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Glossary Billing and Insurance Terms Defined

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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.


Coronary Care/Intensive Care



Adult Mental Health



Maternity/Obstetrics/Labor & Delivery



Adolescent Mental Health






Medical Rehabilitation



Medical Surgical – Semi private



Chemical Dependency Rehabilitation



Medical Surgical – Private





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)








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



Critical Care, 30-74 minutes



Level 2 Acuity



Critical Care each Additional 30 Minutes



Level 3 Acuity



Level 4 Acuity



Level 5 Acuity





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



Extremity Major



Arthroscopic Assisted Repair



Minimally Invasive Surgery - General



Bronchoscopy/Esophagoscopy Procedure



Minimally Invasive Surgery - Gynecological



Cataract Procedure



Major General



Cystoscopy Procedure



Minor General



Extremity Minor





Recovery Room 30 Min or Less



Recovery Room Initial Hour



Recovery Room Each Additional Hour





Polysomnography with Sleep Staging



Polysomnography with CPAP



Home Sleep Study





PT Evaluation Low Complexity



Therapeutic Activity Per 15 Min



PT Evaluation Moderate Complexity



Gait Training Per 15 Min





Plethysmography Lung Volume



Drug Aerosol Initial



Spirometry Pre & Post Bronch



Mechanical Ventilation Initial



Diffusing Capacity








CT Abdomen Pelvis with Contrast



Ultrasound Breast Unilateral Complete



CT Abdomen Pelvis without Contrast



Ultrasound Carotid Doppler Complete



CT Brain with Contrast



Ultrasound Obstetrical Limited



CT Brain without Contrast



Ultrasound Renal



CT Chest with and without Contrast



Ultrasound Transvaginal (Non-Pregnant)



CT Chest with Contrast



Ultrasound Thyroid



CT Chest without Contrast



Ultrasound Venous Compression Unilateral



CT Cervical Spine with and without Contrast



X-Ray Abdomen Complete Minimum 2 Views



CT Maxillofacial w/o Contrast



X-Ray Cervical Spine Complete



CT Contract Material (estimated)



X-Ray Chest One View



Dexa Scan Hips, Pelvis, Spine



X-Ray Chest Two Views



Mammography Digital Screening



X-Ray Foot Complete Minimum 3 Views



Nuclear Medicine Cardiac Spect Multi



X-Ray Hand 3 Views



MRI Brain with and w/o Contrast



X-Ray Hip Complete



MRI L Spine Detail H Res without Contrast



X-Ray Knee One or Two Views



MRI Contract Material (estimated)



X-Ray Knee Complete Four Views



PET CT Skull Base to Mid-Thigh



X-Ray Shoulder Complete



PET CT Whole Body



X-Ray Wrist Complete Minimum 3 Views



PET Contract Material



X-Ray Contrast Material (estimated)








Hepatic Function Panel






LDL Cholesterol Direct



Basic Metabolic Panel



Lipid Panel



Blood Culture



Microalbumin, Urine, Quantitative



B-Natriuretic Peptide 2



Microbiology (Urine Culture)



Chlamydia Trachomatis



Neisseria Gonorrhoeae



Complete Blood Count (CBC)






Comprehensive Metabolic Panel



Point of Care Glucose



Creatine Kinase



Prothrombin Time



Creatine Kinase, MB Fraction



Thyroid Stimulating Hormone TSH



Creatinine, Urine, Random






Free Thyroxin (T4 Free)



Urinalysis Automated W/Microscopy



Hemoglobin A1C



Vitamin D 25-Oh






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.