General
|
Price
|
|
|
Room and Board - Private |
$798.00 |
|
Nursery
-General
-Neonatal ICU |
$798.00
$798.00 |
|
Intensive Care
-General |
$798.00 |
|
Coronary Care
-General |
$798.00 |
|
Rehabilitation
-General |
$798.00 |
|
Incremental Nursing Charge
-Nursery Care
(Isolation & Step Down)
-Intensive Care
-Intermediate Care
-NICU Level III |
$260.00
$1,561.15
$1,068.00
$2,272.00 |
|
Emergency Room
-Level I
-Level II
-Level III
-Level IV
-Level V |
$120.00
$230.00
$420.00
$670.00
$990.00 |
|
Labor and Delivery
-General
-Circumcision |
$2,829.00
$300.00 |
|
Psychiatric/Psychological
Services
-General and Basic
Treatment Program |
$1,232.00 |
|
Cosmetic or Elective Surgery
|
General Anesthesia
|
IV Sedation
|
|
Abdominoplasty - 3 day stay |
$6,703.00 |
NA |
|
Abdominoplasty - mini |
$4,348.00 |
NA |
|
Abdominoplasty - up to 2 day stay |
$6,306.00 |
NA |
|
Panniculectomy |
$6,306.00 |
NA |
|
Augmentation w/Mastop |
$3,717.00 |
$2,422.00 |
|
Bilateral Breast Augmentation |
$2,809.00 |
$1,494.00 |
|
Bilateral Breast Reduction |
$13,009.00 |
NA |
|
Bilateral Cheek Lift (facial) |
NA |
$3,186.00 |
|
Bilateral Gynecomasatia reduction |
$8,482.00 |
NA |
|
Bilateral Mastopexy w/Augmentation |
$3,717.00 |
NA |
|
Blepharoplasty top and bottom |
NA |
$2,622.00 |
|
Blepharoplasty top or bottom |
NA |
$1,659.00 |
|
Chemical peel - full face |
NA |
$796.00 |
|
Chin Implant |
NA |
$1,062.00 |
|
Dermabrasion |
$2,523.00 |
$1,260.00 |
|
Exchange bilateral silicone implants w/Saline Implants |
$3,319.00 |
NA |
|
Face lift - outpatient (Rhytidectomy) |
NA |
$3,451.00 |
|
Face lift - 1 day stay |
$5,243.00 |
$3,950.00 |
|
Face lift - 2 day stay |
$5,708.00 |
$4,879.00 |
|
Liposuction 1 area |
$2,589.00 |
$1,249.00 |
|
Liposuction 2 areas |
$2,721.00 |
$1,494.00 |
|
Liposuction 3 areas |
$2,953.00 |
$1,726.00 |
|
Mastopexy (both sides) |
$3,717.00 |
$2,622.00 |
|
Otoplasty (surgical repair-ear) |
$3,817.00 |
$2,389.00 |
|
Rhinoplasty-Complex |
$3,219.00 |
$1,958.00 |
|
Rhinoplasty-Minimal |
$2,688.00 |
$1,461.00 |
|
Rhinoplasty-Standard |
$2,821.00 |
$1,494.00 |
|
Septoplasty |
$2,821.00 |
NA |
|
Septoplasty & Rhinoplasty |
$4,348.00 |
NA |
|
Submental Lipectomy |
$2,788.00 |
$1,494.00 |
|
Vasectomy Reversal |
$3,451.00 |
NA |
|
Bilateral Arm Lift (lipectomy) |
$5,906.00 |
NA |
|
Thigh Lift (same as Surgery Ctr) |
$4,546.00 |
NA |
|
Abdominal Scar Revision |
$5,708.00 |
NA |
|
Bilateral Thigh Lift |
$12,744.00 |
NA |
Outpatient Procedures
|
Average Charge
|
|
|
Esophagogastroduodenoscopy (EGD) w/ Closed Biopsy |
$4,433.00 |
|
|
Colonoscopy |
$1,952.00 |
|
|
Endoscopic Polypectomy of Large Intestine |
$3,239.00 |
|
|
Left Heart Cardiac Catheterization |
$9,922.00 |
|
|
Closed Biopsy of Large Intestine |
$3,740.00 |
|
|
Closed Biopsy of Breast |
$5,920.00 |
|
|
Polysomnogram |
$3,430.00 |
|
|
Endoscopy of Small Intestine |
$3,495.00 |
|
|
Atrial Cardioversion |
$2,082.00 |
|
|
Right/Left Heart Cardiac Catheterization |
$12,947.00 |
|
|
Laparoscopic Cholecystectomy |
$11,912.00 |
|
|
Carpal Tunnel Release |
$2,487.00 |
|
|
Excision of Semilunar Cartilage of Knee |
$5,381.00 |
|
|
Local Excision of Lesion of Breast |
$5,119.00 |
|
|
Diagnostic Ultrasound of Heart |
$3,293.00 |
|
|
Lithotripsy of Kidney/Ureter/Bladder |
$6,616.00 |
|
|
Phacoemulsification and Aspiration of Cataract |
$4,327.00 |
|
|
Mechanical Vitrectomy |
$6,219.00 |
|
|
Shoulder Arthroplasty |
$10,839.00 |
|
|
Thoracentesis |
$1,986.00 |
|
|
Tonsillectomy |
$3,537.00 |
|
|
Tonsillectomy/Adnoidectomy |
$3,256.00 |
|
Laboratory Tests
|
Average Charge
|
CPT Code
|
|
Alanine Amino Transferase |
$51.70 |
84460 |
|
Basic Metabolic Panel |
$98.70 |
80048 |
|
Complete Blood Count |
$82.50 |
85025 |
|
Comprehensive Metabolic Panel |
$110.00 |
80053 |
|
Urine Culture |
$82.50 |
87088 |
|
Ferritin |
$95.70 |
82728 |
|
Glycosylated Hemoglobin |
$90.30 |
83036 |
|
Hemoglobin |
$47.30 |
85018 |
|
Hemogram |
$70.40 |
85027 |
|
Hepatic Function Panel |
$94.70 |
80076 |
|
Iron and TIBC |
$114.50 |
83540, 83550 |
|
Lipid Panel |
$115.50 |
80061 |
|
Magnesium |
$55.10 |
83735 |
|
Occult Blood, Stool Guaiac |
$42.90 |
82272 |
|
Potassium |
$46.30 |
84132 |
|
Prothrombin |
$56.10 |
85610 |
|
PSA |
$125.40 |
84153 |
|
T4, Thyroxine, Free |
$103.50 |
84439 |
|
Thyroid Stimulating Hormone |
$146.30 |
84443 |
|
Routine Urinalysis |
$46.30 |
81003 |
Radiology Tests
|
Average Charge
|
CPT Code
|
X-RAY
Chest, 1 View |
$100.70 |
71010 |
|
Chest, PA & Lateral |
$136.10 |
71020 |
CT SCAN
Head CT Scan w/o Contrast |
$1,288.10 |
70450 |
|
Combo - Abdomen w/ Contrast |
$1,659.95 |
74160 |
|
Combo - Pelvis w/ Contrast |
$1,425.35 |
72193 |
|
Combo - Abdomen w/o Contrast |
$1,612.35 |
74150 |
|
Combo - Pelvis w/o Contrast |
$1,352.30 |
72192 |
|
Chest CT PE Protocol w/ Contrast |
$1,799.40 |
71260 |
|
C-Spine CT w/o Contrast |
$1,612.35 |
72125 |
|
|
|
|
MAMMOGRAPHY
Screening mammogram |
$302.68 |
G0202 |
|
- CAD for Screening Mammography |
$45.85 |
77052 |
|
Diagnostic mammogram |
$316.68 |
G0204 |
|
- CAD for Screening Mammography |
$45.85 |
77051 |
|
|
|
|
ULTRASOUND
Ultrasound, transvaginal |
$421.60 |
76830 |
|
Ultrasound, pelvic |
$369.60 |
76856 |
|
|
|
|
MRI
C-Spine MRI w/o Contrast |
$3,029.95 |
72141 |
|
C-Spine MRI w/Contrast |
$3,399.60 |
72142 |
|
C-Spine MRI w/o and w/Contrast |
$4,409.95 |
72156 |
|
T-Spine MRI w/o Contrast |
$3,290.05 |
72146 |
|
T-Spine MRI w/Contrast |
$3,603.20 |
72147 |
|
T-Spine MRI w/o and w/Contrast |
$4,645.65 |
72157 |
|
L-Spine MRI w/o Contrast |
$3,156.15 |
72148 |
|
L-Spine MRI w/Contrast |
$3,552.35 |
72149 |
|
L-Spine MRI w/o and w/Contrast |
$4,620.20 |
72158 |
|
Joint of Upper Extremity MRI w/o Contrast |
$2,655.95 |
73221 |
|
Joint of Upper Extremity MRI w/Contrast |
$3,070.95 |
73222 |
|
Joint of Upper Extremity MRI w/o and w/Contrast |
$3,952.90 |
73223 |
|
Joint of Lower Extremity MRI w/o Contrast |
$2,691.35 |
73721 |
|
Joint of Lower Extremity MRI w/Contrast |
$3,070.95 |
73722 |
|
Joint of Lower Extremity MRI w/o and w/Contrast |
$3,862.15 |
73723 |