WellSpan Surgery & Rehabilitation Hospital
55 Monument Road, York PA 17403, PA · Wellspan · · NPI 1760787576
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 |
|---|---|---|---|---|
| Cyanocobalamin (vit b-12) 1,000 mcg/ml injection solution HCPCS J3420 | $20.00 | $25.00 | $0.69 – $3.06 | 9 |
| Cyclic citrullinated peptide antibody CPT 86200 | $54.40 | $68.00 | $12.95 – $53.48 | 25 |
| Cyclosporine modified 25 mg capsule HCPCS J7515 | $4.00 | $5.00 | $0.80 – $2.59 | 9 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $60.00 | $75.00 | $14.39 – $67.42 | 25 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $204.80 | $256.00 | $51.58 – $313.07 | 25 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $1,312.40 | $1,640.50 | $14.00 – $52.50 | 9 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $4,891.60 | $6,114.50 | $3.45 – $397.60 | 25 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | not published | not published | $386.78 – $1,101.92 | 21 |
| Decalcification CPT 88311 | $103.20 | $129.00 | $16.72 – $81.82 | 10 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $387.20 | $484.00 | $31.33 – $561.93 | 22 |
| Decompression unspecified nerve 64722 CPT 64722 | not published | not published | $966.25 – $1,101.92 | 6 |
| Delay flap fccnaxghf 15620 CPT 15620 | not published | not published | $970.00 – $3,098.97 | 21 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $279.20 | $349.00 | $14.77 – $344.58 | 22 |
| Design mlc device for imrt CPT 77338 | $7,554.40 | $9,443.00 | $183.04 – $620.18 | 17 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $182.40 | $228.00 | $14.10 – $62.86 | 24 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $3.40 | $4.25 | $0.12 – $1.68 | 9 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $19.40 | $24.25 | $0.38 – $1.54 | 9 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $33.40 | $41.75 | $1.81 – $6.37 | 8 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $92.00 | $115.00 | $21.00 – $91.81 | 25 |
| Diabetes (HbA1c) Test CPT 83036 | $25.00 | $75.00 | $7.00 – $40.10 | 26 |
| Dialysis one evaluation CPT 90945 | $464.80 | $581.00 | $119.00 – $721.40 | 17 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $248.80 | $311.00 | $12.80 – $44.68 | 9 |
| Digoxin total therapeutic drug level CPT 80162 | $55.20 | $69.00 | $11.00 – $54.85 | 25 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $33.80 | $42.25 | $0.76 – $2.88 | 9 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $366.40 | $458.00 | $14.16 – $57.05 | 9 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $121.00 | $151.25 | $6.80 – $25.32 | 9 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $131.60 | $164.50 | $11.10 – $42.00 | 9 |
| Drsg wnd mesh bovine bilayer 4x10in matrix-q4104-cost per sq cm HCPCS Q4104 | $18,762.68 | $23,453.35 | $51.00 – $174.27 | 5 |
| Drug test def 1-7 classes HCPCS G0480 | $202.40 | $253.00 | $63.95 – $472.60 | 25 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $253.60 | $317.00 | $62.14 – $256.64 | 25 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $448.00 | $560.00 | $100.64 – $314.47 | 22 |
| Ecg 12 lead tracing only CPT 93005 | $314.40 | $393.00 | $13.08 – $100.63 | 22 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $3,666.40 | $4,583.00 | $122.67 – $928.90 | 22 |
| Eeg recording awake and asleep CPT 95819 | $838.40 | $1,048.00 | $16.88 – $527.56 | 22 |
| Ehrlicha chaffeensis amp prb CPT 87484 | $162.40 | $203.00 | $28.07 – $144.92 | 25 |
| Elbow arthroscopy/surgery CPT 29837 | not published | not published | $970.00 – $1,165.00 | 6 |
| Electrical stimulation/unattended 97014 CPT 97014 | $142.40 | $178.00 | $11.82 – $56.95 | 22 |
| Electrolyte panel CPT 80051 | $34.40 | $43.00 | $7.00 – $28.95 | 25 |
| Endoscopy swallow (fees) vid CPT 92612 | $278.40 | $348.00 | $78.60 – $319.04 | 22 |
| Enoxaparin 30 mg/0.3 ml subcutaneous syringe HCPCS J1650 | $145.20 | $181.50 | $1.76 – $5.47 | 9 |
| Epinephrine 0.1 mg/ml injection syringe HCPCS J0168 | $110.80 | $138.50 | $22.60 – $77.34 | 8 |
| Epinephrine 1 mg/ml im kit - adult HCPCS J0169 | $114.60 | $143.25 | $13.59 – $42.24 | 8 |
| Epinephrine hcl (pf) 1 mg/ml (1 ml) injection solution HCPCS J0166 | $400.40 | $500.50 | $48.00 – $729.60 | 8 |
| Epoetin alfa-epbx 40,000 unit/ml injection solution HCPCS Q5106 | $2,534.20 | $3,167.75 | $9.26 – $49.49 | 25 |
| Ertapenem 1000 mg/10 ml IV (dilution #1) desensitization - cnr HCPCS J1335 | $105.60 | $132.00 | $18.72 – $64.26 | 9 |
| ER Visit (level 3) CPT 99283 | $1,740.80 | $2,176.00 | $70.81 – $469.09 | 22 |
| ER Visit (level 4) CPT 99284 | $2,678.40 | $3,348.00 | $119.16 – $721.40 | 22 |
| ER Visit (level 5, high severity) CPT 99285 | $2,981.60 | $3,727.00 | $173.42 – $1,038.68 | 22 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $38.00 | $47.50 | $2.18 – $9.80 | 9 |
| Established Patient Office Visit (level 1) CPT 99211 | $61.60 | $77.00 | $8.88 – $136.00 | 9 |
| Established Patient Office Visit (level 3) CPT 99213 | $113.60 | $142.00 | $50.00 – $136.00 | 8 |
| Established Patient Office Visit (level 4) CPT 99214 | $168.00 | $210.00 | $50.00 – $136.00 | 8 |
| Established Patient Office Visit (level 5) CPT 99215 | $206.40 | $258.00 | $50.00 – $218.33 | 22 |
| Ethylene glycol -sendout CPT 82693 | $62.40 | $78.00 | $7.45 – $61.54 | 20 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $373.60 | $467.00 | $50.00 – $203.89 | 21 |
| Exc ben+marg excep skin tag snhfg 0.6-1cm 11421 CPT 11421 | not published | not published | $681.13 – $1,191.98 | 21 |
| Exc ben+marg excep skin tag snhfg 2.1-3cm 11423 CPT 11423 | not published | not published | $863.75 – $1,101.92 | 6 |
| Exc ben+marg excep skin tag snhfg >4cm 11426 CPT 11426 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc foot/toe tum subq < 1.5 cm 28043 CPT 28043 | not published | not published | $926.25 – $1,101.92 | 6 |
| Exc forearm les sc 3 cm/> CPT 25071 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc forearm tum deep < 3 cm CPT 25076 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc hand les sc < 1.5 cm CPT 26115 | not published | not published | $926.25 – $1,101.92 | 6 |
| Excise intrspinl lesion lmbr CPT 63267 | not published | not published | $970.00 – $1,101.92 | 6 |
| Excise wrist tendon sheath CPT 25118 | not published | not published | $970.00 – $1,101.92 | 6 |
| Excision benign lesion scalp/neck/hands/feet/genitalia 1.1 - 2.0 cm CPT 11422 | not published | not published | $926.25 – $1,101.92 | 6 |
| Excision olecranon bursa CPT 24105 | not published | not published | $956.25 – $1,101.92 | 6 |
| Excision tumor soft tissue back/flank subcutaneous >= 3 cm CPT 21931 | not published | not published | $970.00 – $1,101.92 | 6 |
| Excis partial tal calc CPT 28120 | not published | not published | $970.00 – $1,263.75 | 6 |
| Exc malig snhfg 2.1-3 cm 11623 CPT 11623 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc prtl bn phlnx toe CPT 28124 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc shoulder tum deep < 5 cm CPT 23076 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc sq tum/leg or ankle area <3 cm 27618 CPT 27618 | not published | not published | $852.50 – $1,101.92 | 6 |
| Exc sq tumor/foot or toe < 1.5 cm 28039 CPT 28039 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc sq tum/vasc malform/hand/fngr 26111 CPT 26111 | not published | not published | $970.00 – $1,101.92 | 6 |
| Exc tendon sheath or cap lesion 26160 CPT 26160 | not published | not published | $968.75 – $1,101.92 | 6 |
| Exploration of foot joint CPT 28022 | not published | not published | $970.00 – $1,202.50 | 6 |
| Explore penetrating wnd/extremity 20103 CPT 20103 | not published | not published | $970.00 – $1,101.92 | 6 |
| Explore/treat finger joint CPT 26080 | not published | not published | $713.75 – $1,101.92 | 6 |
| Exp w remove/deep fb/forearm/wrist 25248 CPT 25248 | not published | not published | $970.00 – $1,101.92 | 6 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | $28.60 | $35.75 | $0.72 – $2.80 | 9 |
| Fat/lipids feces qualitative CPT 82705 | $21.60 | $27.00 | $5.10 – $23.94 | 25 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $30.60 | $38.25 | $1.00 – $3.34 | 9 |
| Ferritin CPT 82728 | $40.00 | $71.00 | $12.00 – $56.29 | 26 |
| Fibrin degradation d dimer quantitative CPT 85379 | $50.40 | $63.00 | $10.18 – $42.04 | 25 |
| Finger tendon transfer CPT 26498 | not published | not published | $970.00 – $1,101.92 | 6 |
| Fixation of knee joint CPT 27570 | not published | not published | $868.75 – $1,101.92 | 6 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $71.00 | $88.75 | $2.26 – $12.53 | 9 |
| Fluoroguide needle placement CPT 77002 | $641.60 | $802.00 | $44.59 – $188.33 | 7 |
| Fluoroscopy up to 1 hour CPT 76000 | $534.40 | $668.00 | $14.38 – $1,342.45 | 23 |
| Folic acid CPT 82746 | $45.00 | $77.00 | $12.00 – $60.71 | 25 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $185.80 | $232.25 | $30.00 – $105.00 | 9 |
| Fondaparinux sodium HCPCS J1652 | $75.40 | $94.25 | $3.62 – $15.05 | 9 |
| Foot X-ray CPT 73630 | $290.40 | $363.00 | $14.38 – $497.84 | 24 |
| Full thick gft w/close donor fccmnaghf <=20sqcm 15240 CPT 15240 | not published | not published | $970.00 – $3,098.97 | 21 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $44.00 | $55.00 | $0.72 – $6.40 | 9 |
| Fusion of ankle joint open CPT 27870 | not published | not published | $970.00 – $1,101.92 | 6 |
| Fusion of big toe joint CPT 28750 | not published | not published | $970.00 – $1,316.25 | 6 |
| Fusion of big toe joint CPT 28755 | not published | not published | $970.00 – $1,306.25 | 6 |
| Fusion of finger joint CPT 26860 | not published | not published | $970.00 – $1,101.92 | 6 |
| Fusion of finger tendons CPT 26471 | not published | not published | $970.00 – $1,101.92 | 6 |
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.