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 |
|---|---|---|---|---|
| Small bowel endoscopy/biopsy CPT 44361 | $2,413.20 | $4,022.00 | $132.16 – $3,619.80 | 18 |
| Small bowel endoscopy br/wa CPT 44380 | $671.40 | $1,119.00 | $46.91 – $1,179.90 | 18 |
| Small bowel endoscopy br/wa CPT 44381 | $807.00 | $1,345.00 | $739.75 – $2,387.31 | 17 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $13.20 | $22.00 | $3.00 – $19.80 | 18 |
| Smear gram stain CPT 87205 | $10.20 | $17.00 | $4.27 – $15.30 | 18 |
| Smear nasal eosinophil CPT 89190 | $11.40 | $19.00 | $5.79 – $17.10 | 18 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $14.40 | $24.00 | $4.50 – $21.60 | 18 |
| Smear wet mount CPT 87210 | $10.20 | $17.00 | $5.82 – $15.30 | 18 |
| Sodium 24 hour urine CPT 84300 | $12.00 | $20.00 | $5.06 – $18.00 | 18 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $4.40 | $5.50 | $0.00 – $4.50 | 12 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $4.20 | $5.25 | $1.26 – $4.50 | 12 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $122.40 | $153.00 | $0.65 – $4.50 | 12 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $22.80 | $38.00 | $0.01 – $0.90 | 12 |
| Sodium ferric gluconate complex in sucrose 62.5 mg/5 ml intravenous HCPCS J2916 | $13.40 | $16.75 | $1.91 – $14.40 | 18 |
| Sodium serum/plasma/whole blood CPT 84295 | $12.00 | $20.00 | $4.81 – $18.00 | 18 |
| Solid skin barrier 6x6 HCPCS A5121 | $7.20 | $12.00 | $5.83 – $10.80 | 10 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $243.00 | $405.00 | $76.81 – $364.50 | 18 |
| Speech audiometry complete CPT 92556 | $58.80 | $98.00 | $18.75 – $182.02 | 18 |
| Speech recep thresh CPT 92555 | $36.00 | $60.00 | $8.12 – $182.02 | 18 |
| Speech Therapy Session (one-on-one) CPT 92507 | $135.60 | $226.00 | $27.12 – $203.40 | 13 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $1,357.80 | $2,263.00 | $86.08 – $2,036.70 | 18 |
| Spine X-ray (single view, one level) CPT 72020 | $108.60 | $181.00 | $25.45 – $269.80 | 18 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $121.20 | $202.00 | $38.38 – $181.80 | 11 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $243.00 | $405.00 | $76.81 – $364.50 | 18 |
| Staph a dna amp probe CPT 87640 | $99.00 | $165.00 | $35.09 – $148.50 | 18 |
| Stent/athrectomy/fem/pop/unilat 37227 CPT 37227 | $12,528.60 | $20,881.00 | $590.05 – $22,598.08 | 17 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $8,620.80 | $14,368.00 | $449.73 – $2,130.30 | 13 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $293.40 | $489.00 | $32.30 – $153.00 | 13 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $2,703.00 | $4,505.00 | $79.61 – $377.10 | 13 |
| Stent iliac/open or perc/uni/init 37221 CPT 37221 | $3,420.60 | $5,701.00 | $404.85 – $14,271.82 | 17 |
| Stent iliac/open/perc/ea ad/ipsila 37223 CPT 37223 | $3,420.60 | $5,701.00 | $174.22 – $5,130.90 | 12 |
| Sterile gauze <= 16 sq in HCPCS A6402 | $1.80 | $3.00 | $0.10 – $2.70 | 10 |
| Sterile needle HCPCS A4215 | $2,119.80 | $3,533.00 | $0.16 – $48.60 | 10 |
| Sterile water/saline, 10 ml HCPCS A4216 | $5.00 | $6.25 | $0.08 – $1.06 | 12 |
| Sterile water/saline, 500 ml HCPCS A4217 | $3.20 | $4.00 | $2.20 – $3.60 | 11 |
| St evaluate speech sound production CPT 92522 | $171.00 | $285.00 | $76.81 – $256.50 | 18 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $212.40 | $354.00 | $52.90 – $318.60 | 13 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $840.60 | $1,401.00 | $168.74 – $1,260.90 | 18 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $690.00 | $1,150.00 | $14.89 – $1,035.00 | 18 |
| Strep b dna amp probe CPT 87653 | $99.00 | $165.00 | $35.09 – $148.50 | 18 |
| Stress test pulmonary CPT 94618 | $151.80 | $253.00 | $33.90 – $394.97 | 18 |
| Stress tte complete CPT 93351 | $594.00 | $990.00 | $231.93 – $1,680.09 | 18 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $63.80 | $79.75 | $0.81 – $12.60 | 12 |
| Sugars single quant CPT 84378 | $201.60 | $336.00 | $11.53 – $302.40 | 18 |
| Sulbactam 1 gram-durlobactam 1 gram (0.5 gram x2) intravenous solution HCPCS C9399 | $13,842.00 | $23,070.00 | $77.75 – $962.38 | 11 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $0.32 | $0.40 | $0.05 – $0.36 | 10 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $41.00 | $51.25 | $25.00 – $69.57 | 13 |
| Supp non-insulin inf cath/wk HCPCS A4221 | $17.40 | $29.00 | $15.95 – $26.10 | 10 |
| Support clav 29.6-40.5in med HCPCS L3650 | $121.20 | $202.00 | $37.51 – $181.80 | 11 |
| Surg dx exam anorectal CPT 45990 | not published | not published | $87.62 – $3,484.74 | 12 |
| Surgical pathology level 1 gross examination only CPT 88300 | $35.40 | $59.00 | $5.05 – $75.04 | 18 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $35.40 | $59.00 | $11.29 – $120.28 | 18 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $66.00 | $110.00 | $16.53 – $163.72 | 18 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $108.60 | $181.00 | $18.74 – $163.72 | 18 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $401.40 | $669.00 | $25.09 – $1,102.25 | 18 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $566.40 | $944.00 | $34.85 – $2,503.13 | 18 |
| Susceptibility agar dilution per agent CPT 87181 | $21.00 | $35.00 | $4.75 – $31.50 | 18 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $11.40 | $19.00 | $4.75 – $17.10 | 18 |
| Susceptibility mic per plate CPT 87186 | $21.00 | $35.00 | $8.00 – $31.50 | 18 |
| Suscept studies macrobroth dilution ea CPT 87188 | $70.80 | $118.00 | $6.00 – $106.20 | 18 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | not published | not published | $879.33 – $1,632.23 | 4 |
| Swallowing Evaluation (Bedside) CPT 92610 | $210.00 | $350.00 | $48.62 – $315.00 | 13 |
| Swallowing Therapy Session CPT 92526 | $118.20 | $197.00 | $76.81 – $177.30 | 18 |
| Synvisc or synvisc-one HCPCS J7325 | $30.60 | $51.00 | $7.95 – $45.90 | 17 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $10.80 | $18.00 | $4.40 – $16.20 | 18 |
| System pacing micra av HCPCS C1786 | $7,800.60 | $13,001.00 | $1,161.36 – $7,372.80 | 12 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $11,490.60 | $19,151.00 | $286.44 – $8,426.70 | 12 |
| T3 (triiodothyronine) free CPT 84481 | $122.40 | $204.00 | $16.94 – $183.60 | 18 |
| T3 (triiodothyronine) total CPT 84480 | $34.80 | $58.00 | $8.00 – $52.20 | 18 |
| T4 (thyroxine) free CPT 84439 | $21.60 | $36.00 | $8.00 – $32.40 | 18 |
| T4 (thyroxine) total CPT 84436 | $16.80 | $28.00 | $6.87 – $25.20 | 18 |
| Tacrol astagraf ex rel oral HCPCS J7508 | $1.60 | $2.00 | $0.52 – $5.51 | 12 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $15.20 | $19.00 | $0.17 – $7.20 | 12 |
| Tacrolimus 5 mg/ml intravenous solution HCPCS J7525 | $1,884.00 | $2,355.00 | $233.92 – $2,119.50 | 16 |
| Tacrolimus therapeutic drug level CPT 80197 | $33.60 | $56.00 | $13.73 – $50.40 | 18 |
| Tafasitamab-cxix 200 mg intravenous solution HCPCS J9349 | $27.00 | $45.00 | $12.76 – $40.50 | 17 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $133.80 | $223.00 | $30.68 – $269.80 | 18 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | $0.20 | $0.25 | $0.14 – $0.29 | 11 |
| Target gsa panel hmtlmph neop CPT 81450 | $1,353.00 | $2,255.00 | $607.62 – $2,029.50 | 18 |
| Tarlatamab-dlle 10 mg intravenous solution HCPCS J9026 | $2,828.40 | $4,714.00 | $1,564.64 – $4,242.60 | 15 |
| Tbo-filgrastim 300 mcg/0.5 ml subcutaneous syringe HCPCS J1447 | $3.60 | $6.00 | $0.28 – $5.40 | 17 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $479.40 | $799.00 | $19.83 – $719.10 | 18 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $152.40 | $254.00 | $19.83 – $228.60 | 21 |
| Tc-99m exametazime diag HCPCS A9521 | $1,696.20 | $2,827.00 | $802.34 – $2,544.30 | 16 |
| Tc-99m labeled rbc HCPCS A9560 | $141.60 | $236.00 | $95.27 – $212.40 | 11 |
| Tc-99m maa HCPCS A9540 | $46.20 | $77.00 | $30.60 – $69.30 | 11 |
| Tc-99m mebrofenin HCPCS A9537 | $112.20 | $187.00 | $56.42 – $168.30 | 11 |
| Tc-99m medronate HCPCS A9503 | $61.20 | $102.00 | $13.26 – $91.80 | 11 |
| Tc-99m mertiatide HCPCS A9562 | $358.20 | $597.00 | $256.71 – $537.30 | 11 |
| Tc-99m non-heu per study dose HCPCS Q9969 | $15.00 | $25.00 | $10.00 – $25.08 | 15 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $89.40 | $149.00 | $14.90 – $134.10 | 11 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $427.20 | $712.00 | $51.00 – $640.80 | 11 |
| Tc-99m sulfur colloid HCPCS A9541 | $70.80 | $118.00 | $64.90 – $272.71 | 11 |
| Tc-99m tilmanocept diag HCPCS A9520 | $5,843.40 | $9,739.00 | $479.20 – $8,765.10 | 11 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $175.20 | $292.00 | $46.98 – $262.80 | 18 |
| T cells absolute cd 4 count CPT 86361 | $66.00 | $110.00 | $26.78 – $99.00 | 18 |
| T cells total count CPT 86359 | $133.80 | $223.00 | $37.73 – $200.70 | 18 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $13,621.20 | $22,702.00 | $141.56 – $431.91 | 17 |
| Tenodesis biceps tdn at elbw CPT 24340 | not published | not published | $591.88 – $9,077.48 | 14 |
| Tenotomy open tndn flxr toe sgl tndn spx CPT 28232 | $1,422.60 | $2,371.00 | $103.75 – $2,904.64 | 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.