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 |
|---|---|---|---|---|
| X-ray exam entire spi 4/5 vw CPT 72083 | $181.80 | $303.00 | $64.15 – $325.85 | 18 |
| X-ray exam entire spi 6/> vw CPT 72084 | $221.40 | $369.00 | $76.60 – $332.10 | 18 |
| X-ray exam of arm infant CPT 73092 | $122.40 | $204.00 | $33.08 – $325.85 | 17 |
| X-ray exam of femur 1 CPT 73551 | $70.20 | $117.00 | $30.30 – $269.80 | 17 |
| X-ray exam si joints CPT 72200 | $133.80 | $223.00 | $30.68 – $325.85 | 18 |
| X-ray exam thorac spine4/>vw CPT 72074 | $191.40 | $319.00 | $39.41 – $325.85 | 18 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $114.60 | $191.00 | $33.81 – $269.80 | 17 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $152.40 | $254.00 | $61.37 – $325.85 | 17 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $175.20 | $292.00 | $53.74 – $325.85 | 18 |
| X-ray joint survey 1 view CPT 77077 | $141.60 | $236.00 | $45.92 – $325.85 | 18 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $122.40 | $204.00 | $33.08 – $269.80 | 17 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $235.20 | $392.00 | $38.79 – $352.80 | 18 |
| X-ray mandible ltd <4 views CPT 70100 | $66.00 | $110.00 | $29.69 – $269.80 | 18 |
| X-ray nose to rectum for foreign body child CPT 76010 | $64.80 | $108.00 | $18.12 – $269.80 | 18 |
| X-ray optic foramina CPT 70190 | $118.80 | $198.00 | $38.31 – $269.80 | 18 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $439.20 | $732.00 | $46.88 – $1,094.32 | 18 |
| X-ray ribs 2 views left CPT 71100 | $121.20 | $202.00 | $33.12 – $269.80 | 18 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $322.20 | $537.00 | $34.38 – $1,680.09 | 18 |
| X-ray small intestine follow-through study CPT 74248 | $395.40 | $659.00 | $77.69 – $593.10 | 12 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $146.40 | $244.00 | $23.75 – $269.80 | 18 |
| X-ray surgical specimen CPT 76098 | $391.80 | $653.00 | $23.39 – $1,680.09 | 18 |
| X-ray thoracolumbar spine including skull cervical & sacral spine 1 view CPT 72081 | $82.80 | $138.00 | $36.98 – $269.80 | 18 |
| Yersinia antibody CPT 86793 | $111.60 | $186.00 | $11.35 – $167.40 | 18 |
| Zidovudine in d5w IV syringe 4 mg/ml (neo/peds) - cnr HCPCS J3485 | $3.60 | $6.00 | $1.49 – $5.40 | 12 |
| Zika virus igm antibody CPT 86794 | $69.60 | $116.00 | $16.64 – $104.40 | 18 |
| Zinc paste band w >=3"<5"/yd HCPCS A6456 | $31.20 | $41.00 | $1.12 – $35.10 | 10 |
| Ziprasidone 20 mg/ml (final concentration) intramuscular solution HCPCS J3486 | $51.80 | $64.75 | $6.83 – $57.60 | 12 |
| Zoledronic acid 4 mg/5 ml intravenous solution HCPCS J3489 | $1,069.60 | $1,337.00 | $5.06 – $111.60 | 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.