Contact the Price Line for Verification and Tests/Procedures Not Listed (585)

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1 F. F. Thompson Hospital Hospital s (Price Line Common Requested) Contact the Price Line for Verification and Tests/Procedures Not Listed (585) Lab Tests Venipuncture $8.00 Lipid Panel $55.00 BMP (Basic Metabolic Panel) $32.00 CMP (Comprehensive Metabolic Panel $42.00 TSH $67.00 T4 $29.00 T4 Free $36.00 T3 Total $58.00 T3 Free $69.00 Iron $27.00 Iron Binding (TIBC) $35.00 Ferritin $56.00 CBC $27.00 CBC w/ Diff $32.00 Hemoglobin A1C $39.00 Blood Typing $26.00 Semen Analysis $47.00 Urine Culture (Negative) $33.00 Urine Culture (Positive) $ MMR Titer $ Vitamin D $49.00 Vitamin B12 $60.00 Pap Smear $89.00 Stool Culture $ Strep (Throat Culture) $28.00 Rapid Strep $47.00 PSA Screening $75.00 Protime (INR) $16.00 PPD $20.00 ESR Sed Rate $10.00 Pregnancy Tests: Quantitative (Blood) $61.00 Qualitative $31.00 Urine $27.00

2 Diagnostic Imaging All diagnostic imaging services will receive a separate bill from URMC Radiology for Professional Reading of the image Mammo Digital Screening (Bilateral) with CAD $464 Mammo Digital Screening (Bilateral) with CAD and 3D Tomo $540 Mammo Digital Diagnostic (Bilateral) with CAD $528 Mammo Digital Diagnostic (Bilateral) with CAD and 3D Tomo $604 Mammo Digital (Unilateral) with CAD $435 Mammo Digital (Unilateral) with CAD and 3D Tomo $511 Dexascan $332 Chest Xray $253 Abdominal Xray $253 Hysterosalpinography (HSG) $837 Hysterosalpinography (Total Procedure) $1,453 Ultrasound, Breast Limited (Unilateral) $265 Ultrasound, Breast Limited (Bilateral) $309 Ultrasound, Breast Complete (Unilateral) $265 Ultrasound, Breast Complete (Bilateral) $309 Ultrasound, Pelvic Complete $457 Ultrasound, Pelvic Complete with Transvaginal $914 CT Scan, Head/Brain without Dye $857 CT Scan, Head/Brain with Dye $1255-$1273 CT Scan, Abdomen and Pelvis without Dye $1,305 CT Scan, Abdomen and Pelvis with Dye $ $1922 MRI Scan, Any (Unilateral) without Contrast $1,877 MRI Scan, Any (Bilateral) without Contrast $2,441 MRI Scan, Any (Unilateral) with Contrast $ $2444 MRI Scan, Any (Bilateral) with Contrast $ $3128 MRI Scan, Any (Unilateral) with and without Contrast $ $3043 MRI Scan, Any (Bilateral) with and without Contrast $ $3905 Cardiology For charges not including Professional - Professional billed by Finger Lakes Cardiology EKG (includes Professional ) $188 Stress Test (does NOT include Professional ) $659 Stress Echo (does NOT include Professional ) $ $2297 Cardiac Rehab $142

3 Sleep Clinic Sleep Study - Normal (includes Professional ) $3,416 Sleep Study - CPAP (includes Professional ) $3,461 Home Sleep Test $1,304 Sleep Consult - Level 3 $426 Sleep Consult - Level 4 $596 Sleep Follow-up Visit $271 Ambulatory Procedures All ambulatory procedures will receive a separate bill from the physician providing the service - contact your physician for pricing. Separate charges for anesthesia also may apply - contact the anesthesia group Cataract $ $2350 Colonoscopy (Screening) $ $2200 Colonoscopy (Diagnostic) $ $3700 Note: Colonoscopies can range from $ $3700 or higher depending on what the procedure finds during the scope (ex: polyps and biopsy) EGD $ $2200 Inguinal Hernia $ $7185 Inguinal Hernia Laparoscopic $ $17330 Carpal Tunnel $ $2750 Gallbladder (Lap Chole) $ $7450 PPV Vitrectomy (Eye Surgery) $ $10600 Tonsils and Adenoids $ $5486 Myringotomy (Ear Tubes) $ $2028 Blepharoplasty (Eyelid Surgery) $ $6500 Septoplasty $ $5500 Knee Arthroscopy $ $7200 ACL Repair $ $22350 Image Guided FESS $ $16315 F. F. Thompson Family/Specialty Practices - Office Visits Office Visit - New Patient - Level 1 $72.00 Office Visit - New Patient - Level 2 $ Office Visit - New Patient - Level 3 $ Office Visit - New Patient - Level 4 $ Office Visit - New Patient - Level 5 $344.00

4 Office Visit - Established Patient - Level 1 $33.00 Office Visit - Established Patient - Level 2 $72.00 Office Visit - Established Patient - Level 3 $ Office Visit - Established Patient - Level 4 $ Office Visit - Established Patient - Level 5 $ Preventive Visit - New Patient - Under 1 YR $ Preventive Visit - New Patient YRS $ Preventive Visit - New Patient YRS $ Preventive Visit - New Patient YRS $ Preventive Visit - New Patient YRS $ Preventive Visit - New Patient YRS $ Preventive Visit - New Patient - 65 YRS and Over $ Preventive Visit - Established Patient - Under 1 YR $ Preventive Visit - Established Patient YRS $ Preventive Visit - Established Patient YRS $ Preventive Visit - Established Patient YRS $ Preventive Visit - Established Patient YRS $ Preventive Visit - Established Patient YRS $ Preventive Visit - Established Patient - 65 YRS and Over $ Facility Office Outpatient Visit $ Case Management - Rheumatology $35.00 Hospitalist - Hospital Visits Hospitalist Inpatient Care Visits Inpatient - Initial Care - Low $ Inpatient - Initial Care - Moderate $ Inpatient - Initial Care - High $ Inpatient - Subsequent Care - Low $66.00 Inpatient - Subsequent Care - Moderate $ Inpatient - Subsequent Care - High $ Inpatient - Admit/Discharge Same Day - Low $ Inpatient - Admit/Discharge Same Day - Moderate $ Inpatient - Admit/Discharge Same Day - High $ Inpatient - Discharge - Low $ Inpatient - Discharge - Moderate $180.00

5 Hospitalist Observation Care Visits Observation - Initial Care - Low $ Observation - Initial Care - Moderate $ Observation - Initial Care - High $ Observation - Subsequent Care - Low $66.00 Observation - Subsequent Care - Moderate $ Observation - Subsequent Care - High $ Observation - Admit/Discharge Same Day - Low $ Observation - Admit/Discharge Same Day - Moderate $ Observation - Admit/Discharge Same Day - High $ Observation - Discharge $122.00

F. F. Thompson Hospital Hospital Charges (Price Line Common Requested)

F. F. Thompson Hospital Hospital Charges (Price Line Common Requested) F. F. Thompson Hospital Hospital s (Price Line Common Requested) Contact the Price Line for Verification and Tests/Procedures Not Listed (585)396-6194 Lab Tests Venipuncture $8.00 Lipid Panel $60.00 BMP

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