Patient Price Information List

Disclaimer: John Muir Medical Center-Walnut Creek determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, John Muir Medical Center-Walnut Creek has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/18. John Muir Medical Center-Walnut Creek's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Alta Bates Summit Med Ctr-Alta Bates

Berkeley

CA

Alta Bates Summit Med Ctr-Summit

Oakland

CA

California Pacific Med Ctr-Pacific

San Francisco

CA

Eden Medical Center

Castro valley

CA

John Muir Medical Center-Walnut Creek

Walnut Creek

CA

NorthBay Medical Center

Fairfield

CA

San Ramon Regional Medical Center

San Ramon

CA

Stanford Hospital

Stanford

CA

Sutter Delta Medical Center

Antioch

CA

UC Davis Medical Center

Sacramento

CA

UCSF Medical Center

San Francisco

CA

Valley Memorial Center

Livermore

CA

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$8,147
$6,315

29% higher than market

Semi-Private Room

$8,147
$6,247

30% higher than market

Intensive Care Unit

$11,972
$12,693

6% lower than market

INPATIENT LABOR AND DELIVERY CHARGES

The following list does not include charges for anesthesia, drugs, or supplies or charges outside the delivery room (i.e., room & board) required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.

Description

Our Charge
Market Charge

Variance

Normal vaginal delivery without complications

$32,402
$47,528

32% lower than market

Cesarean Section without complications

$78,672
$69,522

13% higher than market

Other antepartum diagnoses w medical complications

$47,037
$71,749

34% lower than 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

$2,730
$3,340

18% lower than market

Emergency Critical Care, First 30 Minutes

$10,621
$11,345

6% lower than market

Emergency Department Visit - Level 1

$709
$522

36% higher than market

Emergency Department Visit - Level 2

$1,490
$1,315

13% higher than market

Emergency Department Visit - Level 3

$2,650
$2,637

Approximately equal to market

Emergency Department Visit - Level 4

$5,039
$5,221

3% lower than market

Emergency Department Visit - Level 5

$7,448
$7,075

5% higher 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

Application of Electrical Stimulation - 15 Minutes

$147
$163

10% lower than market

Gait Training - 15 Minutes

$220
$276

20% lower than market

Physical Therapy, complex evaluation

$338
$863

61% lower than market

Physical Therapy, standard evaluation

$173
$435

60% lower than market

PT Evaluation - Moderate Complexity

$443
$520

15% lower than market

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

$252
$280

10% lower than market

Physical Therapy 1 or More Regions (15 min)

$214
$204

5% higher than market

Physical Therapy Exercise, 15 Minutes

$251
$248

1% higher than market

Physical Therapy, re-evaluation

$380
$449

15% lower 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, complex evaluation

$338
$750

55% lower than market

Occupational Therapy, standard evaluation

$189
$518

63% lower than market

Occupational Therapy Evaluation - Moderate Complexity

$443
$601

26% lower than market

Paraffin Wax Bath

$128
$127

Approximately equal to market

Self Care - Home Management Training - 15 Minutes

$180
$227

21% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$278
$252

10% higher 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

Aerosol Treatment

$742
$786

6% lower than market

Holter Testing - 48-Hour EKG

$476
$840

43% lower than market

Routine EKG - Minimum 12 Leads

$407
$591

31% lower than market

Spirometry - medicated breathing procedure

$1,617
$1,462

11% higher than market

Stress Test

$3,041
$2,622

16% higher than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Evaluation of Speech Sound Production

$182
$929

80% lower than market

Evaluation of Speech Sound Production and Language Comprehenson

$656
$675

3% lower than market

Speech Therapy

$507
$667

24% lower than market

Swallow Evaluation

$381
$712

46% lower than market

Swallow Treatment

$498
$458

9% higher 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

Albumin Level

$106
$112

5% lower than market

Alpha-1-antitrypsin; total

$11
$40

73% lower than market

Analysis for antibody to HIV-1 and HIV-2 virus

$39
$85

54% lower than market

Apolipoprotein level

$9
$40

77% lower than market

Arterial Blood Gases Measurement

$904
$822

10% higher than market

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

$339
$344

2% lower than market

Bacterial Culture, Any Source Blood

$315
$348

9% lower than market

Bilirubin Level; Total

$106
$100

6% higher than market

Bilirubin Level; Direct

$106
$110

4% lower than market

Blood Creatinine

$106
$156

32% lower than market

Blood Glucose Level Test

$106
$116

9% lower than market

Blood Potassium Level

$106
$148

28% lower than market

Blood Sodium Level

$106
$212

50% lower than market

Blood Unit Compatibility Test; Immediate Spin Technique

$303
$510

41% lower than market

Blood chloride level

$106
$108

2% lower than market

Blood gases measurement

$837
$1,077

22% lower than market

Blood typing for red blood cell antigens

$62
$151

59% lower than market

Blood Unit Compatibility Test; Antiglobulin Technique

$608
$536

13% higher than market

Blood Unit Compatibility Test; Electronic Technique

$268
$384

30% lower than market

Body fluid cell count with cell identification

$215
$263

18% lower than market

Calcium Level

$106
$110

3% lower than market

Carbon dioxide (bicarbonate) level

$106
$109

2% lower than market

Carboxyhemoglobin

$209
$270

22% lower than market

Cholesterol Level

$99
$117

16% lower than market

Complete Blood Count

$165
$164

Approximately equal to market

Concentration of specimen for infectious agents

$115
$166

31% lower than market

Creatine Kinase

$226
$184

22% higher than market

Cryoprecipitate, each unit

$325
$325

Approximately equal to market

Culture for acid-fast bacilli

$221
$325

32% lower than market

Detection test for Chlamydia pneumoniae

$102
$102

Approximately equal to market

Detection test for Mycoplasma pneumoniae (bacteria)

$102
$102

Approximately equal to market

Infectious agent detection by nucleic acid (DNA or RNA); Streptococcus, group A, amplified probe technique

$188
$325

42% lower than market

Detection test for adenovirus enteric types 40/41

$100
$100

Approximately equal to market

Detection test for identification of organism

$27
$124

78% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); Legionella pneumophila, amplified probe technique

$52
$52

Approximately equal to market

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reve

$1,216
$2,561

53% lower than market

Detection test for organism; amplified probe technique

$102
$430

76% lower than market

Fresh frozen plasma thawing, each unit

$268
$357

25% lower than market

Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker

$90
$448

80% lower than market

Fungal culture (mold or yeast)

$214
$325

34% lower than market

Gammaglobulin (immune system protein) measurement

$31
$33

6% lower than market

Gastrin (GI tract hormone) level

$13
$14

13% lower than market

Gene analysis (epidermal growth factor receptor), common variants

$443
$762

42% lower than market

Gene analysis (v-raf murine sarcoma viral oncogene homolog B1)

$200
$962

79% lower than market

Glycated protein level

$6
$10

41% lower than market

Immunologic analysis for detection of antigen or antibody

$5
$10

47% lower than market

Iron Binding Capacity

$121
$115

6% higher than market

Iron Level

$107
$120

11% lower than market

Lactic Acid

$340
$284

20% higher than market

Lamotrigine level

$35
$139

75% lower than market

Levetiracetam level

$64
$149

57% lower than market

Liver Enzyme (SGOT) Level

$106
$128

17% lower than market

Liver Enzyme (SGPT) Level

$106
$128

17% lower than market

MLH1 (mutL homolog 1, colon cancer, nonpolyposis type 2) (eg, hereditary non-polyposis colorectal cancer, Lynch syndrome) gene analysis; promoter methylation analysis

$360
$513

30% lower than market

Measurement of complement function, each antigen

$46
$42

11% higher than market

Measurement of immune substance (oligoclonal bands)

$80
$195

59% lower than market

Microscopic genetic analysis of tumor; each single antibody stain procedure

$273
$547

50% lower than market

Nephelometry, test method using light

$41
$164

75% lower than market

Organic acid level

$50
$103

51% lower than market

PSA Measurement; Total

$65
$278

76% lower than market

Pap test; with fine needle aspirate and immediate study for diagnosis

$19
$46

58% lower than market

Pathology consultation during surgery; cytologic examination (eg, touch prep, squash prep), each additional site

$35
$80

56% lower than market

Pathology examination of tissue specimen during surgery

$35
$175

80% lower than market

Phenytoin level

$17
$17

2% lower than market

Phosphatase (enzyme) level; alkaline

$106
$111

4% lower than market

Phosphate Level

$121
$126

4% lower than market

Platelet rich plasma, each unit

$37
$37

Approximately equal to market

Platelets, pheresis, leukocytes reduced, each unit

$492
$958

49% lower than market

Platelets, pheresis, leukocytes reduced, irradiated, each unit

$532
$2,013

74% lower than market

Procalcitonin (hormone) level

$122
$152

20% lower than market

Protein Measurement, Serum

$49
$108

54% lower than market

Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step metho

$65
$228

72% lower than market

Quantitation of therapeutic drug

$56
$164

66% lower than market

Red Blood Cell Concentration Measurement

$121
$157

23% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$220
$486

55% lower than market

Red blood cell sickling measurement

$62
$56

11% higher than market

Red blood cells, leukocytes reduced, irradiated, each unit

$267
$982

73% lower than market

Screening Test for Red Blood Cell Antibodies

$342
$280

22% higher than market

Screening test for compatible blood unit

$118
$174

32% lower than market

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

$115
$142

19% lower than market

Special stained specimen slides to examine tissue

$321
$366

12% lower than market

Stool Analysis for Blood

$107
$118

9% lower than market

Stool fat analysis

$19
$21

10% lower than market

T cells count, total

$110
$301

63% lower than market

Total Protein Level, Blood

$17
$57

71% lower than market

Total Protein Level, Body Fluid

$272
$222

23% higher than market

Triglycerides Level

$106
$139

23% lower than market

Urea Nitrogren

$106
$148

28% lower than market

Vitamin B-1 (thiamine) level

$17
$20

15% lower than market

Vitamin D-3 Level

$110
$237

54% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Application of heat wave therapy to 1 or more areas

$113
$113

Approximately equal to market

Application of low energy heat (infrared) to 1 or more areas

$122
$108

13% higher than market

Application of mechanical traction to 1 or more areas

$166
$160

4% higher than market

Assessment of expressive and receptive speech with interpretation and report per hour

$659
$614

7% higher than market

Behavioral and qualitative analysis of voice and resonance

$656
$917

29% lower than market

Chemotherapy administration into spinal canal requiring spinal tap

$7,008
$5,675

24% higher than market

Demonstration and/or evaluation of manual maneuvers to chest wall to assist movement of lung secreti

$613
$525

17% higher than market

Determination of lung volumes using gas dilution or washout

$983
$842

17% higher than market

Exercise test for bronchospasm, including pre- and post-spirometry, electrocardiographic recording(s), and pulse oximetry

$371
$442

16% lower than market

External shock to heart to regulate heart beat

$6,228
$5,668

10% higher than market

Fluoroscopic and video recorded motion evaluation of swallowing function

$659
$1,217

46% lower than market

Hemophilus influenza B vaccine PRP-OMP, 3 dose

$367
$367

Approximately equal to market

Health and behavior assessment each 15 minutes

$210
$202

4% higher than market

Heart rhythm analysis, interpretation and report of 48-hour EKG

$238
$1,100

78% lower than market

Hemodialysis procedure with one physician evaluation

$4,524
$4,246

7% higher than market

Hydration Infusion into a Vein

$687
$571

20% higher than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$1,116
$1,052

6% higher than market

Imaging of digestive tract done from the inside of the digestive tract

$7,508
$6,177

22% higher than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$627
$632

1% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$1,491
$1,244

20% higher than market

Infusion of chemotherapy into a vein

$687
$660

4% higher than market

Infusion of different chemotherapy drug or substance into a vein up to 1 hour

$667
$924

28% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$387
$328

18% higher than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$450
$428

5% higher than market

Insertion of stent, removal of plaque and/or balloon dilation of coronary vessel during heart attack

$38,518
$38,518

Approximately equal to market

Measurement and recording of brain wave (EEG) activity, awake and asleep

$2,528
$2,292

10% higher than market

Measurement and recording of brain wave (EEG) activity, awake and drowsy

$2,528
$2,069

22% higher than market

Medical nutrition therapy re-assessment and intervention, each 15 minutes

$122
$131

7% lower than market

Medical nutrition therapy, assessment and intervention, each 15 minutes

$122
$148

17% lower than market

Moderate sedation services - each additional 15 minutes intraservice time

$269
$477

43% lower than market

Moderate sedation services - initial 15 minutes, patient age 5 or older

$269
$571

53% lower than market

Multiple measurements and graphic recordings of the amount and speed of breathed air, before and fol

$1,585
$1,761

10% lower than market

Negative pressure wound therapy, surface area greater than 50 square centimeters, per session

$597
$1,010

41% lower than market

Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per sessi

$405
$423

4% lower than market

Neurobehavioral status examination, interpretation, and report by psychologist or physician per hour

$692
$1,020

32% lower than market

Noninvasive vascular diagnostic study

$588
$588

Approximately equal to market

Physical performance test or measurement with report, each 15 minutes

$157
$246

36% lower than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session

$306
$345

11% lower than market

Pulmonary stress testing, including measurement of heart rate, oximetry and oxygen titration

$371
$1,504

75% lower than market

Remote evaluations of implantable heart recorder system including transmissions, technician review,

$52
$199

74% lower than market

Repositioning maneuvers for treatment of vertigo, per day

$173
$283

39% lower than market

Respiratory inhaled aerosol treatment to relieve airway obstruction, first hour

$670
$672

Approximately equal to market

Testing of lung function at high altitude with supplemental oxygen delivery

$624
$556

12% higher than market

Therapeutic hot and cold baths to 1 or more areas, each 15 minutes

$122
$113

8% higher than market

Therapeutic procedures in a group setting

$101
$251

60% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$668
$605

10% higher than market

Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk each 15 minu

$150
$201

25% lower than market

Training in use of prosthesis for arms and/or legs each 15 minutes

$160
$240

34% lower than market

Ventilation assist and management; hospital inpatient/observation, initial day

$7,440
$8,847

16% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Addition to lower extremity, pelvic control, hip joint, adjustable flexion, extension, abduction control, each

$2,556
$2,556

Approximately equal to market

Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)

$2,169
$4,779

55% lower than market

Ankle foot orthosis, plastic or other material, prefabricated, includes fitting and adjustment

$364
$307

18% higher than market

Apligraf, per square centimeter

$210
$183

15% higher than market

Application of low cost skin substitute graft to face, scalp, eyelids, mouth, neck, ears, orbits, genitalia, hands, feet, and/or multiple digits, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface

$1,914
$1,914

Approximately equal to market

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; each additional 25 sq cm wound surface area, or part thereof (list separately in addition to code for primary proce

$1,914
$1,914

Approximately equal to market

Application of low cost skin substitute graft to trunk, arms, legs, total wound surface area up to 100 sq cm; first 25 sq cm or less wound surface area

$1,914
$1,914

Approximately equal to market

Paracentesis of anterior chamber of eye (separate procedure); with removal of aqueous

$3,763
$10,047

63% lower than market

Brachytherapy source, non-stranded, high dose rate iridium-192, per source

$1,850
$1,893

2% lower than market

Catheter, drainage

$364
$546

33% lower than market

Catheter, extravascular tissue ablation, any modality (insertable)

$18,644
$14,942

25% higher than market

Catheter, guiding (may include infusion/perfusion capability)

$364
$344

6% higher than market

Catheter, hemodialysis/peritoneal, long-term

$2,568
$2,710

5% lower than market

Catheter, infusion, inserted peripherally, centrally or midline (other than hemodialysis)

$477
$1,294

63% lower than market

Catheter, transluminal angioplasty, laser

$9,245
$8,428

10% higher than market

Cervical, collar, semi-rigid, thermoplastic foam, two piece with thoracic extension, prefabricated, off-the-shelf

$894
$1,090

18% lower than market

Changing & maintaining body position functional limitation, current status, at therapy episode outset and at reporting intervals

$1
$1

Approximately equal to market

Changing & maintaining body position functional limitation, projected goal status, at therapy episode outset, at reporting intervals, and at discharge or to end reporting

$1
$1

Approximately equal to market

Closure device, vascular (implantable/insertable)

$1,753
$2,558

31% lower than market

Computed tomography (CT) of brain blood flow, volume, and timing of flow analysis with contrast

$8,505
$7,439

14% higher than market

Connective tissue, human (includes fascia lata)

$2,556
$8,787

71% lower than market

Connective tissue, non-human (includes synthetic)

$2,112
$3,263

35% lower than market

Crushing of stone in urinary duct (ureter) with stent using an endoscope

$23,004
$25,823

11% lower than market

Dermagraft, per square centimeter

$247
$247

Approximately equal to market

Destruction and/or removal of (0.5 to 2.0 centimeters) small growths of the bladder using an endosco

$24,376
$20,528

19% higher than market

Destruction and/or removal of (2.0 to 5.0 centimeters) medium growths of the bladder and bladder can

$26,026
$30,410

14% lower than market

Destruction and/or removal of large growths of the bladder using an endoscope

$30,536
$33,483

9% lower than market

Diabetes outpatient self-management training services, group session (2 or more), per 30 minutes

$102
$107

5% lower than market

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

$35
$144

76% lower than market

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

$440
$512

14% lower than market

Elbow orthosis, double upright with forearm/arm cuffs, extension/ flexion assist, custom fabricated

$1,146
$1,146

Approximately equal to market

Electric Stimulation for Therapy

$119
$129

8% lower than market

Embolization protective system

$12,016
$11,730

2% higher than market

Epifix or epicord, per square centimeter

$1,776
$1,653

7% higher than market

External EKG recording for more than 48 hours up to 21 days

$476
$832

43% lower than market

Gastrostomy/jejunostomy tube, standard, any material, any type, each

$2,112
$1,911

11% higher than market

Graft, vascular

$11,289
$9,248

22% higher than market

High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml

$9
$12

23% lower than market

Hip orthosis, abduction control of hip joint, postoperative hip abduction type, prefabricated, includes fitting and adjustment

$6,308
$6,308

Approximately equal to market

Hospital Observation per Hour

$480
$424

13% higher than market

Hospital Outpatient Clinic Visit for Assessment and Management of a Patient

$392
$363

8% higher than market

Infusion pump, non-programmable, temporary (implantable)

$171,516
$171,516

Approximately equal to market

Injection of anesthetic agent, other peripheral nerve or branch

$1,502
$2,410

38% lower than market

Injection, Edaravone

$244
$244

Approximately equal to market

Injection, gadobutrol, 0.1 ml

$6
$7

4% lower than market

Injection, interferon beta-1a, 1 mcg for intramuscular use

$849
$849

Approximately equal to market

Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, other than peel-away

$967
$1,662

42% lower than market

Introducer/sheath, guiding, intracardiac electrophysiological, fixed-curve, peel-away

$605
$483

25% higher than market

Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries

$705
$1,399

50% lower than market

Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie

$147
$245

40% lower than market

Joint device (implantable)

$12,417
$12,006

3% higher than market

Knee orthosis, immobilizer, canvas longitudinal, prefabricated, off-the-shelf

$364
$1,004

64% lower than market

Lead, cardioverter-defibrillator, other than endocardial single or dual coil (implantable)

$3,181
$4,007

21% lower than market

Lead, pacemaker, transvenous vdd single pass

$3,181
$3,253

2% lower than market

Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml

$9
$26

66% lower than market

Magnetic resonance angiography without contrast followed by with contrast, abdomen

$2,294
$9,621

76% lower than market

Magnetic resonance angiography without contrast followed by with contrast, lower extremity

$2,569
$2,945

13% lower than market

Material for vocal cord medialization, synthetic (implantable)

$3,388
$3,624

7% lower than market

Mesh (implantable)

$3,181
$3,493

9% lower than market

Oasis ultra tri-layer wound matrix, per square centimeter

$73
$73

Approximately equal to market

Oasis wound matrix, per square centimeter

$102
$102

Approximately equal to market

Pacemaker, single chamber, rate-responsive (implantable)

$32,007
$26,632

20% higher than market

Placement of interstitial device(s) for radiation therapy/surgery guidance (e.g., fiducial markers, dosimeter), for other than the following sites (any approach): abdomen, pelvis, prostate, retroperitoneum, thorax, single or

$4,539
$3,683

23% higher than market

Placement of occlusive device into either a venous or arterial access site, post surgical or interventional procedure (e.g., angioseal plug, vascular plug)

$1,448
$3,767

62% lower than market

Port, indwelling (implantable)

$3,594
$2,864

25% higher than market

Prosthesis, penile, inflatable

$42,927
$46,742

8% lower than market

Removal of kidney drainage tube (ureter) using fluoroscopic guidance

$5,059
$4,751

6% higher than market

Removal of lens material and capsule for dislocated lens

$1
$1

Approximately equal to market

Removal of recurring cataract in lens capsule using laser

$3,055
$2,741

11% higher than market

Repair of detached retina and drainage of eye fluid between lens and retina, with vitrectomy

$30,984
$34,718

11% lower than market

Repair of hernia at navel patient age 5 years or older

$16,343
$18,105

10% lower than market

Repair of incisional or abdominal hernia, initial

$20,142
$22,713

11% lower than market

Repair recurrent inguinal hernia, any age; reducible

$19,043
$19,881

4% lower than market

Repositioning of recurrent groin hernia using an endoscope

$61,998
$61,001

2% higher than market

Retinal tamponade device, silicone oil

$3,181
$3,250

2% lower than market

Retrieval device, insertable (used to retrieve fractured medical devices)

$364
$764

52% lower than market

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

$433
$397

9% higher than market

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

$436
$419

4% higher than market

Tlso, flexible, provides trunk support, thoracic region, rigid posterior panel and soft anterior apron, prefabricated item that has been trimmed

$5,328
$5,328

Approximately equal to market

Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test usin

$4,324
$4,463

3% lower than market

Trauma response team associated with hospital critical care service

$26,233
$21,441

22% higher than market

Upper limb orthosis, not otherwise specified

$364
$1,339

73% lower than market

Walking boot, non-pneumatic, with or without joints, with or without interface material, prefabricated item that has been trimmed, bent, molded, assembled, or otherwise customized to fit a specific patient by an individual wi

$695
$695

Approximately equal to market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Chemotherapy Infustion - Up to 1 Hour

$1,490
$1,605

7% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$544
$484

12% higher than market

Aprepitant, oral, 5 mg

$217
$299

27% lower than market

Atezolizumab - 1200 mg

$7
$21

66% lower than market

Infusion, normal saline solution, 250 cc

$14
$69

80% lower than market

Injection, Cefazolin Sodium, 500 mg

$36
$41

12% lower than market

Injection, Ceftriaxone Sodium, per 250 mg

$58
$107

46% lower than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$9
$11

16% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$22
$70

68% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$15
$56

74% lower than market

Injection, Furosemide, up to 20 mg

$39
$55

29% lower than market

Injection, Heparin Sodium, per 1000 Units

$17
$15

16% higher than market

Injection, Hydralazine hcl, Up to 20 mg

$97
$237

59% lower than market

Injection, Hydromorphone, Up to 4 mg

$45
$75

40% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$15
$64

77% lower than market

Injection, Levofloxacin, 250 mg

$32
$98

67% lower than market

Injection, Magnesium Sulfate, per 500 mg

$47
$43

9% higher than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$67
$177

62% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$18
$78

77% lower than market

Injection, Morphine Sulfate, up to 10 mg

$30
$92

68% lower than market

Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)

$16
$17

2% lower than market

Injection, ampicillin sodium, 500 mg

$57
$66

14% lower than market

Injection, atropine sulfate, 0.01 mg

$1
$2

10% lower than market

Injection, benztropine mesylate, per 1 mg

$397
$1,580

75% lower than market

Injection, calcium gluconate, per 10 ml

$88
$128

32% lower than market

Injection, cefepime hydrochloride, 500 mg

$137
$163

16% lower than market

Injection, ceftazidime, per 500 mg

$43
$50

13% lower than market

Injection, chlorpromazine hcl, up to 50 mg

$89
$199

55% lower than market

Injection, daratumumab, 10 mg

$336
$476

30% lower than market

Injection, deferoxamine mesylate, 500 mg

$151
$189

20% lower than market

Injection, dicyclomine hcl, up to 20 mg

$785
$856

8% lower than market

Injection, digoxin, up to 0.5 mg

$101
$132

24% lower than market

Injection, dobutamine hydrochloride, per 250 mg

$149
$181

18% lower than market

Injection, docetaxel, 1 mg

$61
$61

Approximately equal to market

Injection, dopamine hcl, 40 mg

$18
$22

17% lower than market

Injection, garamycin, gentamicin, up to 80 mg

$39
$100

61% lower than market

Injection, haloperidol, up to 5 mg

$37
$76

52% lower than market

Injection, hyaluronidase, recombinant, 1 usp unit

$6
$6

8% higher than market

Injection, immune globulin (hizentra), 100 mg

$125
$119

5% higher than market

Injection, immune globulin, (gammagard liquid), non-lyophilized, (e.g., liquid), 500 mg

$451
$430

5% higher than market

Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg

$374
$403

7% lower than market

Injection, iron sucrose, 1 mg

$8
$18

55% lower than market

Injection, levetiracetam, 10 mg

$9
$10

9% lower than market

Injection, meperidine hydrochloride, per 100 mg

$51
$50

2% higher than market

Injection, meropenem, 100 mg

$19
$51

62% lower than market

Injection, methylprednisolone sodium succinate, up to 40 mg

$86
$114

24% lower than market

Injection, naloxone hydrochloride, per 1 mg

$126
$188

33% lower than market

Injection, neostigmine methylsulfate, up to 0.5 mg

$25
$37

31% lower than market

Injection, oxytocin, up to 10 units

$13
$13

Approximately equal to market

Injection, paclitaxel, 1 mg

$4
$9

52% lower than market

Injection, pamidronate disodium, per 30 mg

$224
$214

5% higher than market

Injection, phytonadione (vitamin k), per 1 mg

$71
$67

6% higher than market

Injection, procainamide hcl, up to 1 gm

$152
$227

33% lower than market

Injection, propofol, 10 mg

$5
$6

18% lower than market

Injection, sargramostim (gm-csf), 50 mcg

$659
$659

Approximately equal to market

Injection, sincalide, 5 micrograms

$623
$733

15% lower than market

Injection, succinylcholine chloride, up to 20 mg

$26
$23

13% higher than market

Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

$1,148
$1,593

28% lower than market

Injection, thiamine hcl, 100 mg

$84
$93

10% lower than market

Injection, tobramycin sulfate, up to 80 mg

$24
$23

5% higher than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$37
$47

23% lower than market

Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg

$41
$45

8% lower than market

Injection, zoledronic acid, 1 mg

$729
$633

15% higher than market

Methotrexate sodium, 5 mg

$6
$15

60% lower than market

Methylprednisolone oral, per 4 mg

$19
$18

8% higher than market

Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams

$1,908
$1,908

Approximately equal to market

OUTPATIENT PROSTHETIC PROCEDURES CHARGES

Description

Our Charge
Market Charge

Variance

Nasal prosthesis, provided by a non-physician

$1,529
$1,529

Approximately equal to market

Ocular implant

$894
$1,331

33% lower than market

Prosthetic implant, not otherwise specified

$1,890
$3,242

42% lower than 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

Arterial Puncture

$253
$375

32% lower than market

CO Diffusion Capacity

$1,077
$903

19% higher than market

Nebulizer Treatment

$382
$523

27% lower than market

Thoracic Gas Volume

$983
$787

25% higher than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Female external urinary collection device; meatal cup, each

$184
$184

Approximately equal to market

Foam dressing, wound cover, sterile, pad size more than 48 sq. in., with any size adhesive border, each dressing

$364
$364

Approximately equal to market

Gradient compression stocking/sleeve, not otherwise specified

$184
$184

Approximately equal to market

Indwelling catheter; foley type, two-way latex with coating (teflon, silicone, silicone elastomer, or hydrophilic, etc.), each

$184
$184

Approximately equal to market

Insertion tray with drainage bag with indwelling catheter, foley type, two-way, all silicone

$364
$364

Approximately equal to market

Perianal fecal collection pouch with adhesive, each

$1,640
$1,640

Approximately equal to market

Tracheostomy/laryngectomy tube, cuffed, polyvinylchloride (pvc), silicone or equal, each

$692
$692

Approximately equal to market

Urinary drainage bag, leg or abdomen, vinyl, with or without tube, with straps, each

$364
$364

Approximately equal to market

Wound care set, for negative pressure wound therapy electrical pump, includes all supplies and accessories

$5,926
$6,159

4% lower than market

Wound pouch, each

$695
$695

Approximately equal to market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Repair of groin hernia patient age 5 years or older

$18,143
$25,502

29% lower than market

Application of Short Arm Splint

$842
$819

3% higher than market

Application of Short Leg Splint (Calf to Foot)

$970
$840

16% higher than market

Application of chemical agent to excessive wound tissue

$381
$417

9% lower than market

Application of long arm splint (shoulder to hand)

$914
$836

9% higher than market

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

$970
$1,103

12% lower than market

Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck; first 25 sq cm

$1,914
$2,687

29% lower than market

Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck; each additional 25 sq cm

$1,914
$1,914

Approximately equal to market

Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq

$1,914
$2,665

28% lower than market

Application of vein wound compression system lower leg below knee including ankle and foot

$485
$403

20% higher than market

Aspiration of breast cyst

$691
$962

28% lower than market

Aspiration and/or injection: large joint/bursa

$873
$1,018

14% lower than market

Esophagogastroduodenoscopy, flexible, transoral; with transendoscopic balloon dilation of esophagus (less than 30 mm diameter)

$7,507
$6,621

13% higher than market

Biopsy of Large Bowel, Using an Endoscope

$5,063
$4,734

7% higher than market

Biopsy of abdomen using an endoscope

$30,040
$26,277

14% higher than market

Biopsy, breast, with placement of breast localization device(s); first lesion, including stereotactic guidance

$6,967
$5,900

18% higher than market

Biopsy, breast, with placement of breast localization device(s); each additional lesion, including stereotactic guidance

$6,967
$5,661

23% higher than market

Biopsy of rectum and large bowel using an endoscope

$3,612
$3,612

Approximately equal to market

Change of breathing tube of windpipe in neck

$2,934
$10,075

71% lower than market

Closed treatment of broke forearm bone at elbow

$770
$770

Approximately equal to market

Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation

$1,858
$2,539

27% lower than market

Closed treatment of broken toe

$1,096
$1,096

Approximately equal to market

Closed treatment of shoulder dislocation and broken of upper arm bone with manipulation

$317
$698

55% lower than market

Closed treatment of upper arm fracture; proximal humeral fracture

$673
$885

24% lower than market

Collection of blood specimen from a completely implantable venous access device

$612
$552

11% higher than market

Collection of blood specimen from central or peripheral venous catheter

$612
$745

18% lower than market

Colonoscopy, flexible; with ablation of tumor(s), polyp(s) or other lesion(s)

$1,899
$3,984

52% lower than market

Control Nose Bleed - Simple Case

$1,051
$920

14% higher than market

Control of esophageal bleeding using an endoscope

$8,145
$8,145

Approximately equal to market

Conversion of stomach tube to small bowel tube using fluoroscopic guidance with contrast, accessed t

$5,366
$5,366

Approximately equal to market

Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with first metatarsal and medial cuneiform joint arthrodesis, any method

$29,437
$26,126

13% higher than market

Declotting infusion of implanted central venous access device or catheter

$2,688
$2,240

20% higher than market

Diagnostic examination of lung airways using an endoscope

$6,818
$5,798

18% higher than market

Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope

$2,589
$2,143

21% higher than market

Drainage of abscess or blood accumulation in nose

$472
$472

Approximately equal to market

Drainage of cyst of the esophagus, stomach, and/or upper small bowel using an endoscope

$15,012
$14,237

5% higher than market

Drainage of multiple abscess

$1,407
$1,362

3% higher than market

Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endosc

$29,877
$29,405

2% higher than market

Fine needle aspiration using imaging guidance

$820
$1,487

45% lower than market

Gallbladder Removal Using an Endoscope

$28,742
$40,052

28% lower than market

Implantation patient-activated heart monitoring device

$6,228
$13,227

53% lower than market

Injection of bladder and urinary duct (ureter) for X-ray imaging

$1,373
$1,275

8% higher than market

Injection of dye for X-ray imaging and/or CT of lower spinal canal

$2,832
$2,272

25% higher than market

Injection of dye for X-ray imaging of hip joint

$1,493
$3,150

53% lower than market

Injection of dye for X-ray imaging of shoulder joint

$1,710
$1,924

11% lower than market

Injection procedure to induce erection

$249
$481

48% lower than market

Injection(s) of diagnostic or therapeutic substance(s)

$2,757
$4,220

35% lower than market

Insertion of Breathing Tube Using an Endoscope

$1,113
$1,186

6% lower than market

Insertion of Central Venous Catheter

$9,936
$12,673

22% lower than market

Insertion of Needle into Vein to Collect Blood

$40
$93

57% lower than market

Insertion of catheter for suction of secretions

$331
$340

3% lower than market

Selective catheter placement, venous system; first order branch

$6,777
$6,173

10% higher than market

Insertion of tunneled centrally inserted central venous catheter, without subcutaneous port or pump; age 5 years or older

$9,032
$9,229

2% lower than market

Insertion of lower heart chamber blood flow assist device through the skin including radiological su

$20,127
$20,127

Approximately equal to market

Insertion of radiation therapy devices in vagina for radiation therapy

$2,106
$2,041

3% higher than market

Insertion of stents into windpipe using an endoscope

$1
$1

Approximately equal to market

Insertion or replacement of brain neurostimulator generator or receiver, 2 or more electrode arrays

$19,154
$21,572

11% lower than market

Intravascular ultrasound (noncoronary vessel) during diagnostic evaluation and/or therapeutic intervention, including radiological supervision and interpretation; initial noncoronary vessel (List separately in addition to cod

$7,955
$12,397

36% lower than market

Intro of needle(s) and/or catheter(s), dialysis circuit

$7,763
$18,037

57% lower than market

Introduction of needle(s) and/or catheter(s), dialyis circuit, with diagnostic angiography

$3,043
$3,082

1% lower than market

Irrigation and suction of lung airways to obtain cells using an endoscope

$5,114
$7,478

32% lower than market

Vitrectomy, mechanical, pars plana approach; with focal endolaser photocoagulation

$28,978
$30,881

6% lower than market

Vitrectomy, mechanical, pars plana approach; with endolaser panretinal photocoagulation

$29,450
$25,484

16% higher than market

Mechanical separation of plasma from opening blood

$7,934
$10,885

27% lower than market

Needle biopsy of abdominal cavity growth, accessed through the skin

$2,664
$2,520

6% higher than market

Needle biopsy of kidney, accessed through the skin

$1,041
$2,773

62% lower than market

Needle biopsy of liver, accessed through the skin

$3,292
$3,643

10% lower than market

Needle biopsy of muscle, accessed through the skin

$3,292
$4,118

20% lower than market

Needle biopsy of thyroid, accessed through the skin

$1,463
$1,610

9% lower than market

Needle or trocar bone marrow biopsy

$2,441
$1,985

23% higher than market

Open treatment of bimalleolar ankle fracture

$32,737
$27,461

19% higher than market

Open treatment of trimalleolar ankle fracture

$31,558
$26,100

21% higher than market

Open treatment of ulnar fracture, proximal end

$31,793
$32,183

1% lower than market

Open treatment of broken forearm bone at elbow with prosthetic replacement

$38,873
$38,873

Approximately equal to market

Open treatment of calcaneal fracture, includes internal fixation, when performed;

$33,992
$33,992

Approximately equal to market

Open treatment of tibial fracture, proximal (plateau); bicondylar, with or without internal fixation

$34,464
$34,464

Approximately equal to market

Open treatment of broken upper arm bone; includes internal fixation

$37,710
$30,213

25% higher than market

Cystectomy, partial; simple

$62,123
$62,123

Approximately equal to market

Percutaneous transluminal mechanical thrombectomy

$21,460
$20,224

6% higher than market

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inc

$31,396
$28,171

11% higher than market

Percutaneous vertebral augmentation, including cavity creation (fracture reduction and bone biopsy included when performed) using mechanical device (eg, kyphoplasty), 1 vertebral body, unilateral or bilateral cannulation, inc

$31,278
$27,996

12% higher than market

Percutaneous vertebroplasty (bone biopsy included when performed), 1 vertebral body, unilateral or bilateral injection, inclusive of all imaging guidance; lumbosacral

$16,957
$14,496

17% higher than market

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; first lesion, including mammographic guidance

$3,296
$3,215

3% higher than market

Placement of breast localization device(s) (eg, clip, metallic pellet, wire/needle, radioactive seeds), percutaneous; each additional lesion, including mammographic guidance

$3,296
$2,675

23% higher than market

Placement of nephrostomy catheter, percutaneous, including diagnostic nephrostogram and/or ureterogram when performed, imaging guidance (eg, ultrasound and/or fluoroscopy) and all associated radiological supervision and inter

$8,760
$8,336

5% higher than market

Preparation of graft site at trunk, arms, or legs (first 100 sq cm or 1% body area infants and child

$24,465
$22,018

11% higher than market

Puncture aspiration of breast cyst

$380
$380

Approximately equal to market

Rectal procedure

$4,732
$5,871

19% lower than market

Arteriovenous anastomosis, open; by upper arm basilic vein transposition

$33,849
$32,470

4% higher than market

Arteriovenous anastomosis, open; direct, any site (eg, Cimino type) (separate procedure)

$23,179
$28,306

18% lower than market

Removal and replacement of inflatable urethral/bladder neck sphincter including pump, reservoir, and cuff at the same operative session

$44,177
$38,242

16% higher than market

Removal of Polyps in Large Bowel, Using an Endoscope

$2,531
$4,957

49% lower than market

Removal of blood clot from dialysis graft, open procedure

$26,589
$26,799

1% lower than market

Removal of breast and underarm lymph nodes

$30,593
$129,284

76% lower than market

Removal of deep bone implant

$31,396
$28,289

11% higher than market

Removal of external bone fixation under anesthesia

$20,584
$28,504

28% lower than market

Removal of fluid accumulation in one testicle and sperm reservoir

$14,743
$17,714

17% lower than market

Removal of fluid from chest cavity

$1,815
$1,997

9% lower than market

Removal of foreign body from ear canal

$560
$446

25% higher than market

Removal of foreign body from inside the eye or lens

$28,151
$38,931

28% lower than market

Removal of foreign body in large bowel using an endoscope

$3,591
$3,591

Approximately equal to market

Removal of foreign material from skin, tissue, muscle, and bone at open fracture and/or dislocation

$1,174
$1,174

Approximately equal to market

Removal of growth of tongue and/or vocal cord stripping using an endoscope

$1
$1

Approximately equal to market

Removal of infected skin, tissue or muscle of abdomen

$18,342
$18,342

Approximately equal to market

Removal of peripheral venous catheter for infusion

$6,104
$6,559

7% lower than market

Removal of pressure sore and lower pelvic bone in preparation of muscle flap or skin graft closure

$7,445
$7,445

Approximately equal to market

Removal of scar tissue of ovaries or uterine tubes using an endoscope

$40,069
$40,069

Approximately equal to market

Removal of skin and/or muscle first 20 sq cm or less

$2,550
$2,453

4% higher than market

Removal of skin of finger or toe nail

$958
$800

20% higher than market

Removal of uterus, cervix, and lymph nodes on both sides of pelvis and aortic lymph node biopsy usin

$77,248
$77,248

Approximately equal to market

Removal or bivalving of gauntlet, boot, or body cast

$933
$933

Approximately equal to market

Removal or exploration of parathyroid glands

$34,554
$30,653

13% higher than market

Repair of Wound (2.6 to 7.5 centimeters)

$1,068
$918

16% higher than market

Repair of Wound (7.6 to 12.5 cm)

$1,068
$1,073

Approximately equal to market

Repair of dialysis access in arm

$30,659
$30,659

Approximately equal to market

Reconstruction of dislocating patella; with extensor realignment and/or muscle advancement or release (eg, Campbell, Goldwaite type procedure)

$54,335
$54,335

Approximately equal to market

Repair of finger or toe nail bed

$1,152
$1,062

9% higher than market

Repair of herniated bladder into vaginal wall

$18,242
$38,745

53% lower than market

Repair of inflatable bladder canal (urethra) or bladder neck sphincter, including pump, reservoir, a

$27,457
$27,457

Approximately equal to market

Repair of collateral ligament, metacarpophalangeal or interphalangeal joint

$6,139
$6,139

Approximately equal to market

Repair of laceration; cornea and/or sclera, perforating, with reposition or resection of uveal tissue

$28,608
$28,608

Approximately equal to market

Repair of wound (1.1 to 2.5 centimeters) of forehead, cheeks, chin, mouth, neck, underarms, genitals

$1,863
$5,091

63% lower than market

Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/

$1,068
$1,132

6% lower than market

Repair of wound (12.6 to 20.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs

$1,213
$1,317

8% lower than market

Repair of wound (2.6 to 5.0 centimeters) of face, ears, eyelids, nose, lips, and/or mouth

$1,213
$1,107

10% higher than market

Repair of wound (20.1 to 30.0 centimeters) of the scalp, underarms, trunk, arms, and/or legs

$1,213
$1,213

Approximately equal to market

Repair of wound (5.1 to 7.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membr

$1,068
$1,103

3% lower than market

Repair of wound (7.6 to 12.5 centimeters) of face, ears, eyelids, nose, lips, and/or mouth

$1,213
$1,194

2% higher than market

Replacement of peripheral venous catheter, with subcutaneous port

$7,002
$7,002

Approximately equal to market

Replacement of stent pancreatic or bile duct using an endoscope

$8,986
$9,870

9% lower than market

Revision of dialysis graft with removal of blood cot, open procedure

$30,659
$28,259

8% higher than market

Revision of dialysis graft, open procedure

$26,589
$29,547

10% lower than market

Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)

$12,232
$26,152

53% lower than market

Spinal tap for diagnosis

$1,889
$1,938

3% lower than market

Tissue transfer repair of wound (10 sq centimeters or less) of the forehead, cheeks, chin, mouth, ne

$7,617
$18,107

58% lower than market

Total removal of thyroid lobe on one side of the neck

$31,144
$34,227

9% lower than market

Transluminal balloon angioplasty (except dialysis circuit), open or percutaneous, including all imaging and radiological supervision and interpretation necessary to perform the angioplasty within the same vein; initial vein

$23,207
$20,749

12% higher than market

Transluminal balloon angioplasty, central dialysis segment, performed through dialysis circuit, including all imaging and radiological supervision and interpretation required to perform the angioplasty (List separately in add

$3,043
$9,892

69% lower than market

Treatment of incomplete abortion

$15,243
$38,989

61% lower than market

Treatment of spontaneous hip dislocation under anesthesia

$2,312
$2,312

Approximately equal to market

Trimming of fingernails or toenails

$209
$452

54% lower than market

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

$1,068
$1,120

5% lower than market

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

$1,068
$1,058

1% higher than market

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

$1,068
$965

11% higher 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

Cardiac testing - doppler color flow, add on

$1,258
$1,457

14% lower than market

Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers

$960
$928

3% higher than market

Follow-up or limited ultrasound examination of heart

$3,051
$2,476

23% higher than market

Ultrasound Blood Flow Outside the Brain

$1,438
$2,495

42% lower than market

Ultrasound Heart

$7,289
$6,424

13% higher than market

Ultrasound Veins of Both Arms or Legs

$1,357
$2,765

51% lower than market

Ultrasound Veins of One Arm or Leg

$1,115
$1,698

34% lower than market

Ultrasound evaluation of heart blood vessel or graft; initial vessel

$10,601
$18,806

44% lower than market

Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow

$1,785
$2,443

27% lower than market

Ultrasound of Arteries of Both Legs

$1,300
$3,325

61% lower than market

Ultrasound of Arteries of One Leg

$1,064
$2,396

56% lower than market

Ultrasound of dialysis access

$685
$2,157

68% lower than market

Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow

$2,479
$3,137

21% lower than market

Ultrasound scanning of blood flow (outside of brain) on one side of head and neck or limited

$669
$2,086

68% lower than market

Ultrasound study of arteries and arterial grafts of one arm or limited

$972
$2,159

55% lower than market

Physical Therapy, ultrasound therapy

$139
$145

4% lower than market

3 Phase Bone Scan

$5,460
$4,727

16% higher than market

3D radiographic procedure

$1,653
$1,550

7% higher than market

3D radiographic procedure with computerized image postprocessing

$1,653
$1,953

15% lower than market

Bone Density Scan (DEXA Scan)

$790
$796

1% lower than market

Bone density measurement using dedicated X-ray machine

$321
$455

29% lower than market

Breast Ultrasound - Limited

$533
$653

18% lower than market

CT Abdomen & Pelvis with Contrast

$1,818
$7,570

76% lower than market

CT Abdomen & Pelvis without Contrast

$1,720
$4,617

63% lower than market

CT Angiogram Abdomen & Pelvis with and without Contrast

$4,862
$13,370

64% lower than market

CT Angiogram Abdomen with and without Contrast

$2,356
$9,762

76% lower than market

CT Angiogram Chest with and without Contrast

$2,432
$7,468

67% lower than market

CT Angiogram Head with and without Contrast

$2,305
$7,362

69% lower than market

CT Angiogram Neck with and without Contrast

$2,533
$7,688

67% lower than market

CT Chest with Contrast

$1,821
$5,293

66% lower than market

CT Chest without Contrast

$2,125
$3,554

40% lower than market

CT Cranial Cavity without Contrast

$1,626
$5,119

68% lower than market

CT Face without Contrast

$1,309
$3,336

61% lower than market

CT Head Brain without Contrast

$1,249
$3,341

63% lower than market

CT Leg without Contrast

$1,541
$4,091

62% lower than market