WellSpan Waynesboro Hospital
501 E. Main St., Waynesboro, PA · Wellspan · · NPI 1821091059
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 |
|---|---|---|---|---|
| St evaluation swallow function CPT 92610 | $380.00 | $475.00 | $42.00 – $273.46 | 20 |
| Stress test pulmonary CPT 94618 | $455.20 | $569.00 | $28.48 – $467.26 | 21 |
| St treatment speech individual CPT 92507 | $304.80 | $381.00 | $22.89 – $50.00 | 6 |
| St treatment swallow dysfunction/oral CPT 92526 | $296.80 | $371.00 | $42.20 – $56.80 | 6 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $15.00 | $18.75 | $7.28 – $49.92 | 3 |
| Sugars single quant CPT 84378 | $48.00 | $60.00 | $11.53 – $76.06 | 24 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $22.00 | $27.50 | $5.60 – $33.60 | 4 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $5.60 | $7.00 | $65.37 – $524.03 | 3 |
| Surgical pathology level 1 gross examination only CPT 88300 | $126.40 | $158.00 | $5.75 – $88.77 | 24 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $126.40 | $158.00 | $8.63 – $175.39 | 24 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $252.80 | $316.00 | $6.53 – $211.58 | 24 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $218.40 | $273.00 | $4.88 – $283.77 | 24 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $1,124.00 | $1,405.00 | $12.50 – $1,304.00 | 24 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $20.00 | $25.00 | $4.75 – $31.32 | 24 |
| Susceptibility mic per plate CPT 87186 | $52.80 | $66.00 | $8.40 – $57.03 | 24 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $18.40 | $23.00 | $4.40 – $29.06 | 24 |
| T3 (triiodothyronine) free CPT 84481 | $70.40 | $88.00 | $13.75 – $111.80 | 24 |
| T3 (triiodothyronine) total CPT 84480 | $59.20 | $74.00 | $8.40 – $93.55 | 24 |
| T4 (thyroxine) free CPT 84439 | $35.00 | $69.00 | $8.40 – $59.52 | 25 |
| T4 (thyroxine) total CPT 84436 | $28.00 | $35.00 | $6.87 – $45.33 | 24 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $2.20 | $2.75 | $0.13 – $0.67 | 4 |
| Tacrolimus therapeutic drug level CPT 80197 | $50.00 | $72.00 | $13.73 – $90.56 | 24 |
| Target gsa panel hmtlmph neop CPT 81450 | $3,160.00 | $3,950.00 | $63.76 – $3,136.86 | 24 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $327.60 | $409.50 | $0.33 – $388.50 | 20 |
| Tbs techl calculation only CPT 77091 | $398.40 | $498.00 | $54.34 – $497.84 | 17 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $309.60 | $387.00 | $16.25 – $408.93 | 24 |
| Tc-99m labeled rbc HCPCS A9560 | $363.20 | $454.00 | $74.54 – $337.44 | 3 |
| Tc-99m maa HCPCS A9540 | $320.80 | $401.00 | $3.19 – $107.10 | 3 |
| Tc-99m mebrofenin HCPCS A9537 | $94.40 | $118.00 | $75.45 – $363.07 | 3 |
| Tc-99m medronate HCPCS A9503 | $52.80 | $66.00 | $16.57 – $189.41 | 3 |
| Tc-99m mertiatide HCPCS A9562 | $824.80 | $1,031.00 | $61.77 – $2,458.34 | 2 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $17.60 | $22.00 | $7.50 – $32.00 | 16 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $321.60 | $402.00 | $7.55 – $65.22 | 3 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $68.80 | $86.00 | $4.33 – $34.14 | 3 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $94.40 | $118.00 | $299.64 – $1,441.86 | 3 |
| Tc-99m sulfur colloid HCPCS A9541 | $146.40 | $183.00 | $499.68 – $2,404.48 | 3 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $195.20 | $244.00 | $12.34 – $310.01 | 24 |
| T cells absolute cd 4 count CPT 86361 | $111.20 | $139.00 | $6.80 – $176.65 | 24 |
| T cells total count CPT 86359 | $157.60 | $197.00 | $27.23 – $248.91 | 24 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $26,651.20 | $33,314.00 | $20.94 – $29,277.57 | 20 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $5.20 | $6.50 | $4.94 – $22.47 | 4 |
| Test stress cardiovascular tracing only CPT 93017 | $1,102.40 | $1,378.00 | $48.83 – $2,409.40 | 22 |
| Tetanus immune globulin inj HCPCS J1670 | $1,468.40 | $1,835.50 | $18.40 – $2,016.20 | 20 |
| Theophylline therapeutic drug level CPT 80198 | $59.20 | $74.00 | $11.55 – $93.36 | 24 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $31.80 | $39.75 | $2.76 – $12.32 | 4 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $2,428.00 | $3,035.00 | $30.00 – $2,241.21 | 21 |
| Thrombin time CPT 85670 | $40.80 | $51.00 | $5.13 – $38.14 | 24 |
| Thyroglobulin antibody CPT 86800 | $66.40 | $83.00 | $3.75 – $104.93 | 24 |
| Thyroid (TSH) Test CPT 84443 | $40.00 | $127.00 | $3.75 – $110.85 | 25 |
| Thyroid Ultrasound CPT 76536 | $635.20 | $794.00 | $34.38 – $602.31 | 24 |
| Thyroxine binding globulin (tbg) CPT 84442 | $61.60 | $77.00 | $8.75 – $97.57 | 24 |
| Tissue exam koh skin/hair/nails CPT 87220 | $17.60 | $22.00 | $4.10 – $22.82 | 24 |
| Tissue transglutaminase iga CPT 86364 | $57.60 | $72.00 | $8.65 – $52.11 | 18 |
| Tlh w/t/o 250 g or less CPT 58571 | not published | not published | $814.80 – $37,740.78 | 22 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $17.00 | $21.25 | $1.80 – $7.87 | 4 |
| Tobramycin peak therapeutic drug level CPT 80200 | $67.20 | $84.00 | $16.13 – $106.33 | 24 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $6,214.80 | $7,768.50 | $6.73 – $8,232.00 | 20 |
| Tomosynthesis breast screen bilateral CPT 77063 | $157.60 | $197.00 | $21.59 – $149.23 | 24 |
| Toxoplasma antibody igg CPT 86777 | $60.00 | $75.00 | $7.23 – $94.99 | 24 |
| Toxoplasma antibody igm CPT 86778 | $60.00 | $75.00 | $9.01 – $95.04 | 24 |
| Tranexamic acid 1,000 mg/10 ml (100 mg/ml) intravenous solution HCPCS J3290 | $16.20 | $20.25 | $0.07 – $0.07 | 1 |
| Transferrin CPT 84466 | $50.00 | $97.00 | $12.76 – $84.24 | 25 |
| Transfusion blood/blood component(s) CPT 36430 | $1,714.40 | $2,143.00 | $29.23 – $1,584.77 | 21 |
| Treat fracture of radius CPT 25505 | not published | not published | $649.95 – $15,024.43 | 23 |
| Treat humerus fracture CPT 24535 | $849.60 | $1,062.00 | $216.30 – $5,801.52 | 21 |
| Treat knee fracture 27530 CPT 27530 | $1,445.60 | $1,807.00 | $134.93 – $869.58 | 21 |
| Treatment fx radial distal open w/internal fixation 2 frag left (restricted method ii cah) CPT 25608 | not published | not published | $814.80 – $25,896.10 | 22 |
| Treatment inhalation continuous aerosol medication acute airway obstruction 1st hour CPT 94644 | $549.60 | $687.00 | $26.99 – $467.26 | 21 |
| Treatment inhalation continuous aerosol medication acute airway obstruction each additional hour CPT 94645 | $255.20 | $319.00 | $10.34 – $13.92 | 5 |
| Treatment inhalation pressurized/nonpressurized acute airway obstruction CPT 94640 | $252.00 | $315.00 | $152.54 – $357.80 | 15 |
| Treatment of ankle fracture 27786 CPT 27786 | $518.40 | $648.00 | $124.43 – $869.58 | 21 |
| Treatment of fibula fracture 27780 CPT 27780 | $593.60 | $742.00 | $144.38 – $869.58 | 16 |
| Treatment of heel fracture 28400 CPT 28400 | $513.60 | $642.00 | $147.00 – $869.58 | 21 |
| Treatment of toe fracture 28510 CPT 28510 | $752.00 | $940.00 | $61.25 – $869.58 | 16 |
| Treat metacarpal fracture CPT 26608 | not published | not published | $814.80 – $18,105.94 | 23 |
| Treat ulnar fracture CPT 24685 | not published | not published | $814.80 – $25,896.10 | 22 |
| Treponema pallidum antibody CPT 86780 | $65.60 | $82.00 | $6.25 – $85.73 | 24 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $35.60 | $44.50 | $2.58 – $12.18 | 4 |
| Triglycerides CPT 84478 | $28.00 | $35.00 | $5.74 – $37.96 | 24 |
| Trluml dil aq o/f can without st CPT 66174 | not published | not published | $970.00 – $17,057.00 | 21 |
| Trml dstrj ios bvn 1st 2 l/s CPT 64628 | not published | not published | $970.00 – $43,981.00 | 20 |
| Troponin quantitative CPT 84484 | $118.40 | $148.00 | $10.00 – $57.48 | 24 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $300.80 | $376.00 | $17.50 – $602.31 | 24 |
| Ultrasound breast complete CPT 76641 | $540.80 | $676.00 | $19.35 – $602.31 | 24 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $492.00 | $615.00 | $29.55 – $497.84 | 24 |
| Ultrasound chest CPT 76604 | $724.00 | $905.00 | $21.88 – $602.31 | 24 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $329.60 | $412.00 | $39.41 – $602.31 | 23 |
| Ultrasound encephalogram CPT 76506 | $588.80 | $736.00 | $26.75 – $602.31 | 24 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $544.00 | $680.00 | $23.75 – $615.27 | 24 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $909.60 | $1,137.00 | $38.68 – $602.31 | 23 |
| Ultrasound guidance for vascular access CPT 76937 | $504.00 | $630.00 | $26.93 – $124.11 | 6 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $1,184.80 | $1,481.00 | $75.96 – $866.55 | 6 |
| Ultrasound guide intraoperative CPT 76998 | $1,126.40 | $1,408.00 | $713.38 – $713.38 | 1 |
| Ultrasound hips infant dynamic CPT 76885 | $636.80 | $796.00 | $38.79 – $497.84 | 24 |
| Ultrasound infant hips ltd without stress CPT 76886 | $558.40 | $698.00 | $21.88 – $497.84 | 18 |
| Ultrasound joint complete left CPT 76881 | $575.20 | $719.00 | $45.78 – $602.31 | 24 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $468.00 | $585.00 | $24.98 – $602.31 | 24 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $892.00 | $1,115.00 | $57.98 – $193.43 | 7 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $666.40 | $833.00 | $61.68 – $602.31 | 24 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $728.00 | $910.00 | $50.78 – $602.31 | 24 |
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.