UPMC Wellsboro
32-36 Central Ave, Wellsboro, PA · UPMC · · NPI 1427501766
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 |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $597.60 | $823.00 | $17.50 – $29.82 | 8 |
| 17-hydroxypregnenolone CPT 84143 | $372.00 | $512.00 | $22.55 – $53.75 | 8 |
| 17-ketosteroids CPT 83586 | $415.20 | $572.00 | $12.65 – $30.15 | 8 |
| 24 hr ambulatory b/p monitor CPT 93786 | $460.80 | $635.00 | $90.66 – $90.66 | 1 |
| 2d tee w or without fol w/con,in HCPCS C8925 | $1,026.40 | $1,414.00 | $578.38 – $578.38 | 1 |
| 2d tte w or without fol w/con,co HCPCS C8923 | $1,026.40 | $1,414.00 | $578.38 – $578.38 | 1 |
| 3d ech img cgen car anomal CPT 93319 | $1,716.80 | $2,366.00 | $21.73 – $62.37 | 8 |
| 3d recon without postprocess indpndt CPT 76376 | $843.20 | $1,162.00 | $11.65 – $218.62 | 2 |
| 5' nucleotidase - sendout CPT 83915 | $294.40 | $405.00 | $11.02 – $26.26 | 8 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $110.40 | $152.00 | $12.52 – $74.03 | 8 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | $134.40 | $224.00 | $25.60 – $25.60 | 1 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $143.40 | $239.00 | $25.60 – $25.60 | 1 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $151.20 | $252.00 | $25.60 – $25.60 | 1 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $122.40 | $204.00 | $25.60 – $25.60 | 1 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $134.40 | $224.00 | $25.60 – $25.60 | 1 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $134.40 | $224.00 | $25.60 – $25.60 | 1 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $151.20 | $252.00 | $25.60 – $25.60 | 1 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $178.80 | $298.00 | $25.60 – $25.60 | 1 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $4,845.00 | $8,075.00 | $44.11 – $48.52 | 6 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $140.00 | $193.00 | $11.87 – $28.29 | 8 |
| Abciximab injection HCPCS J0130 | $6,244.80 | $10,408.00 | $1,873.44 – $9,367.20 | 13 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $1,530.40 | $2,109.00 | $152.76 – $537.16 | 8 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $1,262.40 | $1,740.00 | $100.61 – $422.11 | 8 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $4,204.00 | $5,794.00 | $142.72 – $888.14 | 8 |
| Abdominal CT scan (with contrast) CPT 74160 | $3,352.80 | $4,621.00 | $115.20 – $732.91 | 8 |
| Abdominal CT scan (without contrast) CPT 74150 | $2,630.40 | $3,625.00 | $99.20 – $624.29 | 8 |
| Abdominal MRI (with and without contrast) CPT 74183 | $4,850.40 | $6,684.00 | $604.49 – $2,009.77 | 8 |
| Abdominal MRI (with contrast) CPT 74182 | $3,689.60 | $5,085.00 | $399.62 – $1,125.45 | 8 |
| Abdominal MRI (without contrast) CPT 74181 | $3,040.00 | $4,190.00 | $344.32 – $1,141.28 | 8 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,689.00 | $2,815.00 | $92.76 – $993.28 | 8 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,108.80 | $1,528.00 | $73.60 – $273.02 | 8 |
| Abdominal Ultrasound (limited) CPT 76705 | $835.20 | $1,151.00 | $48.00 – $198.49 | 8 |
| Abdominal X-ray (2 views) CPT 74019 | $395.20 | $545.00 | $21.09 – $44.00 | 8 |
| Abdominal X-ray Series (acute, with chest view) CPT 74022 | $609.60 | $840.00 | $30.72 – $104.08 | 8 |
| Abdominal X-ray (single view) CPT 74018 | $650.40 | $897.00 | $17.63 – $36.03 | 8 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $1,175.20 | $1,619.00 | $59.98 – $993.28 | 8 |
| Ablation cryo thigh/knee CPT 27599 | $507.20 | $699.00 | $161.64 – $161.64 | 1 |
| Ablation of upper extremity nerves rf CPT 64999 | $998.40 | $1,376.00 | $212.29 – $212.29 | 1 |
| Abobotulinumtoxina HCPCS J0586 | $4,582.80 | $7,638.00 | $8.75 – $9.63 | 6 |
| Abscess drain retroperitoneal surg code CPT 49406 | $5,596.80 | $9,281.00 | $190.99 – $1,165.55 | 8 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | $4.00 | $5.00 | $7.32 – $14.65 | 2 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $168.60 | $281.00 | $0.06 – $0.06 | 5 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $256.80 | $321.00 | $19.84 – $21.83 | 5 |
| Acetone qualitative CPT 82009 | $72.40 | $99.00 | $4.47 – $8.98 | 8 |
| Acetylcholine receptor modulating antibody CPT 86043 | $388.20 | $647.00 | $9.64 – $16.43 | 7 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $1,044.60 | $1,741.00 | $0.39 – $0.42 | 5 |
| Acetylcysteine non-comp unit HCPCS J7608 | $92.80 | $116.00 | $0.67 – $9.52 | 4 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $121.80 | $203.00 | $129.92 – $129.92 | 1 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $141.00 | $235.00 | $101.61 – $101.61 | 1 |
| Acromp/acromionectomy prtl CPT 23130 | not published | not published | $993.28 – $1,394.74 | 2 |
| Acute hepatitis panel CPT 80074 | $921.60 | $1,271.00 | $47.07 – $89.74 | 8 |
| Acute venous thrombus image CPT 78456 | $580.00 | $799.00 | $136.52 – $406.58 | 8 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $74.40 | $124.00 | $0.04 – $0.04 | 5 |
| #acylcarnitineprfl CPT 82017 | $268.80 | $371.00 | $13.17 – $16.67 | 2 |
| Adalimumab injection HCPCS J0135 | $7,692.60 | $12,821.00 | not published | 0 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $382.20 | $637.00 | $0.56 – $0.61 | 5 |
| Adenovirus ag ia CPT 87301 | $196.00 | $270.00 | $9.36 – $11.84 | 2 |
| Adenovirus antibody,serum - quest CPT 86603 | $111.20 | $153.00 | $12.72 – $30.32 | 8 |
| Adhesive, liquid or equal HCPCS A4364 | $2,828.00 | $3,898.00 | $2.93 – $6.86 | 2 |
| Adh-sendout CPT 84588 | $375.20 | $517.00 | $33.54 – $61.35 | 8 |
| Adj gastric band via subq port CPT 43999 | $4,264.00 | $5,877.00 | $644.56 – $644.56 | 1 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $120.00 | $150.00 | $4.63 – $4.63 | 1 |
| Admin ecg contrast agent CPT 93352 | $356.80 | $491.00 | $26.73 – $57.05 | 2 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $269.60 | $372.00 | $31.11 – $59.85 | 8 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $269.60 | $372.00 | $67.85 – $128.83 | 8 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $977.60 | $1,347.00 | $137.28 – $262.85 | 8 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $615.20 | $847.00 | $101.42 – $186.41 | 8 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $269.60 | $372.00 | $34.94 – $55.04 | 8 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $223.20 | $372.00 | $55.25 – $101.67 | 8 |
| Administration immunization each additional component CPT 90461 | $58.80 | $81.00 | $7.94 – $17.30 | 2 |
| Administration immunization each additional vaccine CPT 90472 | $16.00 | $21.00 | $12.80 – $12.80 | 1 |
| Administration immunization first component each vaccine CPT 90460 | $283.20 | $391.00 | $17.73 – $34.20 | 2 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $18.40 | $24.00 | $52.68 – $52.68 | 1 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $18.40 | $24.00 | $9.25 – $9.25 | 1 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $25.20 | $42.00 | $20.56 – $20.56 | 1 |
| Administration vaccine hepatitis b HCPCS G0010 | $16.00 | $21.00 | $33.09 – $33.09 | 1 |
| Administration vaccine influenza virus HCPCS G0008 | $16.00 | $20.00 | $11.00 – $17.04 | 7 |
| Administration vaccine pneumococcal HCPCS G0009 | $16.00 | $20.00 | $11.00 – $17.04 | 7 |
| Administration vaccine rsv monoclonal ab seasonal dose im CPT 96381 | $25.20 | $42.00 | $17.52 – $17.52 | 1 |
| Ado-trastuzumab emtansine 100 mg intravenous solution HCPCS J9354 | $139.20 | $232.00 | $42.16 – $46.38 | 6 |
| Aep hearing status deter i&r CPT 92651 | $154.40 | $213.00 | $77.33 – $119.81 | 8 |
| Aep neurodiagnostic i&r CPT 92653 | $295.20 | $406.00 | $74.26 – $115.05 | 8 |
| Aep thrshld est mlt freq i&r CPT 92652 | $295.20 | $406.00 | $101.57 – $157.37 | 8 |
| _afb id by dna probe rflx ast CPT 87149 | $170.40 | $235.00 | $19.82 – $37.78 | 8 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $1,823.20 | $2,513.00 | $114.02 – $225.26 | 8 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | $27,295.80 | $45,493.00 | $230.15 – $253.17 | 6 |
| Albumin body fluid quantitative each specimen CPT 82042 | $76.60 | $106.00 | $6.08 – $7.69 | 2 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $304.00 | $380.00 | $53.08 – $58.38 | 4 |
| Albumin (human), 5%, 250 ml HCPCS P9045 | $682.40 | $853.00 | $53.08 – $58.38 | 5 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $422.40 | $582.00 | $5.71 – $13.63 | 8 |
| Albumin serum plasma or whole blood CPT 82040 | $80.80 | $111.00 | $3.65 – $6.22 | 8 |
| Albuterol ipratrop non-comp HCPCS J7620 | $13.80 | $17.25 | $0.09 – $0.21 | 4 |
| Albuterol non-comp con HCPCS J7611 | $5.00 | $6.25 | $0.17 – $0.45 | 4 |
| Albuterol non-comp unit HCPCS J7613 | $10.00 | $12.50 | $0.06 – $0.08 | 6 |
| Aldesleukin injection HCPCS J9015 | $6,538.20 | $10,897.00 | $5,301.26 – $5,301.26 | 1 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | $8,173.80 | $13,623.00 | $2,429.89 – $2,672.88 | 6 |
| Alginate dressing <=16 sq in HCPCS A6196 | $13.00 | $17.00 | $8.47 – $16.91 | 2 |
| Alginate drsg >16 <=48 sq in HCPCS A6197 | $168.80 | $233.00 | $18.96 – $37.91 | 2 |
| Alginate drsg wound filler HCPCS A6199 | $128.00 | $176.00 | $6.09 – $12.18 | 2 |
| Alkaline phosphatase CPT 84075 | $158.40 | $218.00 | $5.12 – $10.86 | 8 |
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.