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 |
|---|---|---|---|---|
| IV Medicine Infusion (each additional hour) CPT 96366 | $144.00 | $240.00 | $15.36 – $325.67 | 20 |
| IV Medicine Infusion (first hour) CPT 96365 | $153.00 | $255.00 | $49.12 – $645.61 | 18 |
| IV Push Injection (each additional drug) CPT 96375 | $60.00 | $100.00 | $16.26 – $141.37 | 17 |
| IV Push Injection (first drug) CPT 96374 | $108.60 | $181.00 | $38.77 – $645.61 | 18 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $274.80 | $458.00 | $58.12 – $545.49 | 18 |
| Ixabepilone 15 mg intravenous solution HCPCS J9207 | $139.20 | $232.00 | $114.87 – $349.12 | 17 |
| Jak2 targeted sequence analysis CPT 81279 | $1,227.60 | $2,046.00 | $148.16 – $726.30 | 18 |
| Jaw Joint (TMJ) X-ray (both sides, open and closed) CPT 70330 | $155.40 | $259.00 | $34.38 – $269.80 | 18 |
| Jaw (Mandible) X-ray (complete) CPT 70110 | $149.40 | $249.00 | $34.38 – $325.85 | 18 |
| John cunningham antibody CPT 86711 | $53.40 | $89.00 | $15.45 – $80.10 | 18 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $19.80 | $33.00 | $5.00 – $29.70 | 18 |
| Ketorolac (Toradol) Pain Shot, 15 mg HCPCS J1885 | $23.40 | $29.25 | $0.30 – $26.10 | 18 |
| Kidney endoscopy CPT 50570 | not published | not published | $208.68 – $4,382.58 | 14 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $1,260.60 | $2,101.00 | $141.76 – $1,890.90 | 18 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $150.00 | $250.00 | $101.88 – $325.85 | 18 |
| Kidney (Retroperitoneal) Ultrasound (limited) CPT 76775 | $181.80 | $303.00 | $60.61 – $325.85 | 18 |
| Kit case 4.2mm spinejack HCPCS C1062 | $2,731.20 | $4,552.00 | $864.88 – $4,096.80 | 13 |
| Kit gene analys d816 variant CPT 81273 | $1,122.00 | $1,870.00 | $99.90 – $1,683.00 | 18 |
| Kit lead specify 5-6-5 HCPCS C1778 | $8,386.80 | $13,978.00 | $605.90 – $9,158.40 | 13 |
| Knee Arthroscopy (Cartilage Smoothing) CPT 29877 | not published | not published | $1,198.00 – $4,122.90 | 12 |
| Knee Arthroscopy (Meniscus Trimming) CPT 29881 | not published | not published | $679.38 – $4,122.90 | 14 |
| Knee arthroscopy/surgery CPT 29875 | not published | not published | $1,198.00 – $4,122.90 | 12 |
| Knee arthroscopy/surgery CPT 29876 | not published | not published | $1,198.00 – $4,122.90 | 12 |
| Knee arthroscopy/surgery CPT 29880 | not published | not published | $1,198.00 – $4,122.90 | 12 |
| Knee arthroscopy/surgery CPT 29882 | not published | not published | $679.38 – $4,122.90 | 14 |
| Knee arthroscopy/surgery CPT 29888 | not published | not published | $974.00 – $9,077.48 | 12 |
| Knee MRI (with and without contrast) CPT 73723 | $979.20 | $1,632.00 | $429.31 – $1,468.80 | 17 |
| Knee MRI (with contrast) CPT 73722 | $739.80 | $1,233.00 | $348.50 – $2,420.90 | 17 |
| Knee MRI (without contrast) CPT 73721 | $685.80 | $1,143.00 | $221.13 – $1,028.70 | 17 |
| Knee X-ray CPT 73564 | $155.40 | $259.00 | $48.02 – $325.85 | 17 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $122.40 | $204.00 | $35.51 – $269.80 | 17 |
| Knee X-ray (3 views, both knees) CPT 73562 | $130.80 | $218.00 | $42.48 – $269.80 | 17 |
| Knee X-ray (standing, both knees) CPT 73565 | $146.40 | $244.00 | $31.75 – $269.80 | 18 |
| Kras gene variants exon 2 CPT 81275 | $691.20 | $1,152.00 | $157.98 – $1,036.80 | 18 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $229.20 | $382.00 | $0.21 – $0.90 | 11 |
| Lactate dehydrogenase (ldh) CPT 83615 | $14.40 | $24.00 | $6.04 – $21.60 | 18 |
| Lactated ringers intravenous solution HCPCS J7120 | $9.60 | $12.00 | $0.00 – $5.40 | 13 |
| Lactic acid CPT 83605 | $90.60 | $151.00 | $8.00 – $135.90 | 18 |
| Lactoferrin fecal qualitative CPT 83630 | $103.20 | $172.00 | $12.31 – $154.80 | 18 |
| Lactoferrin fecal quant CPT 83631 | $156.00 | $260.00 | $19.63 – $234.00 | 18 |
| Lanreotide 120 mg/0.5 ml subcutaneous syringe HCPCS J1930 | $286.40 | $358.00 | $34.05 – $322.20 | 17 |
| Laparo ablate renal cyst CPT 50541 | not published | not published | $762.37 – $13,229.47 | 12 |
| Laparo-asst vag hysterectomy CPT 58550 | not published | not published | $1,762.66 – $7,413.68 | 12 |
| Laparo cholecystectomy/graph CPT 47563 | not published | not published | $602.13 – $7,413.68 | 12 |
| Laparo partial colectomy 44204 CPT 44204 | not published | not published | $1,280.57 – $2,176.31 | 4 |
| Laparo partial nephrectomy CPT 50543 | not published | not published | $1,238.22 – $31,902.09 | 12 |
| Laparo proc abdm/per/oment 49329 CPT 49329 | not published | not published | $1,580.63 – $7,413.68 | 10 |
| Laparoscopic myomectomy CPT 58545 | not published | not published | $915.02 – $7,413.68 | 12 |
| Laparoscopic nephrectomy CPT 50546 | not published | not published | $1,000.19 – $1,802.30 | 4 |
| Laparoscopy aspiration CPT 49322 | not published | not published | $1,045.29 – $7,413.68 | 12 |
| Laparoscopy biopsy CPT 49321 | not published | not published | $1,045.29 – $7,413.68 | 12 |
| Laparoscopy excise lesions CPT 58662 | not published | not published | $1,365.00 – $7,413.68 | 12 |
| Laparoscopy fundoplasty CPT 43280 | not published | not published | $900.47 – $13,229.47 | 12 |
| Laparoscopy lymphadenectomy CPT 38571 | not published | not published | $1,587.52 – $13,229.47 | 12 |
| Laparoscopy lymph node biop CPT 38570 | not published | not published | $1,483.17 – $7,413.68 | 12 |
| Laparoscopy lysis CPT 58660 | not published | not published | $1,274.49 – $7,413.68 | 12 |
| Laparoscopy pyeloplasty CPT 50544 | not published | not published | $1,032.14 – $13,229.47 | 12 |
| Laparoscopy remove adnexa CPT 58661 | $6,385.20 | $10,642.00 | $1,222.31 – $9,577.80 | 17 |
| Laparoscopy tubal block 58671 CPT 58671 | not published | not published | $784.44 – $7,413.68 | 12 |
| Laparo sling operation 51992 CPT 51992 | not published | not published | $822.15 – $7,413.68 | 12 |
| Laparo-vag hyst incl t/o CPT 58552 | not published | not published | $995.22 – $13,229.47 | 12 |
| Laparo-vag hyst w/t/o compl CPT 58554 | not published | not published | $1,324.09 – $13,229.47 | 12 |
| Lap enterolysis CPT 44180 | not published | not published | $768.79 – $7,413.68 | 12 |
| Lap ing hernia repair init CPT 49650 | not published | not published | $1,045.29 – $7,413.68 | 12 |
| Lap ing hernia repair recur CPT 49651 | not published | not published | $1,196.22 – $7,413.68 | 12 |
| Lap paraesophag hern repair CPT 43281 | not published | not published | $1,283.08 – $13,229.47 | 12 |
| Lap sleeve gastrectomy CPT 43775 | not published | not published | $924.39 – $2,176.31 | 4 |
| Laps surg prst8ect rpbic rad CPT 55866 | not published | not published | $1,465.43 – $13,229.47 | 12 |
| Laps surg prst8ect smpl stot CPT 55867 | not published | not published | $749.45 – $13,229.47 | 11 |
| Large Joint Injection or Fluid Draw (both sides) CPT 20610 | $168.60 | $281.00 | $29.38 – $371.49 | 18 |
| Laryngoscopy w/biopsy CPT 31535 | not published | not published | $558.98 – $4,684.98 | 12 |
| Laryngoscopy w/bx & op scope CPT 31536 | not published | not published | $245.07 – $4,684.98 | 14 |
| Laryngoscopy with biopsy CPT 31576 | not published | not published | $139.53 – $2,191.27 | 14 |
| Laryngoscopy w/w/o tracheoscopy aspiration CPT 31515 | $3,049.20 | $5,082.00 | $87.50 – $4,573.80 | 18 |
| Larynscop w/tumr exc + scope CPT 31541 | not published | not published | $307.82 – $4,684.98 | 14 |
| Laser surgery of prostate CPT 52648 | not published | not published | $1,509.25 – $6,459.72 | 12 |
| Laser surg penis lesion(s) CPT 54057 | not published | not published | $35.00 – $2,324.39 | 14 |
| Lat retinacular release open CPT 27425 | not published | not published | $1,445.90 – $4,122.90 | 12 |
| Lavage cannulation maxillary sinus CPT 31000 | $690.00 | $1,150.00 | $51.25 – $2,904.64 | 18 |
| Lb with mastopexy 15839 CPT 15839 | not published | not published | $555.26 – $3,636.79 | 12 |
| Lead capillary CPT 83655 | $29.40 | $49.00 | $10.00 – $44.10 | 21 |
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $2,043.60 | $3,406.00 | $363.66 – $1,722.60 | 12 |
| Left compres band >=5"/yd HCPCS A6450 | $3.60 | $6.00 | $1.56 – $5.40 | 10 |
| Leg Artery Ultrasound (complete, both legs) CPT 93925 | $436.20 | $727.00 | $183.51 – $740.68 | 18 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $663.60 | $1,106.00 | $181.21 – $995.40 | 17 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $507.60 | $846.00 | $129.93 – $761.40 | 17 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $436.20 | $727.00 | $183.32 – $740.68 | 18 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $270.00 | $450.00 | $85.50 – $405.00 | 11 |
| Leucovorin calcium 100 mg solution for injection (1 mg rounding) HCPCS J0640 | $22.20 | $37.00 | $3.22 – $9.00 | 12 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $3,944.00 | $4,930.00 | $163.80 – $6,206.00 | 18 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $1,721.40 | $2,869.00 | $1,453.85 – $4,339.47 | 17 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $282.00 | $470.00 | $0.04 – $0.90 | 12 |
| Levetiracetam therapeutic drug level CPT 80177 | $32.40 | $54.00 | $13.25 – $48.60 | 18 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $18.00 | $24.00 | $0.84 – $7.20 | 12 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $23.40 | $39.00 | $6.87 – $25.20 | 10 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $0.40 | $0.50 | $0.01 – $0.14 | 11 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $0.60 | $0.75 | $0.00 – $0.09 | 10 |
| Lifileucel til/dose 7.5b-72b snij HCPCS J9999 | $2.40 | $4.00 | $0.25 – $0.90 | 10 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $80.80 | $101.00 | $3.43 – $90.90 | 12 |
| Lipase CPT 83690 | $16.80 | $28.00 | $5.00 – $25.20 | 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.