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 |
|---|---|---|---|---|
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $228.80 | $315.00 | $6.40 – $68.53 | 8 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $256.80 | $354.00 | $8.32 – $84.28 | 8 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $302.40 | $417.00 | $11.52 – $156.82 | 8 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $493.60 | $680.00 | $14.72 – $251.07 | 8 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $748.80 | $1,032.00 | $22.40 – $365.25 | 8 |
| Susceptibility agar dilution per agent CPT 87181 | $111.20 | $153.00 | $4.70 – $10.23 | 8 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $20.40 | $28.00 | $4.70 – $8.95 | 8 |
| Susceptibility mic per plate CPT 87186 | $224.80 | $310.00 | $8.00 – $13.63 | 8 |
| Suscept studies macrobroth dilution ea CPT 87188 | $104.80 | $145.00 | $6.00 – $10.23 | 8 |
| Swallowing Evaluation (Bedside) CPT 92610 | $301.60 | $416.00 | $42.79 – $75.51 | 8 |
| Swallowing Therapy Session CPT 92526 | $216.80 | $299.00 | $61.11 – $82.99 | 2 |
| Synvisc or synvisc-one HCPCS J7325 | $72.00 | $120.00 | $7.95 – $8.75 | 6 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $92.80 | $128.00 | $4.34 – $10.38 | 8 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $8,429.60 | $11,617.00 | $1,896.66 – $9,483.30 | 13 |
| T3 (triiodothyronine) free CPT 84481 | $166.40 | $229.00 | $16.74 – $39.90 | 8 |
| T3 (triiodothyronine) total CPT 84480 | $268.80 | $371.00 | $8.00 – $14.01 | 8 |
| T4 (thyroxine) free CPT 84439 | $362.40 | $500.00 | $8.00 – $13.63 | 8 |
| T4 (thyroxine) total CPT 84436 | $100.00 | $138.00 | $6.79 – $16.19 | 8 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $3.40 | $4.25 | $1.83 – $2.01 | 5 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $27.60 | $34.50 | $0.17 – $0.19 | 6 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $1,588.00 | $1,985.00 | $263.15 – $289.46 | 6 |
| Tacrolimus therapeutic drug level CPT 80197 | $333.60 | $460.00 | $13.56 – $26.52 | 8 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $468.80 | $646.00 | $21.12 – $69.84 | 8 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | $14.80 | $18.50 | $3.33 – $16.65 | 13 |
| Target gsa panel hmtlmph neop CPT 81450 | $3,743.20 | $4,679.00 | $607.62 – $1,035.51 | 8 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $5,631.60 | $9,386.00 | $2,335.68 – $3,980.47 | 8 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $797.40 | $1,329.00 | $69.78 – $118.92 | 8 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $252.80 | $349.00 | $61.26 – $121.03 | 8 |
| Tc-99m apcitide diag HCPCS A9504 | $2,130.40 | $2,936.00 | $479.34 – $2,396.70 | 12 |
| Tc-99m arcitumomab HCPCS A9568 | $3,364.00 | $4,636.00 | $756.90 – $3,784.50 | 12 |
| Tc-99m bicisate HCPCS A9557 | $844.00 | $1,163.00 | $189.90 – $949.50 | 12 |
| Tc-99m depreotide HCPCS A9536 | $252.80 | $349.00 | $56.88 – $284.40 | 12 |
| Tc-99m disofenin HCPCS A9510 | $72.40 | $99.00 | $16.29 – $81.45 | 12 |
| Tc-99m exametazime diag HCPCS A9521 | $867.20 | $1,195.00 | $195.12 – $975.60 | 12 |
| Tc-99m fanolesomab diag HCPCS A9566 | $4,710.40 | $6,491.00 | $1,059.84 – $5,299.20 | 12 |
| Tc-99m labeled rbc HCPCS A9560 | $177.60 | $245.00 | $39.96 – $199.80 | 12 |
| Tc-99m maa HCPCS A9540 | $161.60 | $223.00 | $36.36 – $181.80 | 12 |
| Tc-99m mebrofenin HCPCS A9537 | $353.60 | $487.00 | $79.56 – $397.80 | 12 |
| Tc-99m medronate HCPCS A9503 | $47.80 | $66.00 | $10.76 – $53.77 | 12 |
| Tc-99m mertiatide HCPCS A9562 | $857.60 | $1,182.00 | $192.96 – $964.80 | 12 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $20.00 | $32.00 | not published | 0 |
| Tc-99m oxidronate HCPCS A9561 | $54.20 | $74.00 | $12.20 – $60.98 | 12 |
| Tc-99m pentetate dtpa HCPCS A9539 | $67.40 | $93.00 | $15.16 – $75.83 | 12 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $236.80 | $327.00 | $53.28 – $266.40 | 12 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $72.40 | $99.00 | $16.29 – $81.45 | 12 |
| Tc-99m pyroph diag per dose up to 25 mci HCPCS A9538 | $152.00 | $210.00 | $34.20 – $171.00 | 12 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $287.20 | $396.00 | $64.62 – $323.10 | 12 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $672.80 | $927.00 | $151.38 – $756.90 | 12 |
| Tc-99m sulfur colloid HCPCS A9541 | $191.20 | $264.00 | $43.02 – $215.10 | 12 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $617.60 | $852.00 | $138.96 – $694.80 | 12 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $136.00 | $188.00 | $46.43 – $109.48 | 8 |
| T cells absolute cd 4 count CPT 86361 | $174.40 | $240.00 | $26.46 – $51.01 | 8 |
| T cells total count CPT 86359 | $136.00 | $188.00 | $37.28 – $85.21 | 8 |
| Telehealth original site facility fee HCPCS Q3014 | $120.00 | $158.00 | $20.12 – $20.12 | 1 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $8,196.60 | $13,661.00 | $26.71 – $29.38 | 6 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $27,148.20 | $45,247.00 | $172.22 – $189.44 | 6 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | not published | not published | $91.30 – $993.28 | 8 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $111.20 | $139.00 | $7.39 – $8.13 | 5 |
| Testicular imaging w/vasc flow CPT 78761 | $1,443.20 | $1,989.00 | $121.60 – $453.33 | 8 |
| Test stress cardiovascular tracing only CPT 93017 | $1,957.60 | $2,697.00 | $51.15 – $141.67 | 8 |
| Tetanus immune globulin inj HCPCS J1670 | $2,306.40 | $3,844.00 | $593.00 – $652.30 | 6 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | $48.80 | $61.00 | $18.01 – $19.81 | 6 |
| Theophylline therapeutic drug level CPT 80198 | $198.40 | $273.00 | $11.00 – $18.75 | 8 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $157.60 | $217.00 | $14.30 – $52.42 | 8 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $157.60 | $217.00 | $9.22 – $37.87 | 8 |
| Ther nma rdctj intus/obstrcj CPT 74283 | $1,674.40 | $2,308.00 | $28.80 – $440.31 | 8 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $42.60 | $53.25 | $1.82 – $2.73 | 6 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $724.80 | $999.00 | $21.82 – $41.19 | 2 |
| Thiotepa injection HCPCS J9340 | $2,755.20 | $4,592.00 | not published | 0 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,542.40 | $2,371.00 | $863.16 – $993.28 | 2 |
| Three-Phase Bone Scan (Nuclear Medicine) CPT 78315 | $2,037.60 | $2,808.00 | $152.32 – $616.40 | 8 |
| Thrombin time CPT 85670 | $98.40 | $135.00 | $5.70 – $13.62 | 8 |
| Thromboplastin inhibition CPT 85705 | $333.60 | $460.00 | $7.50 – $12.78 | 8 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $128.00 | $176.00 | $6.39 – $12.39 | 8 |
| Thyroglobulin antibody CPT 86800 | $253.60 | $350.00 | $15.73 – $31.44 | 8 |
| Thyroid imaging CPT 78013 | $1,510.40 | $2,081.00 | $169.87 – $263.18 | 8 |
| Thyroid met imaging CPT 78015 | $1,051.20 | $1,449.00 | $54.40 – $302.32 | 8 |
| Thyroid mets imag whole body CPT 78018 | $3,900.80 | $5,376.00 | $72.32 – $574.49 | 8 |
| Thyroid (TSH) Test CPT 84443 | $542.40 | $748.00 | $16.60 – $39.55 | 8 |
| Thyroid Ultrasound CPT 76536 | $781.60 | $1,077.00 | $65.25 – $194.57 | 8 |
| Thyroid uptake measurement CPT 78012 | $1,076.00 | $1,483.00 | $67.32 – $109.19 | 8 |
| Thyroxine binding globulin (tbg) CPT 84442 | $251.20 | $347.00 | $10.00 – $17.04 | 8 |
| Tigecycline injection HCPCS J3243 | $724.80 | $1,208.00 | $0.39 – $0.42 | 5 |
| Tisotumab vedotin-tftv 40 mg intravenous solution HCPCS J9273 | $306.00 | $510.00 | $188.76 – $207.64 | 6 |
| Tissue culture skin/biopsy CPT 88233 | $1,571.20 | $2,165.00 | $139.08 – $322.09 | 8 |
| Tissue culture tumor CPT 88239 | $2,394.40 | $3,300.00 | $145.80 – $322.09 | 8 |
| Tissue exam koh skin/hair/nails CPT 87220 | $85.60 | $118.00 | $3.90 – $6.65 | 8 |
| Tissue matrix 1.8x1.8cm collagen dermacell porous 4sq cm cost per sq cm HCPCS Q4122 | $4,244.40 | $7,074.00 | $567.90 – $2,839.50 | 13 |
| Tissue transglutaminase iga CPT 86364 | $329.60 | $455.00 | $9.00 – $11.39 | 2 |
| Tixagev and cilgav inj HCPCS M0220 | $1,360.00 | $1,700.00 | $132.44 – $205.19 | 8 |
| Tl-201 thallium diag per mci HCPCS A9505 | $61.40 | $84.00 | $13.81 – $69.08 | 12 |
| Tlh uterus 250 g or less CPT 58570 | not published | not published | $993.28 – $1,327.27 | 2 |
| Tobramycin comp unit HCPCS J7685 | $810.40 | $1,013.00 | $1.47 – $1.47 | 1 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $1,094.40 | $1,824.00 | $0.81 – $2.61 | 6 |
| Tobramycin peak therapeutic drug level CPT 80200 | $217.60 | $300.00 | $15.94 – $29.82 | 8 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $9,652.20 | $16,087.00 | $5.71 – $6.28 | 6 |
| Toe X-ray (both feet) CPT 73660 | $440.80 | $608.00 | $11.52 – $51.81 | 2 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $136.80 | $171.00 | $24.64 – $74.15 | 7 |
| Tomosynthesis breast screen bilateral CPT 77063 | $69.60 | $95.00 | $25.66 – $75.04 | 8 |
| Tonsillectomy (age 12+) CPT 42826 | not published | not published | $671.46 – $896.00 | 2 |
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.