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 |
|---|---|---|---|---|
| Cystoscopy and treatment CPT 52320 | not published | not published | $288.96 – $4,382.58 | 14 |
| Cystoscopy and treatment CPT 52330 | not published | not published | $265.00 – $4,382.58 | 14 |
| Cystoscopy (Bladder Scope) CPT 52000 | $2,992.80 | $4,988.00 | $93.75 – $4,489.20 | 18 |
| Cystoscopy chemodenervation CPT 52287 | not published | not published | $163.43 – $2,603.03 | 14 |
| Cystoscopy removal of clots CPT 52001 | not published | not published | $288.81 – $4,382.58 | 14 |
| Cystoscopy & ureter catheter CPT 52005 | $3,480.00 | $5,800.00 | $145.00 – $5,220.00 | 18 |
| Cystostomy cystotomy w/drainage 51040 CPT 51040 | $4,825.20 | $8,042.00 | $329.09 – $7,237.80 | 18 |
| Cystouretero & or pyeloscope CPT 52351 | not published | not published | $784.44 – $4,382.58 | 12 |
| Cystouretero w/biopsy CPT 52354 | not published | not published | $942.82 – $6,459.72 | 12 |
| Cystouretero w/excise tumor CPT 52355 | not published | not published | $1,116.10 – $6,459.72 | 12 |
| Cysto/uretero w/lithotripsy CPT 52356 | not published | not published | $403.69 – $6,459.72 | 12 |
| Cystouretero w/lithotripsy CPT 52353 | not published | not published | $1,198.00 – $6,459.72 | 12 |
| Cystouretero w/stone remove CPT 52352 | $6,237.60 | $10,396.00 | $1,198.00 – $9,356.40 | 17 |
| Cystourethroscop/calib/dilat stric 52281 CPT 52281 | not published | not published | $134.38 – $2,603.03 | 14 |
| Cystourethroscopy w/biopsy(s) 52204 CPT 52204 | not published | not published | $154.38 – $2,603.03 | 14 |
| Cysto w/ureter stricture tx CPT 52341 | not published | not published | $715.50 – $4,382.58 | 12 |
| Cytarabine 20 mg/ml injection solution HCPCS J9100 | $10.80 | $18.00 | $0.83 – $4.50 | 12 |
| Cytomegalovirus (cmv) antibody igg CPT 86644 | $35.40 | $59.00 | $14.39 – $53.10 | 18 |
| Cytomegalovirus (cmv) antibody igm CPT 86645 | $41.40 | $69.00 | $16.85 – $62.10 | 18 |
| Cyto/molecular report CPT 88291 | $54.60 | $91.00 | $24.03 – $81.90 | 11 |
| Cytopathology cellular enhancement technique non-gyn CPT 88112 | $96.00 | $160.00 | $14.42 – $163.72 | 18 |
| Cytopathology cervical/vaginal thin layer auto screen/manual rescreen/review CPT 88175 | $102.00 | $170.00 | $11.71 – $117.00 | 18 |
| Cytopathology cervical/vaginal thin layer manual screening CPT 88142 | not published | not published | $10.21 – $50.81 | 14 |
| Cytopathology concentration technique smears & interpretation CPT 88108 | $105.00 | $175.00 | $6.85 – $157.50 | 18 |
| Cytopathology fluids/washings/brushings smears with interpretation CPT 88104 | $88.20 | $147.00 | $6.01 – $132.30 | 18 |
| Cytopathology fna adequacy evaluation first episode each site CPT 88172 | $35.40 | $59.00 | $32.45 – $525.08 | 17 |
| Cytopathology fna adequacy evaluation first episode each site interp/rpt CPT 88173 | $149.40 | $249.00 | $8.47 – $224.10 | 17 |
| Dacarbazine 100 mg intravenous solution HCPCS J9130 | $21.40 | $27.00 | $3.45 – $23.40 | 12 |
| Daptomycin 500 mg/10 ml intravenous solution HCPCS J0878 | $797.40 | $1,329.00 | $0.03 – $24.27 | 13 |
| Daratumumab 1,800 mg-hyaluronidase-fihj 30,000 unit/15 ml subcut soln HCPCS J9144 | $103.20 | $172.00 | $46.01 – $154.80 | 17 |
| Darbepoetin alfa 100 mcg/0.5 ml in polysorbate injection syringe HCPCS J0881 | $2,383.80 | $3,973.00 | $2.93 – $446.32 | 18 |
| D&c after delivery 59160 CPT 59160 | $7,156.80 | $11,928.00 | $452.78 – $10,735.20 | 17 |
| D&c/diagnostic/therapeutic/non ob 58120 CPT 58120 | not published | not published | $480.73 – $4,040.20 | 12 |
| Deamidated gliadin antibody iga CPT 86258 | $28.20 | $47.00 | $11.88 – $42.30 | 17 |
| Debrid ecz/inf skin up tp 10% body 11000 CPT 11000 | $178.80 | $298.00 | $23.25 – $2,904.64 | 18 |
| Debridement bone <= 20 sq cm CPT 11044 | $532.80 | $888.00 | $41.25 – $2,039.03 | 18 |
| Debridement/bone/20 sq cm or less 11046 CPT 11046 | $178.80 | $298.00 | $45.96 – $1,033.67 | 12 |
| Debridement/bone/ea add 20 sq cm 11047 CPT 11047 | $909.00 | $1,515.00 | $80.41 – $1,363.50 | 12 |
| Debridement subcutaneous tissue <= 20 sq cm CPT 11042 | $178.80 | $298.00 | $41.25 – $1,033.67 | 18 |
| Debride nail1-5 11720 CPT 11720 | $56.40 | $94.00 | $12.26 – $2,904.64 | 18 |
| Debride nail6 or more 11721 CPT 11721 | $56.40 | $94.00 | $20.14 – $2,904.64 | 18 |
| Debride/subq tissue/ea add 20sq cm 11045 CPT 11045 | $178.80 | $298.00 | $21.75 – $1,033.67 | 12 |
| Debr musc/fascia 20sq cm/< 11043 CPT 11043 | $178.80 | $298.00 | $41.25 – $1,033.67 | 18 |
| Decalcification CPT 88311 | $14.40 | $24.00 | $3.25 – $23.24 | 12 |
| Decitabine 50 mg intravenous solution HCPCS J0894 | $143.40 | $239.00 | $1.22 – $215.10 | 12 |
| Declotting thrombolytic agent implanted vas access device 36 CPT 36593 | $192.00 | $320.00 | $27.13 – $437.20 | 18 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $13.80 | $17.25 | $4.01 – $13.50 | 17 |
| Delivery of placenta 59414 CPT 59414 | $981.60 | $1,636.00 | $77.10 – $4,001.35 | 18 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $149.40 | $249.00 | $14.78 – $623.24 | 18 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $2,731.20 | $4,552.00 | $22.15 – $1,809.19 | 18 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $89.40 | $149.00 | $29.38 – $749.45 | 18 |
| Design mlc device for imrt CPT 77338 | $1,193.40 | $1,989.00 | $276.17 – $1,790.10 | 12 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $468.60 | $781.00 | $3.52 – $8.83 | 17 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $3,635.40 | $6,059.00 | $372.66 – $5,453.10 | 17 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $3,219.00 | $5,365.00 | $59.96 – $4,828.50 | 13 |
| Destroy vulva lesion extensive 56515 CPT 56515 | not published | not published | $145.62 – $2,324.39 | 14 |
| Destruction anal lesion(s) CPT 46910 | not published | not published | $113.04 – $2,904.64 | 14 |
| Destruction benign lesions < 14 lesions CPT 17110 | not published | not published | $50.31 – $2,904.64 | 14 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $3,409.80 | $5,683.00 | $52.90 – $5,114.70 | 13 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $3,409.80 | $5,683.00 | $365.20 – $5,114.70 | 17 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | not published | not published | $169.86 – $2,324.39 | 14 |
| Destruction rectal tumor 45190 CPT 45190 | not published | not published | $436.01 – $3,484.74 | 12 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | not published | not published | $48.12 – $2,904.64 | 14 |
| Device intraute mirena HCPCS J7298 | $2,880.00 | $3,678.00 | $1,167.80 – $3,240.00 | 11 |
| Device tiss remov myosure reach HCPCS C1782 | $1,939.20 | $3,232.00 | $11.61 – $1,719.90 | 10 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $121.20 | $202.00 | $32.10 – $269.80 | 18 |
| Dexametha opth insert 0.1 mg HCPCS J1096 | $505.60 | $632.00 | $102.94 – $568.80 | 16 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $0.80 | $1.00 | $0.02 – $0.90 | 12 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $0.80 | $1.00 | $0.09 – $0.90 | 13 |
| Dexrazoxane hcl 250 mg intravenous solution HCPCS J1190 | $1,551.60 | $2,586.00 | $63.06 – $2,327.40 | 17 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $32.60 | $40.75 | $0.94 – $3.60 | 12 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $5.00 | $6.25 | $3.30 – $7.76 | 12 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $35.00 | $43.75 | $1.69 – $4.50 | 12 |
| Dextrose 5 % IV bolus HCPCS J7070 | $5.00 | $6.25 | $3.11 – $5.40 | 12 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $54.00 | $90.00 | $21.00 – $81.00 | 18 |
| Diabetes (HbA1c) Test CPT 83036 | $24.00 | $40.00 | $7.00 – $36.00 | 18 |
| Diab manage trn ind/group HCPCS G0109 | $93.00 | $155.00 | $13.66 – $139.50 | 19 |
| Diag laparo separate proc 49320 CPT 49320 | not published | not published | $935.36 – $7,413.68 | 12 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $84.60 | $141.00 | $25.00 – $162.21 | 18 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $179.40 | $299.00 | $86.25 – $2,904.64 | 18 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $225.60 | $376.00 | $144.73 – $338.40 | 13 |
| Diagnostic Mammogram (one breast) CPT 77065 | $177.00 | $295.00 | $114.60 – $265.50 | 13 |
| Dialysis one evaluation CPT 90945 | $2,238.60 | $3,731.00 | $84.87 – $3,357.90 | 19 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $90.60 | $151.00 | $6.47 – $66.60 | 12 |
| Dicyclomine injection HCPCS J0500 | $200.80 | $251.00 | $11.36 – $225.90 | 12 |
| Diffusing capacity CPT 94729 | $222.00 | $370.00 | $49.42 – $333.00 | 12 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $33.00 | $41.25 | $7.36 – $36.90 | 12 |
| Digoxin immune fab 40 mg intravenous solution HCPCS J1162 | $10,544.00 | $13,180.00 | $4,225.21 – $12,961.40 | 17 |
| Digoxin total therapeutic drug level CPT 80162 | $32.40 | $54.00 | $11.00 – $48.60 | 18 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $110.40 | $138.00 | $57.17 – $124.20 | 12 |
| Dilate esophagus 1/mult pass CPT 43450 | $424.80 | $708.00 | $66.03 – $1,179.90 | 18 |
| Dilate urethra stricture CPT 53600 | $917.40 | $1,529.00 | $25.00 – $2,904.64 | 18 |
| Dilator fascial 10fx20cm HCPCS C2627 | $103.20 | $172.00 | $18.15 – $29.70 | 10 |
| Dilat xst trc ndurlgc px CPT 50436 | $498.60 | $831.00 | $124.55 – $4,340.44 | 17 |
| Diphenhydramine 12.5 mg/5 ml oral elixir HCPCS Q0163 | $9.60 | $16.00 | $0.02 – $0.90 | 11 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $3.40 | $4.25 | $0.76 – $3.60 | 13 |
| Disability dlco CPT 94727 | $201.00 | $335.00 | $39.45 – $479.44 | 18 |
| Disaccharidases CPT 82657 | $204.00 | $340.00 | $22.17 – $306.00 | 17 |
| Dna antibody native/double stranded CPT 86225 | $33.60 | $56.00 | $13.74 – $50.40 | 18 |
| Dna gardnerella CPT 87510 | $49.20 | $82.00 | $16.04 – $73.80 | 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.