| Emergency Department |
|
| E D Acuity Level 1-2 |
$ 750 |
| E D Acuity Level 3-5 |
$ 500 |
| |
|
| Imaging Procedures |
|
| MRI with contrast, per body site |
$ 525 |
| MRI without contrast, per body site |
$ 525 |
| MRI with and without contrast, per body site |
$ 525 |
| CT Scan with contrast, per body site |
$ 400 |
| CT Scan without contrast, per body site |
$ 400 |
| CT Scan with and without contrast, per body site |
$ 400 |
| Ultrasound |
$ 195 |
| Breast Ultrasound |
$ 150 |
| X-ray |
$ 75 |
| Screening Mammogram |
$ 200 |
| Diagnostic |
$ 225 |
| Bone Density |
$ 75 |
| Pulmonary Function |
$ 75 |
| Echo |
$ 200 |
| Biopsies |
$ 900 |
| |
|
| Maternity Services (includes anesthesia) |
|
| Vaginal Delivery |
$ 2750 |
| C-Section |
$ 3000 |
| Vaginal Delivery and Sterilization or D&C |
$ 3500 |
| |
|
| Primary Care Services |
|
| Family Health Center Physician Office Visit |
$ 85 |
| |
|
| Outpatient Procedures & Studies |
|
| Heart Catheterization |
$ 6500 |
| EKG |
$ 25 |
| EEG |
$ 155 |
| |
|
| Laboratory Services |
|
| ABO/Rh (blood Type) |
$ 20 |
| CBC (Complete Blood Count) |
$ 15 |
| Basic Metabolic Panel |
$ 15 |
| Comprehensive Metabolic Panel |
$ 20 |
| Hemoglobin A1C |
$ 15 |
| Prothrombin Time Test |
$ 10 |
| Lipid Panel |
$ 20 |
| TSH (Thyroid) |
$ 25 |
| Urinalysis Complete |
$ 10 |
| Urine Culture |
$ 15 |
| Urine Pregnancy Test |
$ 10 |
| |
|
| Inpatient (includes anesthesia) |
|
| Major Joint Replacement |
$ 12000 |
| Gall Bladder |
$ 4400 |
|
|