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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 WCA 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 WCA Financial Assistance can be found here. These prices are correct as of January 1, 2016.

Room and Board – Per Day Charges
Coronary Care/Intensive Care $1,725 Medical Surgical – Semi private $625
Maternity/Obstetrics/Labor & Delivery $700 Medical Surgical – Private $700
Nursery   Adult Mental Health $910
     • Bassinet $380 Adolescent Mental Health $910
     • Bassinet-Special $600 Medical Rehabilitation $935
     • Boarder (Mother Discharged) $485 Chemical Dependency Rehabilitation $700

 

Labor and Delivery Charges

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

Normal Delivery (Mother only)$4,333Cesarean Section Delivery (Mother only)$6,782
Nursery$1,967Non Stress Test$297

 

Emergency Department Charges

The Emergency Department charges are based on the type of accommodations needed, the personnel resources, the 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 particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Level 1$162Level 2$222
Level 3$350Level 4$412
Level 5$845Critical Care, 30-74 minutes$2,029
Critical Care each Additional 30 Minutes$823  

 

Operating Room Charges

Operating Room charges are based on the complexity level, with Type 1 being most basic and are billed. The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician. Operating Room charges are billed by the minute.

Level 1 per minute$ 36Level 2 per minute$ 39
Level 3 per minute$ 42Level 4 per minute$ 45

 

Recovery Room Charges

Recovery Room charges are based on the complexity level, with Type 1 being most basic and are billed. The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.

Level 1$358Level 2$593
Level 3$1,009Level 4$1,336

 

Ambulatory Surgery Charges

Ambulatory Surgery charges are based on the complexity level, with Type 1 being most basic and are billed. The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.

Level 1$418Level 2$835
Level 3$1,365  

 

Physical Therapy Charges

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Evaluation & Report$98Therapeutic Exercise/per 15 min$83
Gait Training/per 15 min$73  

 

Occupational Therapy Charges

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Evaluation & Report$98Therapeutic Exercise/per 15 min$83

 

Sleep Center Charges

The following charges reflect the most common services offered by our Sleep Center department. Patients may have additional charges, depending on the services performed.

Polysomnography with Sleep Staging (age 6 or older)$1,316
Polysomnography with Sleep Staging and Continuous Positive Pressure Airway (CPAP) (age 6 or older)$1,447
Sleep Study Unattended$244

 

X-Ray and Radiological Charges

The following charges reflect the hospital’s most common x-ray and radiological procedures.

CT Abdomen Pelvis with Contrast$526  
• Additional Contrast based on patients weight $201.60 or $252.00 (supply)
CT Abdomen Pelvis without Contrast$276  
CT Brain with Contrast$673Ultrasound Breast Unilateral Complete$140
• Contrast (supply)$84Ultrasound Carotid Doppler Complete$700
CT Brain without Contrast$548Ultrasound Obstetrical Limited$135
CT Chest with and without Contrast$880Ultrasound Renal$202
• Contrast (supply)$118Ultrasound Transvaginal Non Pregnant$202
CT Chest with Contrast$742Ultrasound Thyroid$202
Contrast (supply)$118Ultrasound Venous Compression Unilateral$245
CT Chest without Contrast$562XR Abdomen Complete Minimum 2 Views$202
• Contrast (supply)$126XR Cervical Spine Complete$25
CT Cervical Spine with and without Contrast$880XR Chest One View$122
CT Moxiofacial w/o Contrast$526XR Chest Two Views$154
Dexa Hips, Pelvis, Spine$156XR Foot Complete Minimum 3 Views$135
Mammography Digital Screening Bilateral$180XR Hand 3 Views$135
Nuclear Medicine Cardiac Spect Multi$891XR Hip Complete$145
MRI Brain with and w/o Contrast$1,080XR Kidney, Ureter, and Bladder One View$135
MRI L Spine Detail H Res without Contrast$756XR Knee One or Two Views$135
PET CT Skull Base to Mid Thigh$1,966XR Knee Complete Four Views$172
• FDG (supply)$1,498XR Lumbo Sacral Minimum 4 Views$266
PET CT Whole Body$1,966XR Shoulder Complete$148
• FDG (supply)$1,498XR Wrist Complete Minimum 3 Views$135

 

Laboratory Charges

The following charges reflect the hospital’s most common laboratory procedures.

Amylase$18Hemogram$18
Antimicrobial Identification$22Hepatic Function Panel$22
Antimicrobial Susceptibility$24LDL Cholesterol Direct$26
APPT or PTT$16Lipid Panel$37
Basic Metabolic Panel$23Microalbumin, Urine, Quantitatve$16
Blood Culture$28Microbiology (Urine Culture)$22
B-Natriuretic Peptide 2$93Neisseria Gonorhoeae$96
Chlamydia Trachomatis$96Phosphorus$13
Complete Blood Count (CBC)$21Point Of Care Glucose$9
Comprehensive Metabolic Panel$29Prothrombin Time$11
Creatine Kinase$18Thyroid Stimulating Hormone TSH$46
Creatine Kinase, MB Fraction$31Toxi 9 Confirmed$367
Creatinine, Urine, Random$14Troponin$27
Free Tyroxin (T4 Free)$25Urinalysis Automated W/Microscopy$9
Hemaglobin A1C$26Vitamin D 25-Oh$81

 

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, 8188 or 8293.

For a link to the New York State Consumer Guide – Understanding Healthcare Prices, please click on the following link Consumer Guide.