75 | $14.88 – $87.36 | 27 |
| Mayo paval fluorescent antibody screen agna type 1 CPT 86255 | $253.40 | $316.75 | $11.93 – $70.05 | 27 |
| Mayo phospholipid neutralization hexagonal lupus anticoagulant CPT 85598 | $55.20 | $69.00 | $17.80 – $100.70 | 27 |
| Mayo pntft phenytoin free therapeutic drug level CPT 80186 | $228.40 | $285.50 | $13.62 – $80.00 | 27 |
| Mayo proinsulin CPT 84206 | $498.00 | $622.50 | $8.80 – $129.42 | 27 |
| Mayo psaft prostate specific antigen free CPT 84154 | $45.00 | $647.75 | $18.21 – $106.86 | 27 |
| Mayo radioimmunoassay procollagen i intact n-terminal antibody quantitative CPT 83519 | $443.80 | $554.75 | $9.20 – $206.39 | 23 |
| Mayo receptor assay transferrin soluble CPT 84238 | $711.20 | $889.00 | $24.20 – $212.50 | 27 |
| Mayo renin CPT 84244 | $226.60 | $283.25 | $13.20 – $127.84 | 27 |
| Mayo repu protein electrophoresis urine CPT 84166 | $45.00 | $314.75 | $17.65 – $103.64 | 27 |
| Mayo selenium CPT 84255 | $351.20 | $439.00 | $25.27 – $351.13 | 22 |
| Mayo sfgp rickettsia rickettsii antibody igg CPT 86757 | $234.40 | $293.00 | $19.16 – $112.48 | 27 |
| Mayo syphilis test non-treponemal antibody qualitative vdrl CPT 86592 | $60.60 | $75.75 | $4.23 – $24.80 | 27 |
| Mayo tgrp testosterone free CPT 84402 | $326.60 | $408.25 | $25.22 – $147.98 | 27 |
| Mayo tgrp testosterone total CPT 84403 | $221.00 | $276.25 | $25.55 – $150.05 | 27 |
| Mayo thiopurine s-methyltransferase CPT 84433 | $204.00 | $255.00 | $19.51 – $107.50 | 27 |
| Mayo thyroglobulin CPT 84432 | $129.80 | $162.25 | $15.90 – $93.33 | 27 |
| Mayo ticks anaplasma phagocytophilum antibody igg CPT 86666 | $230.20 | $287.75 | $10.08 – $59.10 | 27 |
| Mayo ticks babesia microti antibody igg CPT 86753 | $237.60 | $297.00 | $12.27 – $165.21 | 22 |
| Mayo valpg valproic acid free therapeutic drug level CPT 80165 | $356.40 | $445.50 | $13.40 – $73.39 | 27 |
| Mayo vitamin b-2 (riboflavin) CPT 84252 | $407.80 | $509.75 | $8.80 – $117.61 | 27 |
| Mayo vitamin k CPT 84597 | $630.40 | $788.00 | $6.86 – $213.25 | 23 |
| Mayo zonisamide therapeutic drug level CPT 80203 | $426.20 | $532.75 | $13.12 – $72.00 | 27 |
| Measurement post void urine by ultrasound CPT 51798 | $441.00 | $551.25 | $10.91 – $57.37 | 25 |
| Metabolic Blood Panel (Basic) CPT 80048 | $20.00 | $287.00 | $8.38 – $49.19 | 27 |
| Metabolic Blood Panel (Comprehensive) CPT 80053 | $25.00 | $331.00 | $10.45 – $61.45 | 27 |
| Metabolic panel ionized ca CPT 80047 | $92.20 | $115.25 | $13.10 – $66.58 | 27 |
| Methylprednisolone 4 mg tablet HCPCS J7509 | $7.20 | $9.00 | $0.08 – $0.13 | 6 |
| Methylprednisolone acetate 40 mg/ml suspension for injection HCPCS J1010 | $1.40 | $1.75 | $0.09 – $0.38 | 25 |
| Metoprolol tartrate 5 mg/5 ml intravenous (wrapper) HCPCS J0616 | $4.60 | $5.75 | $0.46 – $2.08 | 7 |
| Midazolam 1 mg/ml injection solution HCPCS J2250 | $2.88 | $3.60 | $0.12 – $0.51 | 7 |
| Monitor reveal linq ii cardiac HCPCS C1764 | $15,657.84 | $19,572.30 | $28,528.86 – $28,528.86 | 1 |
| Morphine 4 mg/ml injection (wrapper) HCPCS J2270 | $14.60 | $18.25 | $1.66 – $14.56 | 7 |
| Morphometric analysis tumor ihc qn/sq per specimen each single antibody stain manual CPT 88360 | $724.00 | $905.00 | $91.69 – $488.22 | 27 |
| MRA abdomen post contrast CPT 74185 | $735.50 | $5,238.00 | $250.32 – $2,224.04 | 27 |
| MRA aorta thoracic w/wo contrast CPT 71555 | $734.50 | $5,097.50 | $246.43 – $2,223.70 | 27 |
| MRI breast w IV cont bi CPT 77049 | $705.34 | $5,083.00 | $231.54 – $1,532.33 | 27 |
| MRI chest without contrast CPT 71550 | $457.00 | $4,527.25 | $232.54 – $1,807.44 | 27 |
| MRI chest without & w/contrast CPT 71552 | $706.00 | $7,643.25 | $343.57 – $2,796.09 | 27 |
| MRI lower extremity other than joint without contrast (both sides) CPT 73718 | $463.00 | $4,251.75 | $232.54 – $1,807.10 | 27 |
| MRI lower extremity other than joint without & w/contrast (both sides) CPT 73720 | $712.50 | $6,569.75 | $343.57 – $2,803.30 | 27 |
| MRI orbit/face/neck without contrast CPT 70540 | $463.50 | $3,686.50 | $232.54 – $1,807.10 | 27 |
| MRI orbit/face/neck without & w/contrast CPT 70543 | $713.00 | $6,113.75 | $343.57 – $2,803.63 | 27 |
| MRI upper extremity other than joint without contrast (both sides) CPT 73218 | $463.50 | $4,526.75 | $232.54 – $1,806.82 | 27 |
| MRI upper extremity other than joint without & w/contrast (both sides) CPT 73220 | $712.50 | $7,222.25 | $343.57 – $2,803.30 | 27 |
| Mthfr gene analy common variants CPT 81291 | $698.20 | $872.75 | $32.67 – $341.39 | 21 |
| Mumps antibody igg CPT 86735 | $288.20 | $360.25 | $6.53 – $146.88 | 23 |
| Mycophenolate mofetil 250 mg capsule HCPCS J7517 | $1.60 | $2.00 | $0.12 – $0.51 | 7 |
| Myeloperoxidase ab multi step qualitative/semiquantitative CPT 83516 | $194.40 | $243.00 | $11.41 – $166.24 | 22 |
| Naloxone 0.4 mg/ml injection (wrapper) HCPCS J2312 | $18.60 | $23.25 | $0.22 – $0.90 | 7 |
| Natriuretic peptide CPT 83880 | $80.00 | $412.00 | $38.87 – $197.25 | 27 |
| Neck (Cervical Spine) CT scan (with contrast) CPT 72126 | $472.00 | $3,256.25 | $165.61 – $2,106.92 | 27 |
| Neck (Cervical Spine) CT scan (without contrast) CPT 72125 | $282.00 | $3,074.75 | $102.30 – $1,012.95 | 27 |
| Neck (Cervical Spine) MRI (with and without contrast) CPT 72156 | $701.50 | $6,364.75 | $343.57 – $2,814.97 | 27 |
| Neck (Cervical Spine) MRI (without contrast) CPT 72141 | $454.00 | $4,256.00 | $232.54 – $1,813.08 | 27 |
| Neck MRA (blood vessel MRI, with and without contrast) CPT 70549 | $735.00 | $5,610.75 | $343.57 – $2,793.91 | 27 |
| New Patient Office Visit (level 2) CPT 99202 | $212.00 | $265.00 | $44.00 – $214.18 | 25 |
| New Patient Office Visit (level 3) CPT 99203 | $239.20 | $299.00 | $44.00 – $374.49 | 25 |
| New Patient Office Visit (level 4) CPT 99204 | $266.40 | $333.00 | $44.00 – $609.81 | 25 |
| New Patient Office Visit (level 5) CPT 99205 | $316.00 | $395.00 | $44.00 – $829.47 | 23 |
| Njx aa&/strd nrv nrvtg si jt CPT 64451 | $2,833.60 | $3,542.00 | $666.22 – $2,800.07 | 20 |
| Nm imaging bone/joint 3 phase study CPT 78315 | $2,740.80 | $3,426.00 | $183.01 – $2,259.58 | 27 |
| Nm imaging bone/joint whole body CPT 78306 | $3,111.00 | $3,888.75 | $111.63 – $2,259.58 | 27 |
| Nm imaging cardiac blood pooling planar single study at rest or stress CPT 78472 | $2,520.40 | $3,150.50 | $112.20 – $2,259.58 | 27 |
| Nm imaging gastric emptying study CPT 78264 | $2,307.20 | $2,884.00 | $148.49 – $2,259.58 | 27 |
| Nm imaging gastrointestinal acute blood loss CPT 78278 | $2,804.40 | $3,505.50 | $70.40 – $2,259.58 | 27 |
| Nm imaging hepatobiliary system w/pharmacologic intervention CPT 78227 | $2,654.80 | $3,318.50 | $364.11 – $2,961.19 | 27 |
| Nm imaging pulmonary ventilation/perfusion CPT 78582 | $3,426.40 | $4,283.00 | $262.00 – $2,961.19 | 27 |
| Nm imaging thyroid single/multiple uptake(s) quantitative measurement(s) CPT 78014 | $2,205.00 | $2,756.25 | $196.58 – $2,259.58 | 27 |
| Nuclear Stress Test (Heart) CPT 78452 | $5,698.80 | $7,123.50 | $374.88 – $7,779.35 | 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.