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 |
|---|---|---|---|---|
| Ultrasound infant hips ltd without stress CPT 76886 | $796.80 | $1,098.00 | $67.84 – $184.68 | 2 |
| Ultrasound joint complete left CPT 76881 | $1,025.60 | $1,413.00 | $84.71 – $170.06 | 2 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $373.60 | $515.00 | $54.54 – $602.06 | 8 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $373.60 | $515.00 | $28.13 – $133.29 | 8 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $835.20 | $1,151.00 | $50.92 – $171.17 | 8 |
| Ultrasound prostate/transrectal CPT 76872 | $840.80 | $1,159.00 | $69.31 – $217.75 | 8 |
| Ultrasound spinal canal and contents CPT 76800 | $692.00 | $953.00 | $65.25 – $287.88 | 8 |
| Unlisted CT procedure CPT 76497 | $917.60 | $1,264.00 | $67.84 – $67.84 | 1 |
| Unlisted cv px dx nuc med CPT 78499 | $2,254.40 | $3,107.00 | $303.48 – $303.48 | 1 |
| Unlisted gi px dx nuc med CPT 78299 | $944.00 | $1,301.00 | $303.48 – $303.48 | 1 |
| Unlisted laps px uterus CPT 58578 | not published | not published | $4,069.64 – $4,069.64 | 1 |
| Unlisted misc path test CPT 89240 | $112.80 | $155.00 | $39.16 – $39.16 | 1 |
| Unlisted muscskel px dx nuc CPT 78399 | $660.00 | $909.00 | $303.48 – $303.48 | 1 |
| Unlisted procedure microbiology CPT 87999 | $151.20 | $208.00 | $34.02 – $170.10 | 12 |
| Unlisted procedure rectum CPT 45999 | $3,816.80 | $5,261.00 | $648.87 – $648.87 | 1 |
| Unlisted px casting/strpg CPT 29799 | $152.00 | $210.00 | $113.80 – $113.80 | 1 |
| Unlisted px hands/fingers CPT 26989 | $5,143.20 | $7,088.00 | $161.64 – $161.64 | 1 |
| Unlisted px mediastinum CPT 39499 | $114.40 | $158.00 | $25.74 – $128.70 | 12 |
| Unlisted px small intestine CPT 44799 | $4,264.00 | $5,877.00 | $644.56 – $644.56 | 1 |
| Unlisted ultrasound procedure CPT 76999 | $146.40 | $202.00 | $67.84 – $67.84 | 1 |
| Unlstd hematop ret/endo lymp CPT 78199 | $734.40 | $1,012.00 | $303.48 – $303.48 | 1 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $2,013.60 | $2,775.00 | $492.31 – $492.31 | 1 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $685.60 | $945.00 | $14.72 – $69.84 | 2 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $3,090.40 | $4,259.00 | $112.00 – $744.90 | 8 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $2,508.00 | $3,457.00 | $115.97 – $641.23 | 8 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $4,850.40 | $6,684.00 | $344.32 – $2,405.45 | 8 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $3,689.60 | $5,085.00 | $344.32 – $1,368.07 | 8 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $3,040.00 | $4,190.00 | $239.62 – $1,243.84 | 8 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $776.00 | $1,070.00 | $25.84 – $83.39 | 8 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $666.40 | $919.00 | $27.52 – $89.62 | 8 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $4,264.00 | $5,877.00 | $137.74 – $627.71 | 8 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $4,264.00 | $5,877.00 | $163.44 – $730.25 | 8 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $701.60 | $967.00 | $51.20 – $231.35 | 8 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $701.60 | $967.00 | $49.92 – $216.50 | 8 |
| Uppr gi scope w/submuc inj CPT 43236 | $4,264.00 | $5,877.00 | $166.71 – $993.28 | 8 |
| Urea nitrogen CPT 84520 | $47.80 | $66.00 | $3.90 – $9.27 | 8 |
| Urea nitrogen 24 hour urine CPT 84540 | $76.60 | $106.00 | $4.34 – $5.50 | 2 |
| Ureteral reflux study CPT 78740 | $2,251.20 | $3,103.00 | $64.00 – $365.37 | 8 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $776.80 | $1,071.00 | $28.80 – $164.11 | 8 |
| Urethrocystography void s&i CPT 74455 | $1,539.20 | $2,121.00 | $35.20 – $173.91 | 8 |
| Uric acid blood CPT 84550 | $59.20 | $81.00 | $4.47 – $10.63 | 8 |
| Uric acid urine CPT 84560 | $99.20 | $137.00 | $4.50 – $7.67 | 8 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $62.20 | $85.00 | $2.14 – $5.10 | 8 |
| Urinalysis (with microscopy) CPT 81001 | $84.80 | $117.00 | $3.00 – $5.11 | 8 |
| Urinalysis (without microscopy) CPT 81003 | $45.80 | $63.00 | $2.22 – $5.28 | 8 |
| Urinary bldr retent nuc study CPT 78730 | $1,801.60 | $2,483.00 | $46.27 – $252.52 | 8 |
| Urinary pouch on barr w/flng HCPCS A5073 | $244.00 | $336.00 | $3.97 – $7.52 | 2 |
| Urinary suspensory HCPCS A5105 | $23.40 | $32.00 | $39.49 – $95.06 | 2 |
| Urine Culture Test CPT 87086 | $264.00 | $364.00 | $7.98 – $13.63 | 8 |
| Urine pregnancy test CPT 81025 | $137.40 | $229.00 | $4.00 – $8.51 | 8 |
| Urography, antegrade CPT 74425 | $1,369.60 | $1,888.00 | $28.80 – $153.67 | 8 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $76.00 | $95.00 | $12.99 – $14.29 | 6 |
| Ustekinumab 45 mg/0.5 ml subcutaneous solution HCPCS J3357 | $57.00 | $95.00 | $149.40 – $149.40 | 1 |
| Vaccine Administration (one shot) CPT 90471 | $16.00 | $21.00 | $12.80 – $12.80 | 1 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $340.00 | $425.00 | $44.00 – $161.65 | 7 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $209.40 | $349.00 | $44.00 – $147.06 | 7 |
| Vaccine dtap < 7 years im CPT 90700 | $33.60 | $56.00 | $11.00 – $17.04 | 7 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $39.60 | $66.00 | $11.00 – $17.04 | 7 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $31.20 | $52.00 | $11.00 – $17.04 | 7 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $31.20 | $52.00 | $11.00 – $17.04 | 7 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $32.40 | $54.00 | $11.00 – $17.04 | 7 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $108.00 | $142.00 | $11.00 – $73.79 | 7 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $67.80 | $113.00 | $11.00 – $17.04 | 7 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $86.40 | $113.00 | $11.00 – $143.26 | 8 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $168.80 | $211.00 | $11.00 – $177.56 | 7 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $63.20 | $83.00 | $11.00 – $54.40 | 8 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $157.80 | $263.00 | $11.00 – $17.04 | 7 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $195.60 | $326.00 | $58.68 – $293.40 | 13 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $12.60 | $21.00 | $11.00 – $17.04 | 7 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $12.00 | $20.00 | $11.00 – $32.65 | 8 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $14.40 | $24.00 | $11.00 – $27.25 | 8 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | $54.00 | $90.00 | $11.00 – $59.17 | 7 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $24.00 | $30.00 | $11.00 – $49.49 | 6 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $111.60 | $186.00 | $11.00 – $17.04 | 7 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $86.40 | $144.00 | $11.00 – $17.04 | 7 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $108.80 | $143.00 | $11.00 – $17.04 | 7 |
| Vaccine mmr live subcutaneous CPT 90707 | $64.80 | $85.00 | $11.00 – $17.04 | 7 |
| Vaccine mmrv live subcutaneous CPT 90710 | $112.20 | $187.00 | $11.00 – $17.04 | 7 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $75.00 | $125.00 | $11.00 – $133.47 | 8 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $144.00 | $240.00 | $11.00 – $257.99 | 7 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $192.00 | $240.00 | $11.00 – $312.90 | 7 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $40.20 | $67.00 | $11.00 – $17.04 | 7 |
| Vaccine rabies im CPT 90675 | $800.00 | $1,050.00 | $11.00 – $313.68 | 7 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $672.00 | $882.00 | $11.00 – $17.04 | 7 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $1,184.80 | $1,481.00 | $11.00 – $17.04 | 7 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | $885.00 | $1,475.00 | $11.00 – $17.04 | 7 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | $63.00 | $105.00 | $11.00 – $17.04 | 7 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $60.60 | $101.00 | $11.00 – $17.04 | 7 |
| Vaccine tdap >=7 years im CPT 90715 | $42.40 | $55.00 | $11.00 – $39.81 | 7 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $74.40 | $97.00 | $11.00 – $37.37 | 7 |
| Vaccine typhoid vicps im CPT 90691 | $39.00 | $65.00 | $11.00 – $17.04 | 7 |
| Vaccine varicella live subcutaneous CPT 90716 | $748.80 | $936.00 | $11.00 – $17.04 | 7 |
| Vacuum drain bottle/tube kit HCPCS A7048 | $148.00 | $204.00 | $63.12 – $63.12 | 1 |
| Vaginal bx CPT 58999 | not published | not published | $139.08 – $139.08 | 1 |
| Valproic acid total therapeutic drug level CPT 80164 | $219.20 | $302.00 | $13.38 – $31.90 | 8 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $0.60 | $1.00 | $0.03 – $0.03 | 5 |
| Vancomycin hcl injection HCPCS J3370 | $74.40 | $124.00 | $3.06 – $15.30 | 13 |
| Vancomycin peak therapeutic drug level CPT 80202 | $257.60 | $355.00 | $13.38 – $31.90 | 8 |
| Varicella zoster antibody igg CPT 86787 | $241.60 | $333.00 | $12.73 – $30.35 | 8 |
| Vasectomy CPT 55250 | $4,608.00 | $6,350.00 | $163.35 – $993.28 | 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.