Patient Price Information List

On August 2, 2018, the Centers for Medicare & Medicaid Services("CMS") issued a final rule (CMS-1694-F) updating Medicare payment policies, specifically requiring hospitals "make available a list of their current standard charges via the Internet in a machine readable format and to update this information at least annually, or more often as appropriate."

Community Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/18. Standard charges will be updated quarterly. Next update will be based off adjudicated claims through 6/30/18.

Disclaimer: In compliance with Centers for Medicare and Medicaid Services (CMS), this price list is provided containing our hospital standard charges. This information does not provide a quote or guarantee of actual charges. Standard 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 Financial Counseling staff at (315) 824-6552 to determine whether they qualify for discounts. These prices are correct as of 3/31/2018. Inpatient charges may vary from the hospital price list, due to a variety of reasons including, but not limited to, medical complications, length of stay, condition, and use of laboratory tests, pharmaceuticals, etc. For more specific information, please contact our Financial Counseling Department at (315) 824-6552

LOCAL MARKET HOSPITALS

Community Memorial Hospital’s charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Carthage Area Hospital

Carthage

NY

Chenango Memorial Hospital

Norwich

NY

Clifton-Fine Hospital

Star Lake

NY

Crouse Hospital

Syracuse

NY

Elizabethtown Community Hospital

Elizabethtown

NY

Lewis County General Hospital

Lowville

NY

Little Falls Hospital

Little Falls

NY

Oneida Health Care

Oneida

NY

Rome Memorial Hospital

Rome

NY

Saint Elizabeth Medical Center

Utica

NY

The Mary Imogene Bassett Hospital

Cooperstown

NY

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,300
$1,242

5% higher than market

Swing Bed

$1,000
$1,000

Approximately equal to market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with Level 1 representing basic emergency care, reflect 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.

Description

Our Charge
Market Charge

Variance

Emergency Critical Care, Each Additional 30 Minutes

$206
$742

72% lower than market

Emergency Critical Care, First 30 Minutes

$361
$1,690

79% lower than market

Emergency Department Visit - Level 1

$103
$233

56% lower than market

Emergency Department Visit - Level 2

$321
$355

10% lower than market

Emergency Department Visit - Level 3

$500
$556

10% lower than market

Emergency Department Visit - Level 4

$700
$814

14% lower than market

Emergency Department Visit - Level 5

$900
$1,391

35% lower than market

OUTPATIENT 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.

Description

Our Charge
Market Charge

Variance

Gait Training - 15 Minutes

$111
$105

6% higher than market

Physical Therapy, standard evaluation

$129
$176

27% lower than market

PT Evaluation - Moderate Complexity

$129
$221

42% lower than market

PT to Re-Educate Brain to Muscle Function (15 min)

$111
$99

12% higher than market

Physical Therapy 1 or More Regions (15 min)

$91
$107

14% lower than market

Physical Therapy Exercise, 15 Minutes

$111
$101

10% higher than market

OUTPATIENT 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.

Description

Our Charge
Market Charge

Variance

Occupational Therapy, standard evaluation

$129
$195

34% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$70
$85

17% lower than market

OUTPATIENT PULMONARY THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Routine EKG - Minimum 12 Leads

$160
$182

12% lower than market

Stress Test

$366
$774

53% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY CHARGES

The following charges reflect our most common laboratory procedures. For all lab specimens collected via blood draw, the venipuncture will be charged separately.

Description

Our Charge
Market Charge

Variance

Acute Hepatitis Panel

$329
$301

10% higher than market

Albumin Level

$60
$48

25% higher than market

Alpha-1-antitrypsin; total

$53
$61

15% lower than market

Alpha-1-antitrypsin; phenotype

$89
$86

3% higher than market

Alpha-Fetoprotein (AFP) Level, Serum

$52
$81

37% lower than market

Ammonia Level

$124
$97

29% higher than market

Amylase

$60
$70

14% lower than market

Analysis for antibody Borrelia burgdorferi (Lyme disease bacteria)

$160
$85

89% higher than market

Antibody; Epstein-Barr (EB) virus, early antigen (EA)

$264
$219

20% higher than market

Antibody; Epstein-Barr (EB) virus, nuclear antigen (EBNA)

$46
$49

7% lower than market

Antibody; Epstein-Barr (EB) virus, viral capsid (VCA)

$330
$270

22% higher than market

Analysis for antibody to Rubella (German measles virus)

$122
$87

40% higher than market

Analysis of Substance Using Immunoassay Technique

$36
$46

21% lower than market

Antipsychotics, not otherwise specified; 1-3

$50
$50

Approximately equal to market

Arterial Blood Gases Measurement

$132
$159

17% lower than market

Bacterial Blood Culture

$120
$116

3% higher than market

Bacterial Culture, Any Source Except Urine, Blood, or Stool

$79
$77

2% higher than market

Bacterial Culture, Any Source Blood

$23
$59

60% lower than market

Bacterial Culture for Aerobic Isolates

$32
$68

53% lower than market

Bacterial urine culture; quantitative colony count

$79
$88

10% lower than market

Bacterial culture for anaerobic isolates

$32
$54

40% lower than market

Basic Metabolic Panel

$79
$94

15% lower than market

Bilirubin Level; Total

$60
$63

5% lower than market

Bilirubin Level; Direct

$60
$55

9% higher than market

Blood Creatinine

$60
$78

23% lower than market

Blood Glucose Level Test

$60
$58

3% higher than market

Blood Potassium Level

$60
$52

15% higher than market

Blood Typing, ABO

$48
$55

13% lower than market

Blood Typing, Rh (D)

$60
$60

1% higher than market

Blood Unit Compatibility Test; Immediate Spin Technique

$22
$108

80% lower than market

Blood glucose (sugar) measurement using reagent strip

$27
$30

11% lower than market

Blood Unit Compatibility Test; Electronic Technique

$26
$46

43% lower than market

C-peptide (protein) level

$168
$124

35% higher than market

Calcium Level

$60
$53

14% higher than market

Carbamazepine Level

$100
$127

21% lower than market

Carcinoembryonic Antigen (CEA) Protein Level

$132
$142

7% lower than market

Cell examination of specimen; liquid based slide preparation method

$240
$175

37% higher than market

Cholesterol Level

$60
$54

12% higher than market

Clozapine level

$49
$66

26% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$133
$108

23% higher than market

Complete Blood Count

$34
$49

30% lower than market

Complete Blood Count/Differential

$36
$72

50% lower than market

Comprehensive Metabolic Panel

$102
$170

40% lower than market

Concentration of specimen for infectious agents

$19
$38

49% lower than market

Confirmation test for antibody to Borrelia burgdorferi (Lyme disease bacteria)

$166
$100

67% higher than market

Corticosterone (hormone) level

$18
$18

Approximately equal to market

Cortisol Measurement

$132
$97

36% higher than market

Creatine Kinase

$60
$57

5% higher than market

Creatinine Level to Test for Kidney Function

$60
$67

10% lower than market

Culture for acid-fast bacilli

$100
$148

33% lower than market

Cyanocobalamin (Vitamin B-12)

$96
$106

9% lower than market

Detection Test for Chlamydia; Amplified Probe Technique

$49
$80

38% lower than market

Detection Test for Hepatitis B

$92
$99

7% lower than market

Detection Test for Neisseria Gonorrhoeae

$49
$83

41% lower than market

Detection test for HIV-1 and HIV-2

$54
$91

40% lower than market

Detection test for Rotavirus

$150
$147

2% higher than market

Detection test for Trichomonas vaginal (genital parasite)

$94
$94

Approximately equal to market

Detection test for borrelia burgdorferi (bacteria)

$52
$115

54% lower than market

Detection test for cryptosporidium (parasite); immunoassay technique

$36
$61

41% lower than market

Detection test for giardia; immunoassay technique

$170
$89

91% higher than market

Detection test for multiple types influenza virus

$225
$329

32% lower than market

Detection test for organism; amplified probe technique

$94
$179

47% lower than market

Digoxin Level

$110
$100

11% higher than market

Dihydroxyvitamin D, 1, 25 level

$255
$177

44% higher than market

Electrolyte Panel

$56
$84

34% lower than market

Ferritin

$120
$117

3% higher than market

Folic Acid Level

$98
$111

12% lower than market

Fungal culture (mold or yeast)

$111
$88

26% higher than market

Gabapentin level

$17
$33

48% lower than market

Gammaglobulin Measurement

$72
$85

15% lower than market

Gastrin (GI tract hormone) level

$49
$87

43% lower than market

Glutamyltransferase Level

$48
$55

14% lower than market

Gonadotropin Analysis

$72
$54

33% higher than market

Gonadotropin, chorionic (reproductive hormone) level

$123
$127

4% lower than market

Gonadotropin, follicle stimulating (reproductive hormone) level

$122
$116

5% higher than market

Gonadotropin, luteinizing (reproductive hormone) level

$127
$111

14% higher than market

Heavy metal screening test

$152
$204

26% lower than market

Hemoglobin A1c

$111
$83

35% higher than market

Hemoglobin Measurement

$28
$37

24% lower than market

Hepatitis B Antibody Measurement

$94
$106

11% lower than market

Hepatitis B Surface Antibody Measurement

$83
$67

24% higher than market

Hepatitis C Antibody Measurement

$104
$136

24% lower than market

Histamine (immune system substance) level

$271
$271

Approximately equal to market

Homocysteine (amino acid) level

$53
$87

39% lower than market

IgE (immune system protein) level

$111
$82

36% higher than market

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative; CA 125

$162
$113

43% higher than market

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative CA 15-3

$89
$85

4% higher than market

Infection agent detection by nucleic acid (DNA or RNA); Human Papillomavirus (HPV), high-risk types

$219
$115

90% higher than market

Ionized Calcium

$126
$108

17% higher than market

Iron Binding Capacity

$30
$54

45% lower than market

Iron Level

$30
$59

49% lower than market

Ketone bodies analysis, qualtitative

$106
$61

74% higher than market

Kidney Function Blood Test Panel

$78
$193

60% lower than market

LDL cholesterol level

$51
$63

19% lower than market

Lactate Dehydrogenase

$60
$55

9% higher than market

Lactic Acid

$173
$146

18% higher than market

Lamotrigine level

$17
$78

78% lower than market

Lead level

$100
$89

12% higher than market

Levetiracetam level

$35
$98

64% lower than market

Lipase

$72
$67

8% higher than market

Lipid Panel

$82
$127

35% lower than market

Lithium Level

$60
$60

1% higher than market

Liver Enzyme (SGOT) Level

$60
$85

29% lower than market

Liver Enzyme (SGPT) Level

$60
$85

30% lower than market

Liver Panel

$82
$87

6% lower than market

Magnesium Level

$60
$56

7% higher than market

Measurement C-reactive protein

$46
$62

26% lower than market

Measurement high sensitivity C-reactive protein

$55
$79

30% lower than market

Measurement of Antibody for Assessment of Autoimmune Disorder

$123
$51

143% higher than market

Deoxyribonucleic acid (DNA) antibody; native or double stranded

$96
$82

18% higher than market

Measurement of antibody (IgE) to allergic substance

$60
$39

52% higher than market

Measurement of complement (immune system proteins)

$58
$58

Approximately equal to market

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified

$141
$180

22% lower than market

Microbial toxin or antitoxin assay

$190
$190

Approximately equal to market

Microscopic Examination of White Blood Cells with Manual Count

$36
$25

43% higher than market

Microsomal Antibodies Measurement

$90
$66

37% higher than market

Natriuretic Peptide

$106
$175

39% lower than market

Organic acid level

$256
$112

128% higher than market

PSA Measurement; Total

$140
$148

6% lower than market

PSA Measurement; Free

$140
$115

22% higher than market

Pap test; screening by automated system and manual review

$67
$96

29% lower than market

Pap test (Pap smear), Any Reporting System; Requires Interpretation by Physician

$42
$60

30% lower than market

Parathormone

$243
$175

38% higher than market

Partial Thromblostatin Time, Activated

$52
$44

17% higher than market

Pathology Examination of Tissue with Microscope

$42
$126

67% lower than market

Pathology examination of tissue using a microscope

$35
$111

69% lower than market

Phenobarbital Level

$120
$126

5% lower than market

Phenytoin Level

$110
$116

5% lower than market

Phosphatase (enzyme) level; alkaline

$60
$57

5% higher than market

Phosphate Level

$60
$50

19% higher than market

Prealbumin Level

$145
$77

89% higher than market

Prolactin (Milk Producing Hormone) Level

$152
$120

26% higher than market

Protein Measurement, Serum

$88
$122

28% lower than market

Prothrombin Time

$40
$46

13% lower than market

Red Blood Cell Concentration Measurement

$28
$34

17% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$541
$645

16% lower than market

Red Blood Count, Automated Test

$42
$39

8% higher than market

Antihuman globulin test (Coombs test); indirect, qualitative, each reagent red cell

$52
$52

Approximately equal to market

Red blood cell sedimentation rate, to detect inflammation; automated

$36
$34

5% higher than market

Rheumatoid factor analysis

$46
$57

20% lower than market

Screening Test for Autoimmune Disorder

$79
$79

1% higher than market

Screening test for Pathogenic Organisms

$69
$78

12% lower than market

Screening test for antibody to noninfectious agent

$88
$89

1% lower than market

Screening test for mononucleosis (mono)

$46
$47

3% lower than market

Sirolimus level

$136
$119

14% higher than market

Smear for infectious agents

$42
$48

13% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$32
$39

18% lower than market

Special stain for microorganism; fluorescent and/or acide fast stain

$50
$60

16% lower than market

Special stained specimen slides to examine tissue

$324
$127

154% higher than market

Special stained specimen slides to identify organisms including interpretation and report

$60
$102

42% lower than market

Stool Culture

$102
$102

Approximately equal to market

Stool analysis for blood

$40
$56

28% lower than market

Strep Test

$38
$43

13% lower than market

Streptoccus

$32
$59

45% lower than market

Surgical Pathology, Intermediate Complexity

$76
$184

58% lower than market

Surgical Pathology, Moderate Complexity

$104
$256

59% lower than market

Syphilis Detection Test

$42
$45

7% lower than market

Tacrolimus Level

$300
$188

59% higher than market

Test for Influenza Virus

$36
$75

52% lower than market

Testosterone Level; Free

$172
$90

90% higher than market

Testosterone Level; Total

$336
$139

141% higher than market

Thyroglobulin (thyroid protein) antibody measurement

$89
$69

28% higher than market

Thyroid Hormone, T3 Measurement, Total

$124
$91

37% higher than market

Thyroid Hormone, T3 Measurement, Free

$284
$129

120% higher than market

Thyroid Stimulating Hormone (TSH)

$124
$140

11% lower than market

Thyroxine

$121
$106

14% higher than market

Thyroxine Measurement

$42
$87

52% lower than market

Tissue or Cell Analysis by Immunologic Technique

$53
$178

70% lower than market

Total Protein Level, Blood

$60
$53

13% higher than market

Total Protein Level, Urine

$12
$44

72% lower than market

Triglycerides Level

$60
$57

5% higher than market

Troponin

$190
$135

40% higher than market

Urea Nitrogren

$60
$78

23% lower than market

Uric Acid Level, Blood

$60
$47

28% higher than market

Urinalysis with Microscopy

$17
$32

47% lower than market

Urinalysis, Automated Test

$28
$29

3% lower than market

Urinalysis, Manual Test

$27
$33

19% lower than market

Urine Microalbumin Level

$67
$62

9% higher than market

Urine Pregnancy Test

$56
$63

11% lower than market

Valproic Acid Level

$104
$122

15% lower than market

Vasoactive intestinal peptide (intestinal hormone) level

$307
$383

20% lower than market

Vitamin D-3 Level

$227
$124

83% higher than market

Vitamin measurement

$29
$146

80% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Hydration Infusion into a Vein

$52
$114

55% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$96
$284

66% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$54
$172

69% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$214
$373

43% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$64
$91

29% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$32
$100

68% lower than market

Measurement of lung stretching capacity

$37
$37

Approximately equal to market

Therapeutic massage to 1 or more areas, each 15 minutes

$91
$85

7% higher than market

Tracing of electrical activity of the heart using 1-3 leads

$46
$165

72% lower than market

Vein Infusion for Therapy, Prevention or Diagnosis, Concurrent with Another Infusion

$54
$182

71% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)

$80
$75

6% higher than market

Drug test(s); includes specimen validity testing, per day; 8-14 drug class(es)

$42
$174

76% lower than market

Injection of anesthetic agent, middle or lower spine sympathetic nerves

$2,567
$2,567

Approximately equal to market

Low dose ct scan (ldct) for lung cancer screening

$1,005
$2,176

54% lower than market

Prostate Cancer Screening Test

$140
$134

4% higher than market

Repair of trapped hernia at navel patient age 5 years or older

$6,320
$5,795

9% higher than market

Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries

$44
$165

73% lower than market

Technetium tc-99m sestamibi, diagnostic, per study dose

$209
$340

38% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$80
$183

56% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$54
$163

67% lower than market

Tetanus Vaccine

$31
$89

65% lower than market

Atezolizumab - 1200 mg

$3
$4

24% lower than market

Infusion, normal saline solution, sterile (500 ml = 1 unit)

$3
$3

Approximately equal to market

Injection, Azithromycin, 500 mg

$10
$13

24% lower than market

Injection, Enoxaparin Sodium, 10 mg

$4
$7

46% lower than market

Injection, Furosemide, up to 20 mg

$3
$5

26% lower than market

Injection, Levofloxacin, 250 mg

$7
$11

31% lower than market

Injection, Lorazepam, 2 mg

$6
$6

2% higher than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$6
$26

78% lower than market

Injection, Promethazine HCL, up to 50 mg

$5
$6

15% lower than market

Injection, cosyntropin (cortrosyn), 0.25 mg

$65
$65

Approximately equal to market

Injection, ertapenem sodium, 500 mg

$145
$155

6% lower than market

Injection, glucagon hydrochloride, per 1 mg

$558
$569

2% lower than market

Injection, naloxone hydrochloride, per 1 mg

$66
$66

Approximately equal to market

Injection, regadenoson, 0.1 mg

$111
$135

18% lower than market

Injection, succinylcholine chloride, up to 20 mg

$29
$29

Approximately equal to market

Ringers lactate infusion, up to 1000 cc

$3
$3

Approximately equal to market

OUTPATIENT RESPIRATORY THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Nebulizer Treatment

$32
$89

64% lower than market

Pulse Oximetry

$67
$62

8% higher than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$1,553
$2,640

41% lower than market

Application of Short Arm Splint

$107
$153

30% lower than market

Application of Short Leg Splint (Calf to Foot)

$133
$164

19% lower than market

Application of long leg splint (thigh to ankle or toes)

$149
$151

1% lower than market

Biopsy of Large Bowel, Using an Endoscope

$1,553
$2,696

42% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$1,553
$2,055

24% lower than market

Closed treatment of dislocated hip prosthesis

$240
$392

39% lower than market

Colonscopy

$1,553
$1,853

16% lower than market

Control Nose Bleed - Simple Case

$240
$245

2% lower than market

Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope

$1,553
$1,803

14% lower than market

Fine needle aspiration; without imaging guidance

$234
$690

66% lower than market

Gallbladder Removal Using an Endoscope

$4,971
$7,266

32% lower than market

Insertion of Breathing Tube Using an Endoscope

$117
$495

76% lower than market

Insertion of Central Venous Catheter for Infusion

$586
$1,249

53% lower than market

Insertion of Indwelling Bladder Catheter

$53
$144

63% lower than market

Insertion of Needle into Vein to Collect Blood

$20
$23

13% lower than market

Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older

$213
$1,046

80% lower than market

Insertion of nasal or oral stomach tube using fluoroscopic guidance

$53
$252

79% lower than market

Insertion of temporary bladder catheter

$85
$107

20% lower than market

Open treatment of distal fibular fracture

$4,971
$8,317

40% lower than market

Removal of Polyps in Large Bowel, Using an Endoscope

$1,553
$2,177

29% lower than market

Removal of breast and underarm lymph nodes

$4,971
$5,695

13% lower than market

Extracapsular cataract removal with insertion of intraocular lens prosthesis; complex

$2,567
$3,742

31% lower than market

Extracapsular cataract removal with insertion of intraocular lens prosthesis

$2,567
$3,160

19% lower than market

Removal of growth (4.0 centimeters) of the trunk, arms, or legs

$3,605
$3,690

2% lower than market

Removal of growth (over 4.0 centimeters) of the scalp, neck, hands, feet, or genitals

$1,476
$1,476

Approximately equal to market

Removal of one knee cartilage using an endoscope

$2,946
$5,302

44% lower than market

Removal of skin suture with change of bladder tube

$156
$261

40% lower than market

Repair of Wound (2.6 to 7.5 centimeters)

$107
$264

60% lower than market

Repair of hernia of muscle at esophagus and stomach using an endoscope

$7,003
$15,999

56% lower than market

Repair of muscle to lower esophagus and stomach using an endoscope

$6,320
$6,320

Approximately equal to market

Repair of wound (2.5 centimeters or less) of neck, hands, feet, and/or genitals

$133
$314

57% lower than market

Simple wound repair of face, including ears; 2.5 cm or less

$107
$328

68% lower than market

Simple wound repair of face, including ears; 2.6 cm to 5.0 cm

$107
$344

69% lower than market

Simple wound repair of scalp, neck, external genitalia; 2.5 cm or less

$107
$247

57% lower than market

OUTPATIENT VISION CHARGES

Description

Our Charge
Market Charge

Variance

Posterior chamber intraocular lens

$300
$353

15% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL CHARGES

The following charges reflect our most common x-ray and radiological procedures. For all exams requiring contrast, the contrast will be charged separately.

Description

Our Charge
Market Charge

Variance

Insertion of probe in esophagus for heart ultrasound examination including interpretation and report

$1,018
$1,536

34% lower than market

Ultrasound Blood Flow Outside the Brain

$600
$1,053

43% lower than market

Ultrasound Heart

$1,100
$1,860

41% lower than market

Ultrasound Veins of Both Arms or Legs

$458
$1,233

63% lower than market

Ultrasound Veins of One Arm or Leg

$203
$875

77% lower than market

Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with

$1,079
$1,103

2% lower than market

Bone Density Scan (DEXA Scan)

$351
$634

45% lower than market

Breast Ultrasound - Complete

$322
$554

42% lower than market

CT Abdomen & Pelvis with Contrast

$2,860
$3,442

17% lower than market

CT Abdomen & Pelvis with and without Contrast

$3,200
$3,716

14% lower than market

CT Abdomen & Pelvis without Contrast

$2,505
$2,812

11% lower than market

CT Abdomen with Contrast

$1,018
$2,347

57% lower than market

CT Angiogram Abdomen with and without Contrast

$1,069
$2,123

50% lower than market

CT Angiogram Chest with and without Contrast

$2,085
$2,480

16% lower than market

CT Chest with Contrast

$1,018
$2,289

56% lower than market

CT Chest with and without Contrast

$1,069
$2,427

56% lower than market

CT Chest without Contrast

$1,485
$1,884

21% lower than market

CT Face without Contrast

$1,875
$1,709

10% higher than market

CT Head Brain with Contrast

$1,018
$2,006

49% lower than market

CT Head Brain without Contrast

$1,450
$1,540

6% lower than market

CT Leg without Contrast

$937
$1,551

40% lower than market

CT Neck with Contrast

$1,018
$2,047

50% lower than market

CT Neck without Contrast

$1,520
$1,534

1% lower than market

CT Pelvis without Contrast

$937
$1,555

40% lower than market

CT Spine Cervical without Contrast

$937
$1,563

40% lower than market

CT Spine Lumbar without Contrast

$1,630
$1,772

8% lower than market

CT Spine Thoracic without Contrast

$937
$1,627

42% lower than market

Cardiac Nuclear Stress Testing

$3,060
$3,346

9% lower than market

Chest X-Ray; 2 Views

$275
$310

11% lower than market

Chest X-Ray; Single View

$200
$222

10% lower than market

Diagnostic mammography, bilateral

$392
$539

27% lower than market

Diagnostic mammography, unilateral

$329
$446

26% lower than market

Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, spine), including vertebral fracture assessment

$600
$749

20% lower than market

Imaging guidance for procedure, more than 1 hour

$303
$303

Approximately equal to market

Imaging of Abdomen; Single View

$104
$261

60% lower than market

Imaging of Liver and Bile Duct System with Use of Drugs

$322
$1,468

78% lower than market

MRA Head without Contrast

$1,970
$2,829

30% lower than market

MRI Abdomen with and without Contrast

$2,462
$4,515

45% lower than market

MRI Arm Joint without Contrast

$1,970
$2,692

27% lower than market

MRI Arm with and without Contrast

$2,462
$3,880

37% lower than market

MRI Brain with and without Conrast

$3,730
$4,166

10% lower than market

MRI Brain without Contrast

$1,970
$2,296

14% lower than market

MRI Leg Joint with and without Contrast

$2,462
$4,069

39% lower than market

MRI Leg Joint without Contrast

$2,655
$2,946

10% lower than market

MRI Spin Lumbar with and without Contrast

$2,462
$4,245

42% lower than market

MRI Spine Cervical with and without Contrast

$2,462
$4,367

44% lower than market

MRI Spine Cervical without Contrast

$1,970
$2,774

29% lower than market

MRI Spine Lumbar without Contrast

$2,455
$2,733

10% lower than market

MRI Spine Thoracic with and without Contrast

$2,462
$4,007

39% lower than market

MRI Spine Thoracic without Contrast

$1,970
$2,705

27% lower than market

MRI scan of leg joint with contrast

$1,477
$1,477

Approximately equal to market

Nuclear Medicine Study of Lung Ventilation and Blood Circulation in the Lungs

$611
$1,275

52% lower than market

Radiologic examination, abdomen; 3 or more views

$199
$411

52% lower than market

Radiologic examination, hips, bilateral, with pelvis when performed, min of 5 views

$373
$503

26% lower than market

Radiological supervision and interpretation X-ray of hip joint

$436
$436

Approximately equal to market

Screening Mammography, Bilateral

$405
$439

8% lower than market

Screening digital breast tomosynthesis, bilateral

$80
$116

31% lower than market

Stomach emptying study

$731
$1,537

52% lower than market

Ultrasound Abdomen - Complete

$790
$943

16% lower than market

Ultrasound Abdomen - Limited

$442
$635

30% lower than market

Ultrasound Behind Abdominal Cavity - Complete

$412
$860

52% lower than market

Ultrasound Head Neck

$354
$687

48% lower than market

Ultrasound Joint Soft Tissue - Complete

$376
$593

37% lower than market

Ultrasound Pelvis

$425
$773

45% lower than market

Ultrasound Pelvis through Vagina

$375
$773

51% lower than market

Ultrasound Scrotum

$354
$687

48% lower than market

Ultrasound, abdominal aorta, real time with image documenation, screening study for abdominal aortic aneurysm (AAA)

$391
$554

29% lower than market

X-Ray Ankle, 2 Views

$125
$232

46% lower than market

X-Ray Ankle, 3 Views

$230
$347

34% lower than market

X-Ray Collar Bone

$136
$274

50% lower than market

X-Ray Elbow, 2 Views

$154
$277

44% lower than market

X-Ray Elbow, 3 Views

$230
$319

28% lower than market

X-Ray Esophagus

$310
$509

39% lower than market

X-Ray Femus, 2 Views

$151
$289

48% lower than market

X-Ray Fingers, 2 Views

$125
$239

48% lower than market

X-Ray Foot, 2 Views

$125
$272

54% lower than market

X-Ray Foot, 3 Views

$248
$337

26% lower than market

X-Ray Forearm, 2 Views

$155
$272

43% lower than market

X-Ray Hand, 2 Views

$125
$177

29% lower than market

X-Ray Hand, 3 Views

$178
$327

46% lower than market

X-Ray Hip and Pelvis, 2 Views

$186
$416

55% lower than market

X-Ray Knee, 3 Views

$189
$358

47% lower than market

X-Ray Knee, 4 or More Views

$189
$380

50% lower than market

X-Ray Lower Leg, 2 Views

$132
$281

53% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$240
$344

30% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$336
$562

40% lower than market

X-Ray Middle Spine, 3 Views

$125
$316

60% lower than market

X-Ray Neck Spine, 2-3 Views

$120
$302

60% lower than market

X-Ray Pelvis, 1-2 Views

$151
$325

53% lower than market

X-Ray Pelvis, 2 Views

$165
$309

47% lower than market

X-Ray Sacroiliac Joints, 3 or More Views

$193
$278

30% lower than market

X-Ray Shoulder, 2 Views

$193
$351

45% lower than market

X-Ray Upper Arm, 2 Views

$108
$258

58% lower than market

X-Ray Wrist, 3 Views

$178
$322

45% lower than market

X-Ray of Middle Spine; 3 Views

$195
$326

40% lower than market

X-ray Ribs One Side, Minimum 3 Views

$245
$345

29% lower than market

X-ray of middle spine, minimum of 4 views