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 |
|---|---|---|---|---|
| Removal cerumen impacted (both sides) CPT 69210 | $493.20 | $616.50 | $22.00 – $57.37 | 25 |
| Removal foreign body foot subcutaneous right CPT 28190 | $6,899.60 | $8,624.50 | $33.55 – $679.53 | 25 |
| Removal of breast lesion CPT 19120 | $5,848.80 | $7,311.00 | $190.30 – $224.90 | 7 |
| Removal of implant deep CPT 20680 | not published | not published | $853.60 – $9,100.00 | 8 |
| Remove armpit lymph nodes CPT 38745 | not published | not published | $853.60 – $18,724.00 | 8 |
| Remove bladder stone CPT 52317 | not published | not published | $853.60 – $11,091.00 | 8 |
| Remove epididymis lesion CPT 54840 | not published | not published | $853.60 – $9,100.00 | 8 |
| Remove in/ex hem groups 2+ CPT 46260 | not published | not published | $853.60 – $11,091.00 | 8 |
| Remove tonsils and adenoids CPT 42820 | not published | not published | $853.60 – $1,008.80 | 7 |
| Renal function panel CPT 80069 | $191.60 | $239.50 | $8.59 – $50.47 | 27 |
| Repair biceps tendon CPT 23430 | not published | not published | $853.60 – $18,724.00 | 8 |
| Repair dental ellis ii fx CPT 41899 | not published | not published | $90.65 – $1,956.00 | 26 |
| Repair elbow deb/attch open CPT 24359 | not published | not published | $853.60 – $11,091.00 | 8 |
| Repair of ankle ligament CPT 27698 | not published | not published | $853.60 – $11,091.00 | 8 |
| Repair of nasal septum CPT 30520 | not published | not published | $853.60 – $11,091.00 | 8 |
| Repair rpr lac tongue floor mouth > 2.6 cm/cmplx CPT 41252 | $709.40 | $886.75 | $95.15 – $224.28 | 25 |
| Rerepair ing hernia reduce CPT 49520 | not published | not published | $853.60 – $11,091.00 | 8 |
| Resp virus 6-11 targets CPT 87632 | $907.20 | $1,134.00 | $215.88 – $1,167.63 | 27 |
| Resuscitation cardiopulmonary CPT 92950 | $597.40 | $746.75 | $299.57 – $788.80 | 20 |
| Reticulocyte direct measurement automated CPT 85046 | $36.00 | $45.00 | $5.51 – $32.44 | 27 |
| Revise arm/leg nerve CPT 64708 | not published | not published | $853.60 – $9,100.00 | 8 |
| Rf abltj nrv nrvtg si jt CPT 64625 | $7,732.40 | $9,665.50 | $56.10 – $3,005.54 | 10 |
| Rheumatoid factor quantitative CPT 86431 | $131.60 | $164.50 | $5.61 – $32.99 | 27 |
| Rmvl subq card rhythm mntr CPT 33286 | $1,865.80 | $2,332.25 | $90.36 – $3,265.30 | 21 |
| Ropivacaine 0.2 % epidural pca - 1 hour dose limit HCPCS J2795 | $0.97 | $1.21 | $0.04 – $0.19 | 7 |
| Rp loclzj tum spect w/ct 1 CPT 78830 | $5,883.00 | $7,353.75 | $421.76 – $7,779.35 | 27 |
| Rpl tun cvc wo subq port CPT 36581 | $12,026.00 | $15,032.50 | $204.48 – $241.66 | 7 |
| Rpr aa hrn 1st 3-10 rdc CPT 49593 | not published | not published | $853.60 – $18,724.00 | 8 |
| Rpr aa hrn 1st < 3 cm rdc CPT 49591 | not published | not published | $853.60 – $18,724.00 | 8 |
| Rpr aa hrn 1st < 3 ncr/strn CPT 49592 | not published | not published | $853.60 – $24,338.00 | 8 |
| Rubella antibody igg CPT 86762 | $133.40 | $166.75 | $14.25 – $83.66 | 27 |
| Rubeola antibody igg CPT 86765 | $224.80 | $281.00 | $12.75 – $62.46 | 27 |
| Russell viper venom diluted CPT 85613 | $268.20 | $335.25 | $9.48 – $55.60 | 27 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $2,200.80 | $2,751.00 | $200.70 – $237.19 | 25 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $1,978.20 | $2,472.75 | $102.30 – $170.30 | 25 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $1,371.00 | $1,713.75 | $134.15 – $233.45 | 25 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $985.60 | $1,232.00 | $102.30 – $179.49 | 25 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $1,798.60 | $2,248.25 | $102.30 – $129.74 | 25 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $2,153.00 | $2,691.25 | $161.49 – $233.45 | 25 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $1,706.20 | $2,132.75 | $102.30 – $126.31 | 25 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $653.20 | $816.50 | $102.30 – $121.47 | 25 |
| Screening Mammogram CPT 77067 | $225.00 | $672.00 | $82.23 – $523.85 | 27 |
| Sedimentation rate erythrocyte automated CPT 85652 | $20.00 | $91.00 | $2.67 – $15.68 | 27 |
| Semen analysis presence/motility CPT 89321 | $238.00 | $297.50 | $11.93 – $70.05 | 22 |
| Serpina1 gene CPT 81332 | $261.60 | $327.00 | $43.21 – $211.66 | 25 |
| Sho arthrs srg bicp tenodsis CPT 29828 | not published | not published | $853.60 – $18,724.00 | 8 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | not published | not published | $853.60 – $18,724.00 | 8 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | not published | not published | $853.60 – $18,724.00 | 8 |
| Shoulder MRI (with and without contrast) CPT 73223 | $712.50 | $6,280.50 | $343.57 – $2,804.25 | 27 |
| Shoulder MRI (with contrast) CPT 73222 | $645.50 | $5,087.50 | $421.30 – $4,386.56 | 27 |
| Shoulder MRI (without contrast) CPT 73221 | $461.50 | $4,546.75 | $232.54 – $1,807.44 | 27 |
| Shoulder X-ray CPT 73030 | $657.60 | $822.00 | $27.41 – $497.84 | 27 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $501.60 | $627.00 | $54.71 – $602.31 | 27 |
| Sinus CT scan (with and without contrast) CPT 70488 | $568.00 | $3,060.75 | $171.26 – $1,772.69 | 27 |
| Sinus CT scan (with contrast) CPT 70487 | $494.00 | $3,040.75 | $147.40 – $1,418.27 | 27 |
| Sinus CT scan (without contrast) CPT 70486 | $295.00 | $2,319.50 | $102.30 – $1,011.39 | 27 |
| Sleep Study (Polysomnography) CPT 95810 | $7,018.40 | $8,773.00 | $381.22 – $982.60 | 25 |
| Sleep study unattended CPT 95806 | $536.40 | $670.50 | $78.23 – $2,315.69 | 21 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $127.40 | $159.25 | $3.30 – $27.02 | 27 |
| Smear gram stain CPT 87205 | $96.00 | $120.00 | $4.23 – $24.80 | 27 |
| Smear nasal eosinophil CPT 89190 | $24.00 | $30.00 | $5.73 – $28.08 | 27 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $363.60 | $454.50 | $4.95 – $34.83 | 27 |
| Sodium 24 hour urine CPT 84300 | $59.80 | $74.75 | $5.01 – $28.26 | 27 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $32.00 | $40.00 | $0.01 – $0.01 | 1 |
| Sodium serum/plasma/whole blood CPT 84295 | $52.00 | $65.00 | $4.76 – $27.94 | 27 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $2,203.20 | $2,754.00 | $80.72 – $668.84 | 25 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $602.60 | $753.25 | $20.90 – $300.75 | 25 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $268.80 | $336.00 | $44.00 – $478.64 | 25 |
| Staph a dna amp probe CPT 87640 | $145.60 | $182.00 | $34.74 – $203.98 | 27 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $297.60 | $372.00 | $44.00 – $424.80 | 25 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $34,760.41 | $43,450.51 | $19,489.70 – $19,489.70 | 1 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $11,649.43 | $14,561.79 | $10,252.33 – $10,252.33 | 1 |
| Sterile water/saline, 10 ml HCPCS A4216 | $2.80 | $3.50 | $0.45 – $4.61 | 2 |
| St evaluate speech sound production CPT 92522 | $257.40 | $321.75 | $44.00 – $663.02 | 25 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $389.80 | $487.25 | $44.00 – $953.27 | 25 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $271.40 | $339.25 | $46.55 – $415.17 | 25 |
| St evaluation swallow function CPT 92610 | $271.40 | $339.25 | $44.00 – $407.87 | 25 |
| Stress test pulmonary CPT 94618 | $231.20 | $289.00 | $29.83 – $124.49 | 25 |
| St treatment speech individual CPT 92507 | $213.40 | $266.75 | $23.87 – $320.15 | 25 |
| St treatment swallow dysfunction/oral CPT 92526 | $195.00 | $243.75 | $44.00 – $480.49 | 25 |
| Sugars single quant CPT 84378 | $56.20 | $70.25 | $11.41 – $66.98 | 27 |
| Surgical pathology level 1 gross examination only CPT 88300 | $56.20 | $70.25 | $6.03 – $85.11 | 27 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $193.80 | $242.25 | $12.42 – $154.47 | 27 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $217.40 | $271.75 | $18.18 – $186.35 | 27 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $256.80 | $321.00 | $37.40 – $246.52 | 27 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $466.00 | $582.50 | $50.05 – $1,027.44 | 27 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $705.60 | $882.00 | $74.36 – $2,457.87 | 27 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $20.20 | $25.25 | $4.70 – $27.58 | 27 |
| Susceptibility mic per plate CPT 87186 | $271.00 | $338.75 | $8.56 – $50.23 | 27 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $80.40 | $100.50 | $4.36 – $25.59 | 27 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $9,995.97 | $12,494.96 | $33,780.96 – $33,780.96 | 1 |
| T3 (triiodothyronine) free CPT 84481 | $159.60 | $199.50 | $16.77 – $98.47 | 27 |
| T3 (triiodothyronine) total CPT 84480 | $276.00 | $345.00 | $8.80 – $82.39 | 27 |
| T4 (thyroxine) free CPT 84439 | $35.00 | $161.25 | $8.80 – $52.42 | 27 |
| T4 (thyroxine) total CPT 84436 | $101.40 | $126.75 | $6.80 – $39.92 | 27 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $7.20 | $9.00 | $0.13 – $0.48 | 7 |
| Tacrolimus therapeutic drug level CPT 80197 | $50.00 | $532.25 | $13.59 – $79.76 | 27 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $365.20 | $456.50 | $61.36 – $360.16 | 27 |
| T cells absolute cd 4 count CPT 86361 | $234.40 | $293.00 | $26.51 – $155.58 | 27 |
| T cells total count CPT 86359 | $207.80 | $259.75 | $37.35 – $219.22 | 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.