WELLSPAN WAYNESBORO HOSPITAL

Code	Description	Gross	Cash	Min payer	Max payer	# insurers
22514	Treatment of Broken Lower Spine Bone With Placement of Stabilizing Device	$34,829	$27,863	—	—	37
J3101	TENECTEPLASE 50 MG INTRAVENOUS SOLUTION	$33,314	$26,651	—	—	38
J3380	VEDOLIZUMAB 300 MG INTRAVENOUS SOLUTION	$27,973	$22,379	—	—	38
J2323	NATALIZUMAB 300 MG/15 ML INTRAVENOUS SOLUTION	$24,628	$19,703	—	—	38
J0896	LUSPATERCEPT-AAMT 25 MG SUBCUTANEOUS SOLUTION	$15,738	$12,590	—	—	37
37244	Occlusion of Artery or Vein Bleeding With Review by Radiologist	$15,513	$12,410	—	—	43
J1162	DIGOXIN IMMUNE FAB 40 MG INTRAVENOUS SOLUTION	$14,146	$11,317	—	—	38
37187	Remove/Dissolve Bloodclot Vein With Fluoroscopic Guide, Initial Treatment	$13,160	$10,528	—	—	37
37191	Insertion of Vena Cava Filter With Review by Radiologist	$10,316	$8,253	—	—	37
J0840	CROTALIDAE POLYVAL IMMUNE FAB SOLUTION FOR INJECTION	$8,853	$7,082	—	—	38
360	Operative Session Level 1 Initial 30 Minutes	$8,760	$7,008	—	—	15
C1778	STIMULATOR SPRINT ENDURA NERVE NONSTERILE LATEX FREE DISPOSABLE	$8,085	$6,468	—	—	18
46040	Drainage of Deep Abscess in Rectum	$7,966	$6,373	—	—	43
78452	Nuclear Medicine Studies of Heart Muscle at Rest and With Stress and Spect	$7,800	$6,240	—	—	45
J3262	TOCILIZUMAB 400 MG/20 ML (20 MG/ML) INTRAVENOUS SOLUTION	$7,769	$6,215	—	—	38
C9399	IDARUCIZUMAB 2.5 GRAM/50 ML INTRAVENOUS SOLUTION	$7,587	$6,069	—	—	14
200	Intensive Care Isolation Room and Board	$7,091	$5,673	—	—	6
C1889	PROBE ELECTROSURGICAL RADIOFREQUENCY INTRACEPT	$6,930	$5,544	—	—	18
J0897	DENOSUMAB 60 MG/ML SUBCUTANEOUS SYRINGE	$6,592	$5,274	—	—	37
32550	Insertion of Indwelling Tube for Drainage of Lung Fluid	$6,295	$5,036	—	—	37
81229	Chromosome Analysis to Detect Various Developmental Disorders	$6,032	$4,826	—	—	38
Q5136	DENOSUMAB-BBDZ 60 MG/ML SUBCUTANEOUS SYRINGE	$5,927	$4,741	—	—	37
78451	Nuclear Medicine Study of Heart Muscle at Rest and With Stress and Spect	$5,900	$4,720	—	—	45
20240	Biopsy of Surface Bone	$5,842	$4,674	—	—	43
10140	Drainage of Blood or Fluid Accumulation	$5,551	$4,441	—	—	43
272	SCISSORS LAPAROSCOPIC 31.75CM 8MM DA VINCI XI HOT SHEARS ENDOWRIST 38D CURVE MONOPOLAR 1.3	$5,544	$4,435	—	—	15
20206	Needle Biopsy of Muscle	$5,516	$4,413	—	—	43
55100	Drainage of Abscess of Scrotum	$5,488	$4,390	—	—	43
J2802	ROMIPLOSTIM 125 MCG SUBCUTANEOUS SOLUTION	$5,485	$4,388	—	—	37
37252	Ultrasound Evaluation Blood Vessel With Review by Radiology, Initial Vessel	$5,276	$4,221	—	—	16
19083	Biopsy Breast Place Locating Device Using Ultrasound, First Growth	$5,125	$4,100	—	—	43
36573	Insert Tube for Infusion With Image Guide Over 5 Yr	$5,072	$4,058	—	—	43
C1713	SPEEDPLATE LAPIPLASTY 18X17MM	$5,009	$4,008	—	—	18
74178	CT Scan of Abdomen and Pelvis Before and After Contrast	$4,967	$525	—	—	45
36556	Insert Non-Tunneled Central Venous Tube for Infusion (5 Years or Older)	$4,959	$3,967	—	—	43
19081	Biopsy Breast/Placement Locating Device Using X-Ray With Needle 1st Growth	$4,890	$3,912	—	—	43
J0875	DALBAVANCIN 500 MG INTRAVENOUS SOLUTION	$4,679	$3,743	—	—	37
93312	Ultrasound of Heart With Probe in Esophagus, With Report	$4,628	$3,702	—	—	89
99291	Critical Care, First 30-74 Minutes	$4,467	$3,574	—	—	45
74177	CT Scan of Abdomen and Pelvis With Contrast	$4,340	$438	—	—	45
38505	Needle Biopsy or Removal of Surface Lymph Nodes	$4,283	$3,426	—	—	43
74183	MRI Scan of Abdomen Before and After Contrast	$4,259	$706	—	—	45
70553	MRI Scan of Brain Before and After Contrast	$4,256	$702	—	—	45
73223	MRI Scan of Arm Joint Before and After Contrast	$4,226	$713	—	—	45
P9037	Platelets, Pheresis, Leukocytes Reduced, Irradiated, Each Unit	$3,985	$3,188	—	—	43
81450	Genetic Test Mds/Cmml	$3,950	$3,160	—	—	45
93306	Ultrasound of Heart With Blood Flow, Rate, Direction and Valve Function	$3,933	$3,146	—	—	45
49405	Drainage of Fluid Collection by Tube Through Skin Using Imaging Guidance	$3,792	$3,034	—	—	43
73723	MRI Scan of Leg Joint Before and After Contrast	$3,764	$713	—	—	45
36590	Removal of Central Venous Tube With Port or Pump	$3,745	$2,996	—	—	43

Showing top 50 of 2,074 priced procedures, sorted by gross charge.

Data straight from this hospital's federally-mandated machine-readable file (45 CFR § 180). The compliance grade reflects how completely the hospital published the six required data elements, not the quality of care.