▸ Hospital · PA · CCN 390045

UPMC Williamsport Divine Providence Campus

700 HIGH STREET, WILLIAMSPORT, PA, 17701-

213 bedsAcute Care Hospitals2
Compliance grade
A
100/100
Procedures tracked
164
of 209 target codes
Payers
15
with negotiated rates
Rates published
66,226
last crawl 2026-05-24

Procedures & rates

ProcedureTypeCodePayersGrossCashNeg minNeg medianNeg max
behavioral
PsychosesMS-DRG8857$10,917$11,676$23,838
Psychiatric diagnostic evaluationCPT9079115$176$105.6$33.6$120.56$231.25
Psychotherapy 45 minutesCPT9083415$176$105.6$42.9$117.92$165.43
emergency
ED visit level 1CPT9928115$421$252.6$51.6$227.13$378.9
ED visit level 2CPT9928215$678$406.8$36.28$323.41$610.2
ED visit level 3CPT9928315$1,240$744$62.31$591.48$1,116
ED visit level 4CPT9928415$2,073$1,243.8$104.86$988.82$1,865.7
ED visit level 5CPT9928515$2,146$1,287.6$152.61$1,023.64$1,931.4
Critical care, first hourCPT9929115$2,994$1,796.4$166.79$1,428.14$2,694.6
imaging
CT head without contrastCPT7045015$2,671$1,602.6$99.2$1,274.07$2,403.9
CT head with contrastCPT7046015$3,952$2,371.2$102.4$1,885.1$3,556.8
CT head with and without contrastCPT7047015$4,507$2,704.2$128$2,149.84$4,056.3
CT neck with contrastCPT7049115$4,185$2,511$105.6$1,996.24$3,766.5
MRI brain without contrastCPT7055115$3,997$2,398.2$232.71$1,906.57$3,597.3
MRI brain with contrastCPT7055215$4,851$2,910.6$343.82$2,313.93$4,365.9
MRI brain with and without contrastCPT7055315$6,340$3,804$343.82$3,024.18$5,706
Chest X-ray single viewCPT7104515$292$175.2$10.38$139.28$262.8
Chest X-ray 2 viewsCPT7104615$967$580.2$19.01$461.26$870.3
Chest X-ray 3 viewsCPT7104715$832$499.2$24.19$396.86$748.8
CT chest without contrastCPT7125015$3,741$2,244.6$102.37$1,784.46$3,366.9
CT chest with contrastCPT7126015$4,440$2,664$112$2,117.88$3,996
CT chest with and without contrastCPT7127015$5,254$3,152.4$132.48$2,506.16$4,728.6
MRI chest without contrastCPT7155015$4,190$2,514$232.71$1,998.63$3,771
MRI chest with contrastCPT7155115$5,085$3,051$399.62$2,486.57$4,576.5
MRI chest with and without contrastCPT7155215$6,643$3,985.8$343.82$3,168.71$5,978.7
Lumbosacral spine X-rayCPT7210015$695$417$28.8$331.51$625.5
CT cervical spine without contrastCPT7212515$3,514$2,108.4$102.37$1,676.18$3,162.6
CT thoracic spine without contrastCPT7212815$3,457$2,074.2$102.37$1,648.99$3,111.3
CT lumbar spine without contrastCPT7213115$3,419$2,051.4$102.37$1,630.86$3,077.1
MRI cervical spine without contrastCPT7214115$4,040$2,424$232.71$1,927.08$3,636
MRI thoracic spine without contrastCPT7214615$4,190$2,514$232.71$1,998.63$3,771
MRI lumbar spine without contrastCPT7214815$4,190$2,514$232.71$1,998.63$3,771
MRI lumbar spine with and without contrastCPT7214915$5,085$3,051$343.82$2,486.57$4,576.5
MRI cervical spine with and without contrastCPT7215615$6,446$3,867.6$343.82$3,074.74$5,801.4
MRI lumbar spine with contrastCPT7215815$6,684$4,010.4$343.82$3,188.27$6,015.6
CT pelvis without contrastCPT7219215$2,189$1,313.4$86.4$1,044.15$1,970.1
CT pelvis with contrastCPT7219315$3,170$1,902$110.72$1,512.09$2,853
Shoulder X-rayCPT7303015$512$307.2$21.12$276.23$460.8
Humerus X-rayCPT7306015$945$567$14.72$509.83$850.5
Hand X-ray 3 viewsCPT7313015$491$294.6$14.72$264.9$441.9
MRI upper extremity joint without contrastCPT7322115$4,190$2,514$232.71$2,260.51$3,771
MRI upper extremity joint with and without contrastCPT7322315$6,684$4,010.4$343.82$3,606.02$6,015.6
Knee X-ray 1-2 viewsCPT7356015$1,014$608.4$21.12$547.06$912.6
Ankle X-ray 3 viewsCPT7361015$512$307.2$23.97$276.23$460.8
MRI lower extremity joint without contrastCPT7372115$4,190$2,514$232.71$2,260.51$3,771
MRI lower extremity joint with and without contrastCPT7372315$6,684$4,010.4$343.82$3,606.02$6,015.6
CT abdomen without contrastCPT7415015$3,625$2,175$99.2$1,729.12$3,262.5
CT abdomen with contrastCPT7416015$4,621$2,772.6$115.2$2,204.22$4,158.9
CT abdomen with and without contrastCPT7417015$5,794$3,476.4$142.72$2,763.74$5,214.6
CT abdomen and pelvis without contrastCPT7417615$5,534$3,320.4$129.37$2,639.72$4,980.6
CT abdomen and pelvis with contrastCPT7417715$7,422$4,453.2$246.69$3,540.29$6,679.8
CT abdomen and pelvis with and without contrastCPT7417815$9,539$5,723.4$326.02$4,550.1$8,585.1
MRI abdomen without contrastCPT7418115$4,190$2,514$232.71$1,998.63$3,771
MRI abdomen with and without contrastCPT7418315$6,684$4,010.4$343.82$3,188.27$6,015.6
Abdominal ultrasound completeCPT7670015$1,528$916.8$73.6$728.86$1,375.2
Abdominal ultrasound limitedCPT7670515$1,151$690.6$48$549.03$1,035.9
Retroperitoneal ultrasound completeCPT7677015$1,221$732.6$62.72$582.42$1,098.9
Obstetric ultrasound first trimesterCPT7680115$1,151$690.6$49.14$549.03$1,035.9
Obstetric ultrasound after first trimesterCPT7680515$1,151$690.6$59.52$549.03$1,035.9
Transvaginal ultrasoundCPT7683015$1,131$678.6$59.52$539.49$1,017.9
Pelvic ultrasound completeCPT7685615$1,220$732$59.52$581.94$1,098
Scrotal ultrasoundCPT7687015$1,077$646.2$56.32$513.73$969.3
Diagnostic mammography unilateralCPT7706514$528$316.8$90.89$321.03$475.2
Diagnostic mammography bilateralCPT7706614$805$483$116.26$489.44$724.5
Screening mammography bilateralCPT7706714$342$205.2$92.34$207.94$307.8
EKG tracing onlyCPT9300515$453$271.8$11.51$58.4$407.7
Transthoracic echocardiogram completeCPT9330615$3,775$2,265$125.62$1,800.67$3,397.5
Stress echocardiogramCPT9335015$1,360$816$59.52$737.8$1,224
inpatient
Intracranial hemorrhage/CVA w MCCMS-DRG0649$10,396$16,598$37,832
Intracranial hemorrhage/CVA w CCMS-DRG0659$4,613.08$8,576.43$23,766
Intracranial hemorrhage/CVA w/o CC/MCCMS-DRG0669$4,621.28$5,964.03$18,566
Respiratory infections & inflammations w MCCMS-DRG1779$7,339.78$13,004$29,155
COPD w MCCMS-DRG1909$6,106.17$9,357.18$19,670
COPD w CCMS-DRG1919$6,765.69$7,481.92$44,427
COPD w/o CC/MCCMS-DRG1929$5,259.08$5,815.82$17,709
Simple pneumonia & pleurisy w CCMS-DRG1949$6,487.61$7,174.41$16,656
Simple pneumonia & pleurisy w/o CC/MCCMS-DRG1959$5,157.88$5,703.9$24,716
AMI discharged alive w MCCMS-DRG2809$6,126.2$13,336$29,532
AMI discharged alive w CCMS-DRG2819$3,954.85$7,845.38$20,371
AMI discharged alive w/o CC/MCCMS-DRG2829$3,246.55$6,274.26$18,377
Heart failure & shock w MCCMS-DRG2919$4,644.95$10,769$22,823
Heart failure & shock w CCMS-DRG2929$6,810.68$7,531.67$27,352
Heart failure & shock w/o CC/MCCMS-DRG2939$4,689.42$5,185.85$13,931
Cardiac arrhythmia w MCCMS-DRG3089$9,471.59$10,474$21,179
Cardiac arrhythmia w CCMS-DRG3099$5,961.39$6,592.48$13,338
Cardiac arrhythmia w/o CC/MCCMS-DRG3109$4,690.17$5,186.68$10,428
GI hemorrhage w CCMS-DRG3789$6,420.26$8,339.15$20,748
GI hemorrhage w/o CC/MCCMS-DRG3799$2,916.98$5,531.18$14,631
Esophagitis/gastroenteritis w/o MCCMS-DRG3929$6,290.48$6,956.4$32,203
Fractures of femur w/o MCCMS-DRG5337$12,198$13,046$41,173
Kidney/UTI w MCCMS-DRG6897$9,144.03$9,779.71$24,574
Kidney/UTI w/o MCCMS-DRG6907$6,514.59$6,967.48$13,815
Septicemia or severe sepsis w MV 96+ hrsMS-DRG8717$15,007$16,050$37,778
Septicemia or severe sepsis w/o MV 96+ hrsMS-DRG8727$8,117.15$8,681.44$19,293
lab
Basic metabolic panel (BMP)CPT8004815$311$186.6$8.36$134.42$279.9
Electrolyte panelCPT8005115$218$130.8$6.92$94.22$196.2
Comprehensive metabolic panelCPT8005315$359$215.4$10.43$155.16$323.1
Lipid panelCPT8006115$380$228$13.24$164.24$342
Renal function panelCPT8006915$260$156$8.58$112.37$234
Hepatic function panelCPT8007615$387$232.2$8.08$167.26$348.3
Urinalysis non-automatedCPT8100215$85$51$3.44$8.79$76.5
Urinalysis automatedCPT8100315$63$37.8$2.22$27.23$56.7
Glucose quantitativeCPT8294715$87$52.2$3.89$37.6$78.3
Hemoglobin A1cCPT8303615$276$165.6$3.06$9.9$248.4
Thyroid stimulating hormone (TSH)CPT8444315$378$226.8$16.6$163.38$340.2
Complete blood count with automated differentialCPT8502515$159$95.4$6.6$68.72$143.1
Complete blood count without differentialCPT8502715$134$80.4$6.39$57.92$120.6
Urine culture bacterialCPT8708615$364$218.4$7.98$157.32$327.6
Tissue exam by pathologist level IVCPT8830515$417$250.2$11.52$195.41$375.3
maternity
Fetal non-stress testCPT5902515$622$373.2$6.04$304.16$559.8
Vaginal delivery onlyCPT5940915$15,106$9,063.6$1,230$8,149.69$13,595
Vaginal delivery with postpartumCPT5941015$1,688$1,012.8$455.76$1,145.31$2,951.01
C-section with postpartumCPT5951515$1,688$1,012.8$455.76$1,145.31$3,380.56
office
Office visit, new patient, 15-29 minCPT9920215$418$250.8$38.86$226.77$376.2
Office visit, new patient, 30-44 minutesCPT9920315$545$327$41.85$124$490.5
Office visit, new patient, 45-59 minCPT9920415$702$421.2$41.85$133.24$631.8
Office visit, new patient, 60-74 minCPT9920515$983$589.8$41.85$157.8$884.7
Office visit, established patient, 5 minCPT9921115$333$199.8$22$120.9$299.7
Office visit, established patient, 10-19 minCPT9921215$418$250.8$28.6$120.9$376.2
Office visit, established patient, 20-29 minutesCPT9921315$418$250.8$38.5$120.9$376.2
Office visit, established patient, 30-39 minutesCPT9921415$545$327$41.85$124$490.5
Office visit, established patient, 40-54 minCPT9921515$702$421.2$41.85$128.51$631.8
preventive
Upper GI endoscopy diagnosticCPT4323515$5,877$3,526.2$137.74$2,803.33$5,289.3
Upper GI endoscopy with biopsyCPT4323915$5,877$3,526.2$163.44$2,803.33$5,289.3
Sigmoidoscopy diagnosticCPT4533015$997$598.2$58.47$658.02$938.75
Sigmoidoscopy with biopsyCPT4533115$5,261$3,156.6$70.04$2,509.5$4,734.9
Colonoscopy diagnosticCPT4537815$2,500$1,500$198.55$1,192.5$2,250
Colonoscopy with biopsyCPT4538015$5,421$3,252.6$247.96$2,585.82$4,878.9
Colonoscopy with polyp removalCPT4538515$5,421$3,252.6$294.89$2,585.82$4,878.9
surgery
PCI w drug-eluting stent w MCCMS-DRG2462$5,033.7$5,297.09$5,560.48
PCI w drug-eluting stent w/o MCCMS-DRG2472$5,036.43$5,299.96$5,563.49
Total knee replacementCPT274479$993.28$12,512$13,248
Shoulder arthroscopy with decompressionCPT298264$695.68$2,548.05$2,719.83
Shoulder arthroscopy with rotator cuff repairCPT298279$993.28$6,946.9$7,355.55
Knee arthroscopy with meniscectomyCPT2988110$597.85$2,184.48$3,340.82
Major small/large bowel procedures w MCCMS-DRG3299$3,906.6$37,323$78,444
Major small/large bowel procedures w CCMS-DRG3309$2,642.94$19,694$47,721
Major small/large bowel procedures w/o CC/MCCMS-DRG3319$9,052.28$13,968$35,865
Laparoscopic cholecystectomy w/o CDE w MCCMS-DRG4189$8,765.49$14,038$34,383
Laparoscopic cholecystectomy w/o CDE w CCMS-DRG4199$8,460.51$11,426$28,589
Laparoscopic cholecystectomy w/o CDE w/o CC/MCCMS-DRG4209$5,797.54$27,789$86,768
Laparoscopic appendectomyCPT449709$993.28$5,673.61$6,007.35
Spinal fusion (non-cervical) w MCCMS-DRG4592$15,971$16,807$17,643
Spinal fusion (non-cervical) w/o MCCMS-DRG4602$9,125.11$9,602.59$10,080
Major joint replacement w MCCMS-DRG4697$23,183$24,794$57,664
Major joint replacement w/o MCCMS-DRG4707$14,905$15,941$32,919
Laparoscopic cholecystectomyCPT475629$993.28$5,673.61$6,007.35
Lap cholecystectomy with cholangiographyCPT475639$993.28$5,673.61$6,007.35
Hip & femur procedures except major joint w MCCMS-DRG4809$22,276$24,635$183,620
Hip & femur procedures except major joint w CCMS-DRG4819$16,146$17,856$153,947
Hip & femur procedures except major joint w/o CC/MCCMS-DRG4829$12,672$14,014$36,939
Lap inguinal hernia repairCPT496509$818.32$5,673.61$6,007.35
Lap salpingo-oophorectomyCPT5866115$12,649$7,589.4$993.28$6,956.95$11,384
OR procedure for obesity w MCCMS-DRG6197$22,090$23,625$56,807
OR procedure for obesity w CCMS-DRG6207$12,442$13,307$34,410
OR procedure for obesity w/o CC/MCCMS-DRG6217$11,753$12,570$27,781
Uterine & adnexa procedures w CC/MCCMS-DRG7437$9,746.68$10,424$23,524
Uterine & adnexa procedures w/o CC/MCCMS-DRG7447$15,806$16,905$34,970
PCI single major coronary arteryCPT9292014$6,590$3,954$773.91$4,349.4$5,931
PCI with drug-eluting stentCPT9292814$13,175$7,905$859.73$8,695.5$11,858
PCI bypass graftCPT9293715$20,374$12,224$858.79$11,448$18,337
Left heart catheterizationCPT9345215$6,593$3,955.8$993.28$3,626.15$5,933.7
Coronary angiography with cathCPT9345515$7,939$4,763.4$993.28$4,366.45$7,145.1
Coronary angiography with bypass cathCPT9345815$8,166$4,899.6$993.28$4,491.3$7,349.4

Payer mix (top 15)

PayerCodes coveredMedian rate
UnitedHealthcare160$425.45
upmc health plan159$236.34
pa health & wellness159$253.21
Aetna159$614.88
Blue Cross Blue Shield159$493.4
amerihealth caritas157$179.33
geisinger153$369.83
Multiplan151$951.6
upmc work partners148$820.78
three rivers provider network117$758.64
wirerope works109$678.6
america's choice109$976.4
Cigna109$836.04
First Health109$774.62
intergroup109$976.4