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 |
|---|---|---|---|---|
| Tube trach disp innr can 5 xlt HCPCS A7521 | $105.00 | $175.00 | $41.90 – $102.60 | 10 |
| Tx closed distal humerus fx CPT 24999 | $98.40 | $164.00 | $90.20 – $735.04 | 16 |
| Tx closed hip disl traumatic without anes CPT 27250 | $102.00 | $170.00 | $102.00 – $749.45 | 18 |
| Tx open art fx mcp/iphlngl jnt incl int fixtn ea CPT 26746 | $6,833.40 | $11,389.00 | $280.00 – $10,250.10 | 18 |
| Tympanic membrane repair CPT 69610 | not published | not published | $103.75 – $2,904.64 | 14 |
| Tympanometry & reflex thresh CPT 92550 | $76.20 | $127.00 | $20.31 – $479.44 | 18 |
| Ultrasound breast complete CPT 76641 | $126.00 | $210.00 | $108.40 – $325.85 | 17 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $124.20 | $207.00 | $88.88 – $269.80 | 17 |
| Ultrasound encephalogram CPT 76506 | $181.80 | $303.00 | $97.81 – $325.85 | 18 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $181.80 | $303.00 | $87.64 – $325.85 | 18 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $342.00 | $570.00 | $52.96 – $513.00 | 12 |
| Ultrasound guidance for vascular access CPT 76937 | $49.80 | $83.00 | $31.91 – $74.70 | 12 |
| Ultrasound guide intraoperative CPT 76998 | $243.00 | $405.00 | $56.44 – $364.50 | 11 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $1,693.20 | $2,822.00 | $80.93 – $2,539.80 | 12 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $108.00 | $180.00 | $53.49 – $162.00 | 12 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $257.40 | $429.00 | $128.27 – $740.68 | 18 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $94.80 | $158.00 | $68.87 – $325.85 | 18 |
| Ultrasound prostate/transrectal CPT 76872 | $181.80 | $303.00 | $108.41 – $325.85 | 18 |
| Ultrasound spinal canal and contents CPT 76800 | $122.40 | $204.00 | $122.40 – $325.85 | 18 |
| Ultrasound transabd ea addl gest CPT 76812 | $156.00 | $260.00 | $63.89 – $234.00 | 12 |
| Unlisted CT procedure CPT 76497 | $624.00 | $1,040.00 | $92.72 – $936.00 | 16 |
| Unlisted hematology&coagj px CPT 85999 | $43.80 | $73.00 | $18.25 – $65.70 | 10 |
| Unlisted hystsc px uterus CPT 58579 | not published | not published | $234.14 – $616.42 | 10 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted laps px bladder CPT 51999 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted laps px lymphtc sys CPT 38589 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted laps px renal CPT 50549 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted laps px ureter CPT 50949 | not published | not published | $6,851.00 – $17,877.67 | 10 |
| Unlisted procedure microbiology CPT 87999 | $128.40 | $214.00 | $53.50 – $192.60 | 10 |
| Unlisted procedure rectum CPT 45999 | $383.40 | $639.00 | $351.45 – $2,793.68 | 16 |
| Unlisted px ant segment eye CPT 66999 | $103.80 | $173.00 | $95.15 – $6,988.61 | 16 |
| Unlisted px arthroscopy CPT 29999 | not published | not published | $272.11 – $735.04 | 10 |
| Unlisted px casting/strpg CPT 29799 | $103.20 | $172.00 | $94.60 – $483.50 | 16 |
| Unlisted px forearm/wrist CPT 25999 | not published | not published | $272.11 – $735.04 | 10 |
| Unlisted px hands/fingers CPT 26989 | $4,707.60 | $7,846.00 | $272.11 – $7,061.40 | 16 |
| Unlisted px male genital sys CPT 55899 | not published | not published | $282.44 – $745.25 | 10 |
| Unlisted px posterior segmnt CPT 67299 | $3,949.20 | $6,582.00 | $2,786.64 – $6,988.61 | 16 |
| Unlisted px small intestine CPT 44799 | $1,762.20 | $2,937.00 | $1,085.08 – $2,872.87 | 16 |
| Unlisted px tongue flr mouth CPT 41599 | $97.20 | $162.00 | $89.10 – $711.57 | 16 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $406.20 | $677.00 | $372.35 – $2,193.68 | 16 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $119.40 | $199.00 | $33.08 – $269.80 | 17 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $669.60 | $1,116.00 | $180.06 – $1,004.40 | 18 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $507.00 | $845.00 | $129.93 – $760.50 | 18 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $975.00 | $1,625.00 | $352.58 – $1,462.50 | 18 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $736.20 | $1,227.00 | $300.18 – $1,104.30 | 18 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $682.20 | $1,137.00 | $209.20 – $1,023.30 | 18 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $159.60 | $266.00 | $34.19 – $325.85 | 18 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $176.40 | $294.00 | $39.41 – $325.85 | 18 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $979.80 | $1,633.00 | $102.12 – $1,469.70 | 18 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $1,152.60 | $1,921.00 | $115.04 – $1,728.90 | 18 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $432.00 | $720.00 | $83.12 – $648.00 | 18 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $447.60 | $746.00 | $81.25 – $671.40 | 18 |
| Uppr gi scope w/submuc inj CPT 43236 | $979.80 | $1,633.00 | $114.60 – $1,469.70 | 18 |
| Urea nitrogen CPT 84520 | $9.60 | $16.00 | $3.95 – $14.40 | 18 |
| Urea nitrogen 24 hour urine CPT 84540 | $11.40 | $19.00 | $5.56 – $17.10 | 17 |
| Urea nitrogen clearance CPT 84545 | $135.60 | $226.00 | $5.00 – $203.40 | 18 |
| Ureter endoscopy & treatment CPT 50961 | not published | not published | $372.41 – $6,459.72 | 14 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $312.00 | $520.00 | $46.88 – $740.68 | 18 |
| Urethrocystography void s&i CPT 74455 | $304.20 | $507.00 | $53.12 – $740.68 | 18 |
| Uric acid blood CPT 84550 | $10.80 | $18.00 | $4.52 – $16.20 | 18 |
| Uric acid urine CPT 84560 | $11.40 | $19.00 | $4.50 – $17.10 | 18 |
| Urinalysis microscopic only CPT 81015 | $7.20 | $12.00 | $2.71 – $10.80 | 18 |
| Urinalysis (with microscopy) CPT 81001 | $7.80 | $13.00 | $3.00 – $11.70 | 18 |
| Urinalysis (without microscopy) CPT 81003 | $6.00 | $10.00 | $2.25 – $9.00 | 18 |
| Urine Culture Test CPT 87086 | $19.80 | $33.00 | $8.00 – $29.70 | 18 |
| Urine pregnancy test CPT 81025 | $15.60 | $26.00 | $3.22 – $23.40 | 21 |
| Urography, antegrade CPT 74425 | $228.60 | $381.00 | $46.88 – $1,094.32 | 18 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $66.00 | $82.50 | $12.16 – $73.80 | 17 |
| Vaccine Administration (one shot) CPT 90471 | $12.00 | $20.00 | $11.00 – $218.09 | 17 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $340.00 | $425.00 | $50.00 – $298.80 | 11 |
| Vaccine dtap < 7 years im CPT 90700 | $48.60 | $60.75 | $12.50 – $54.00 | 13 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $108.00 | $135.00 | $12.50 – $121.50 | 19 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $86.40 | $108.00 | $12.50 – $97.20 | 19 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $126.60 | $211.00 | $12.50 – $189.90 | 13 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $63.20 | $79.00 | $12.50 – $71.10 | 13 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $12.00 | $20.00 | $12.00 – $21.52 | 13 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $24.00 | $30.00 | $12.50 – $27.00 | 11 |
| Vaccine mmr live subcutaneous CPT 90707 | $64.80 | $81.00 | $12.50 – $102.02 | 13 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $75.00 | $125.00 | $12.50 – $119.43 | 19 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $144.00 | $240.00 | $12.50 – $257.99 | 13 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $192.00 | $240.00 | $12.50 – $288.66 | 13 |
| Vaccine rabies im CPT 90675 | $800.00 | $1,000.00 | $12.50 – $900.00 | 18 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $672.00 | $840.00 | $12.50 – $756.00 | 11 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $1,196.00 | $1,495.00 | $12.50 – $1,345.50 | 11 |
| Vaccine tdap >=7 years im CPT 90715 | $42.40 | $53.00 | $12.50 – $47.70 | 13 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $74.40 | $93.00 | $12.50 – $83.70 | 13 |
| Vacuum drain bottle/tube kit HCPCS A7048 | $1,686.60 | $2,811.00 | $36.78 – $90.00 | 10 |
| Vag hyst including t/o CPT 58262 | not published | not published | $943.48 – $6,272.71 | 12 |
| Vaginal bx CPT 58999 | $98.40 | $164.00 | $90.20 – $616.42 | 16 |
| Vaginal hysterectomy CPT 58260 | not published | not published | $1,639.68 – $6,272.71 | 12 |
| Valproic acid total therapeutic drug level CPT 80164 | $33.00 | $55.00 | $13.54 – $49.50 | 18 |
| Vancomycin hcl injection HCPCS J3370 | $33.00 | $55.00 | $2.25 – $8.10 | 12 |
| Vancomycin peak therapeutic drug level CPT 80202 | $33.00 | $55.00 | $13.54 – $49.50 | 18 |
| Varicella zoster antibody igg CPT 86787 | $31.20 | $52.00 | $12.88 – $46.80 | 18 |
| Vasectomy CPT 55250 | not published | not published | $185.62 – $2,603.03 | 17 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | $25.40 | $31.75 | $0.93 – $27.90 | 10 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | $15,257.40 | $25,429.00 | $21.31 – $82.80 | 17 |
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $1,193.40 | $1,989.00 | $46.88 – $4,760.04 | 18 |
| Ventilator each subsequent day CPT 94003 | $610.80 | $1,018.00 | $70.57 – $2,025.76 | 16 |
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.