UPMC Chautauqua
207 Foote Avenue, Jamestown, NY · UPMC · · NPI 1770573222
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 |
|---|---|---|---|---|
| Ghs lac repair mouth.ant tong 2.5cm/less CPT 41250 | $70.80 | $118.00 | $39.38 – $1,033.67 | 18 |
| Ghs layer closure 2.5 cm or less - 12031 CPT 12031 | $211.20 | $352.00 | $30.62 – $2,904.64 | 18 |
| Ghs layer closure 2.5 cm or less - 12041 CPT 12041 | $83.40 | $139.00 | $30.62 – $2,904.64 | 18 |
| Ghs layer closure 2.5cm or less - 12051 CPT 12051 | $83.40 | $139.00 | $39.38 – $2,904.64 | 18 |
| Ghs layer closure 2.6 - 5.0 cm - 12052 CPT 12052 | $83.40 | $139.00 | $59.38 – $2,904.64 | 18 |
| Ghs layer closure 2.6 - 7.5 cm - 12042 CPT 12042 | $83.40 | $139.00 | $44.38 – $2,904.64 | 18 |
| Ghs layer closure 5.1 - 7.5 cm - 12053 CPT 12053 | $83.40 | $139.00 | $59.38 – $2,904.64 | 18 |
| Ghs layer closure 7.6 - 12.5 cm - 12034 CPT 12034 | $83.40 | $139.00 | $58.12 – $1,033.67 | 18 |
| Ghs layer closure 7.6 - 12.5 cm - 12044 CPT 12044 | $83.40 | $139.00 | $60.62 – $1,033.67 | 18 |
| Ghs layer closure 7.6 - 12.5 cm - 12054 CPT 12054 | $83.40 | $139.00 | $76.88 – $1,033.67 | 18 |
| Ghs layered repair 12.6 - 20.0 cm -12045 CPT 12045 | $217.80 | $363.00 | $115.00 – $1,033.67 | 18 |
| Ghs mbp CPT 83873 | $42.00 | $70.00 | $15.00 – $63.00 | 18 |
| Ghs moderate sedation ea addtl 15 min CPT 99153 | $62.40 | $104.00 | $10.41 – $93.60 | 12 |
| Ghs myocardial strain img spckl track CPT 93356 | $791.40 | $1,319.00 | $11.58 – $1,187.10 | 11 |
| Ghs nailbed repair/nail removal CPT 11760 | $217.80 | $363.00 | $28.75 – $2,904.64 | 18 |
| Ghs nerve blk intercostal, ea addtl level CPT 64421 | $1,493.40 | $2,489.00 | $54.38 – $2,240.10 | 18 |
| Ghs nerve block brachial plexus CPT 64415 | $2,406.60 | $4,011.00 | $43.75 – $3,609.90 | 18 |
| Ghs nerve block interscaline CPT 64510 | $463.20 | $772.00 | $68.12 – $1,120.40 | 18 |
| Ghs nerve block lumbar or thoracic symp CPT 64520 | $463.20 | $772.00 | $67.50 – $1,120.40 | 18 |
| Ghs nerve block sciatic nerve CPT 64445 | $291.00 | $485.00 | $29.38 – $871.51 | 18 |
| Ghs ng placement w fluoro guidance CPT 43752 | $75.00 | $125.00 | $33.68 – $502.19 | 17 |
| Ghs o2 uptake rest & indirect CPT 94690 | $98.40 | $164.00 | $9.38 – $182.02 | 18 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $165.60 | $276.00 | $53.79 – $248.40 | 12 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $165.60 | $276.00 | $46.44 – $248.40 | 12 |
| Ghs peritonsillar abscess i andd CPT 42700 | $223.20 | $372.00 | $77.50 – $749.45 | 18 |
| Ghs phenylketonurid CPT 84030 | $102.60 | $171.00 | $5.50 – $153.90 | 18 |
| Ghs plngl fx pm cl CPT 26725 | $102.00 | $170.00 | $96.25 – $2,904.64 | 18 |
| Ghs ppd (tb intradermal) CPT 86580 | $10.20 | $17.00 | $5.05 – $30.82 | 21 |
| Ghs protoporphyrins fract CPT 84202 | $93.60 | $156.00 | $14.35 – $140.40 | 18 |
| Ghs removal intranasal foreign body CPT 30300 | $40.80 | $68.00 | $28.12 – $162.21 | 18 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | not published | not published | $276.88 – $2,033.63 | 14 |
| Ghs sedimentation rate CPT 85651 | $8.40 | $14.00 | $3.00 – $12.60 | 18 |
| Ghs sensitivity (per antimicro) CPT 87184 | $16.80 | $28.00 | $7.48 – $25.20 | 18 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $83.40 | $139.00 | $83.40 – $1,033.67 | 18 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $83.40 | $139.00 | $83.40 – $1,033.67 | 18 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $83.40 | $139.00 | $83.40 – $1,033.67 | 18 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $83.40 | $139.00 | $83.40 – $1,033.67 | 18 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $83.40 | $139.00 | $59.38 – $2,904.64 | 18 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $100.20 | $167.00 | $60.62 – $2,904.64 | 18 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $83.40 | $139.00 | $76.88 – $1,033.67 | 18 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $83.40 | $139.00 | $83.40 – $1,033.67 | 18 |
| Ghs sleep study unattended CPT 95800 | $90.00 | $150.00 | $90.00 – $479.44 | 18 |
| Ghs st - eval for alt comm CPT 92567 | $58.80 | $98.00 | $10.57 – $120.28 | 18 |
| Ghs strapping shoulder - 29240 CPT 29240 | $490.20 | $817.00 | $15.57 – $735.30 | 18 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $320.40 | $534.00 | $117.50 – $770.35 | 18 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $2,892.00 | $4,820.00 | $147.50 – $4,338.00 | 18 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $102.00 | $170.00 | $91.25 – $2,904.64 | 18 |
| Ghs urine, porphyrins quant CPT 84120 | $81.00 | $135.00 | $7.50 – $121.50 | 18 |
| Gi inhouse confirmation CPT 87045 | $22.80 | $38.00 | $6.90 – $34.20 | 18 |
| Gi trc img intral esophagus CPT 91111 | $2,569.80 | $4,283.00 | $637.62 – $3,854.70 | 17 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $946.40 | $1,183.00 | $167.60 – $1,064.70 | 17 |
| Glucose 1 hr post dose CPT 82950 | $11.40 | $19.00 | $4.75 – $17.10 | 18 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $24.00 | $40.00 | $2.00 – $36.00 | 18 |
| Glucose blood quantitative CPT 82947 | $9.60 | $16.00 | $3.93 – $14.40 | 18 |
| Glucose body fluid CPT 82945 | $9.60 | $16.00 | $3.93 – $14.40 | 18 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $31.20 | $52.00 | $12.50 – $46.80 | 18 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $9.60 | $16.00 | $3.27 – $14.40 | 18 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $8.80 | $11.00 | $0.46 – $5.40 | 16 |
| Golimumab 12.5 mg/ml intravenous solution HCPCS J1602 | $109.60 | $137.00 | $11.04 – $123.30 | 17 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $45.60 | $76.00 | $17.50 – $68.40 | 18 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $45.00 | $75.00 | $17.00 – $67.50 | 18 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $1,807.80 | $3,013.00 | $392.40 – $1,839.97 | 17 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $2,841.00 | $4,735.00 | $20.33 – $96.30 | 13 |
| Graft axiofill 1000mg HCPCS J3590 | $14,980.80 | $24,968.00 | $1,353.25 – $4,871.70 | 10 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $5,872.80 | $9,788.00 | $409.07 – $1,937.70 | 13 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $6,744.00 | $11,240.00 | $104.12 – $493.20 | 13 |
| Graft sft tiss theraskin lg 5.1x7.6cm meshed 39 sq cm-q4121-cost per sq cm HCPCS Q4121 | $6,217.20 | $10,362.00 | $55.41 – $3,236.40 | 13 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $3,216.00 | $5,360.00 | $24.89 – $117.90 | 13 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $1,774.80 | $2,958.00 | $57.76 – $273.60 | 13 |
| Granisetron 1 mg tab HCPCS Q0166 | $3.00 | $5.00 | $2.75 – $4.50 | 11 |
| Granisetron hcl injection HCPCS J1626 | $21.00 | $35.00 | $0.19 – $2.70 | 12 |
| Great toe with reduction 28495 CPT 28495 | $102.00 | $170.00 | $94.38 – $2,904.64 | 18 |
| Gstrst open wo constj tube CPT 43830 | not published | not published | $589.48 – $2,410.49 | 12 |
| G-tube reposition CPT 43761 | $559.80 | $933.00 | $118.04 – $839.70 | 18 |
| Guided cath fluid drainage 10030 CPT 10030 | $1,172.40 | $1,954.00 | $112.83 – $2,904.64 | 18 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $936.00 | $1,560.00 | $296.40 – $1,404.00 | 11 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $1,680.60 | $2,801.00 | $7.70 – $78.00 | 13 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $147.00 | $245.00 | $0.59 – $220.50 | 10 |
| Gw stiffened micro access kit HCPCS C1894 | $408.00 | $680.00 | $41.80 – $143.60 | 13 |
| Haloperidol decanoate 50 mg/ml intramuscular solution HCPCS J1631 | $441.60 | $736.00 | $4.40 – $119.70 | 13 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $15.00 | $18.75 | $0.77 – $16.20 | 13 |
| Hands-On Manual Therapy (each 15 minutes) CPT 97140 | $75.00 | $125.00 | $19.56 – $112.50 | 19 |
| Hand X-ray CPT 73130 | $122.40 | $204.00 | $34.33 – $269.80 | 17 |
| Hand X-ray (2 views, both hands) CPT 73120 | $52.20 | $87.00 | $30.98 – $325.85 | 17 |
| Haptoglobin quantitative CPT 83010 | $30.60 | $51.00 | $12.00 – $45.90 | 18 |
| Hcg qualitative CPT 84703 | $18.60 | $31.00 | $7.52 – $27.90 | 18 |
| Hcg quantitative CPT 84702 | $36.60 | $61.00 | $15.05 – $54.90 | 18 |
| Hc hearing aid chck binaurl CPT 92593 | $153.00 | $255.00 | $15.00 – $229.50 | 12 |
| Hc hearing aid chck monarl CPT 92592 | $53.40 | $89.00 | $11.25 – $80.10 | 12 |
| Hc hearing aid exam both ears CPT 92591 | $242.40 | $404.00 | $22.50 – $363.60 | 12 |
| Hc hearing aid exam one ear CPT 92590 | $170.40 | $284.00 | $22.50 – $255.60 | 12 |
| Head CT scan (with and without contrast) CPT 70470 | $753.00 | $1,255.00 | $189.22 – $1,129.50 | 18 |
| Head CT scan (with contrast) CPT 70460 | $606.60 | $1,011.00 | $161.03 – $909.90 | 18 |
| Head CT scan (without contrast) CPT 70450 | $495.00 | $825.00 | $114.49 – $742.50 | 18 |
| Heel (Calcaneus) X-ray (both feet) CPT 73650 | $108.60 | $181.00 | $29.96 – $269.80 | 17 |
| Hematocrit CPT 85014 | $5.40 | $9.00 | $2.37 – $8.10 | 18 |
| Hemin 350 mg intravenous powder for solution HCPCS J1640 | $10,821.60 | $18,036.00 | $28.56 – $16,232.40 | 17 |
| Hemodialysis one evaluation CPT 90935 | $406.20 | $677.00 | $71.56 – $2,144.08 | 16 |
| Hemoglobin CPT 85018 | $5.40 | $9.00 | $2.37 – $8.10 | 18 |
| Hemoglobin fetal qualitative CPT 83033 | $64.80 | $108.00 | $6.53 – $97.20 | 18 |
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.