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Patient Price Information List

The amounts provided in this document represent charges and are not necessarily what the hospital receives as payment from individual health plans.
In compliance with New York state law, UPMC Chautauqua is providing this price list containing our most common charges for room and board, labor and delivery, emergency department, operating room, recovery room, ambulatory surgery, physical therapy, pulmonary therapy, sleep center, radiology and laboratory. The hospitals’ charges are the same for all patients, but a patient’s responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our Customer Service staff to determine whether they qualify for discounts.
A link to UPMC Chautauqua Financial Assistance can be found here. These prices are correct as of May 1, 2019.


ROOM AND BOARD – PER DAY CHARGES

Coronary Care/Intensive Care

$1,910

 

Adult Mental Health

$1,005

 

Maternity/Obstetrics/Labor & Delivery

  $820

 

Adolescent Mental Health

$1,005

 

Nursery

  $415

 

Medical Rehabilitation

$1,035

 

Medical Surgical – Semi private

  $820

 

Chemical Dependency Rehabilitation

  $770

 

Medical Surgical – Private

  $820

       
           

LABOR AND DELIVERY CHARGES

 

The following list contains average estimated delivery charges for the entire stay, (including room & board, anesthesia, drugs, supplies, lab tests, etc.). Fees for physician services or anesthesia administration are not included in the charge amounts shown below and will be billed separately by your physician.

 

Normal Delivery (Mother only)

$6,138

       

Nursery

$2,003

       
           

EMERGENCY DEPARTMENT VISIT CHARGES

 

The Emergency Department charges are based on the personnel, resources, intensity of care, and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a patient-specific emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

 

Level 1 Acuity

$223

 

Critical Care, 30-74 minutes

$2,226

 

Level 2 Acuity

$286

 

Critical Care each Additional 30 Minutes

$890

 

Level 3 Acuity

$424

       

Level 4 Acuity

$488

       

Level 5 Acuity

$954

       
           

OPERATING ROOM CHARGES

 

Operating Room charges are based on a combination of OR time (measured in minutes) and specific OR procedure types.  The list below reflects that OR Time charge and most commonly used OR Procedure charges.  Note that operative services may vary greatly from patient to patient based on case complexity.  Also note that the charges below do not include charges for anesthesia, drugs, or supplies required for a patient-specific procedure, nor do the charges reflect fees for the surgeon, anesthesiologist, or other physician services.

 

OR Time per Minute

$31.50

 

Extremity Major

$2410

 

Arthroscopic Assisted Repair

$1940

 

Minimally Invasive Surgery - General

$2056

 

Bronchoscopy/Esophagoscopy Procedure

$1727

 

Minimally Invasive Surgery - Gynecological

$2056

 

Cataract Procedure

$1940

 

Major General

$2410

 

Cystoscopy Procedure

$1727

 

Minor General

$2010

 

Extremity Minor

$2010

       
           

RECOVERY ROOM CHARGES

 

Recovery Room 30 Min or Less

$380

       

Recovery Room Initial Hour

$835

       

Recovery Room Each Additional Hour

$418

       
           

SLEEP CENTER CHARGES

 

Polysomnography with Sleep Staging

$1,395

       

Polysomnography with CPAP

$1,534

       

Home Sleep Study

$1,222

       
           

PHYSICAL THERAPY

 

PT Evaluation Low Complexity

$106

 

Therapeutic Activity Per 15 Min

$88.50

 

PT Evaluation Moderate Complexity

$318

 

Gait Training Per 15 Min

$77.50

 
           

PULMONARY/RESPIRATORY THERAPY

 

Plethysmography Lung Volume

$190

 

Drug Aerosol Initial

$83.75

 

Spirometry Pre & Post Bronch

$353

 

Mechanical Ventilation Initial

$848

 

Diffusing Capacity

$259

 

BIPAP/CPAP Daily

$293

 
           

IMAGING/RADIOLOGICAL SERVICES

 

CT Abdomen Pelvis with Contrast

$558

 

Ultrasound Breast Unilateral Complete

$148

 

CT Abdomen Pelvis without Contrast

$292

 

Ultrasound Carotid Doppler Complete

$742

 

CT Brain with Contrast

$713

 

Ultrasound Obstetrical Limited

$214

 

CT Brain without Contrast

$581

 

Ultrasound Renal

$176

 

CT Chest with and without Contrast

$933

 

Ultrasound Transvaginal (Non-Pregnant)

$214

 

CT Chest with Contrast

$787

 

Ultrasound Thyroid

$214

 

CT Chest without Contrast

$595

 

Ultrasound Venous Compression Unilateral

$260

 

CT Cervical Spine with and without Contrast

$933

 

X-Ray Abdomen Complete Minimum 2 Views

$214

 

CT Maxillofacial w/o Contrast

$595

 

X-Ray Cervical Spine Complete

$271

 

CT Contract Material (estimated)

$200

 

X-Ray Chest One View

$129

 

Dexa Scan Hips, Pelvis, Spine

$380

 

X-Ray Chest Two Views

$164

 

Mammography Digital Screening

$265

 

X-Ray Foot Complete Minimum 3 Views

$143

 

Nuclear Medicine Cardiac Spect Multi

$944

 

X-Ray Hand 3 Views

$143

 

MRI Brain with and w/o Contrast

$1,145

 

X-Ray Hip Complete

$160

 

MRI L Spine Detail H Res without Contrast

$802

 

X-Ray Knee One or Two Views

$143

 

MRI Contract Material (estimated)

$660

 

X-Ray Knee Complete Four Views

$182

 

PET CT Skull Base to Mid-Thigh

$2,084

 

X-Ray Shoulder Complete

$157

 

PET CT Whole Body

$2,084

 

X-Ray Wrist Complete Minimum 3 Views

$143

 

PET Contract Material

$350

 

X-Ray Contrast Material (estimated)

$360

 
           

LABORATORY CHARGES

 

Amylase

$18.75

 

Hepatic Function Panel

$57

 

APPT or PTT

$17.25

 

LDL Cholesterol Direct

$27.50

 

Basic Metabolic Panel

$24.50

 

Lipid Panel

$38.75

 

Blood Culture

$26

 

Microalbumin, Urine, Quantitative

$16.75

 

B-Natriuretic Peptide 2

$98.25

 

Microbiology (Urine Culture)

$23.25

 

Chlamydia Trachomatis

$101

 

Neisseria Gonorrhoeae

$101

 

Complete Blood Count (CBC)

$22.50

 

Phosphorus

$13.75

 

Comprehensive Metabolic Panel

$30.50

 

Point of Care Glucose

$11.25

 

Creatine Kinase

$18.75

 

Prothrombin Time

$11.50

 

Creatine Kinase, MB Fraction

$33

 

Thyroid Stimulating Hormone TSH

$48.50

 

Creatinine, Urine, Random

$15

 

Troponin

$28.50

 

Free Thyroxin (T4 Free)

$26

 

Urinalysis Automated W/Microscopy

$9.25

 

Hemoglobin A1C

$28

 

Vitamin D 25-Oh

$85.75

 

Hemogram

$18.75

       

Hospital Billing Policies
We want to make sure you receive the full benefits of your insurance coverage as well as consideration under our financial assistance programs, if applicable. Before we bill you, we bill your insurance provider, including Medicare and Medicaid, and any secondary insurance providers. We do not charge interest on any balance due after insurance payments are received; however we do pass to you the New York State Surcharge when applicable. We will send a billing statement showing the most current balance owed. If you are not able to pay the amount you owe in full, you may contact us regarding applying for financial assistance or being set up on a payment plan. Emergency service will never be delayed or withheld on the basis of a patient’s ability to pay.
This information is available in our Customer Service office or by calling 716-664-8249, 716-664-8188, or 716-664-8293.
For a link to the New York State Consumer Guide – Understanding Healthcare Prices, please click on the following link Consumer Guide.