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 $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) $100.00 MMR Titer $113.00 Vitamin D $49.00 Vitamin B12 $60.00 Pap Smear $89.00 Stool Culture $188.00 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
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 $1905 - $1922 MRI Scan, Any (Unilateral) without Contrast $1,877 MRI Scan, Any (Bilateral) without Contrast $2,441 MRI Scan, Any (Unilateral) with Contrast $2385 - $2444 MRI Scan, Any (Bilateral) with Contrast $3069 - $3128 MRI Scan, Any (Unilateral) with and without Contrast $2984 - $3043 MRI Scan, Any (Bilateral) with and without Contrast $3846 - $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 ) $1638 - $2297 Cardiac Rehab $142
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 $1845 - $2350 Colonoscopy (Screening) $1550 - $2200 Colonoscopy (Diagnostic) $1800 - $3700 Note: Colonoscopies can range from $1550 - $3700 or higher depending on what the procedure finds during the scope (ex: polyps and biopsy) EGD $1420 - $2200 Inguinal Hernia $4475 - $7185 Inguinal Hernia Laparoscopic $10100 - $17330 Carpal Tunnel $1550 - $2750 Gallbladder (Lap Chole) $5050 - $7450 PPV Vitrectomy (Eye Surgery) $8750 - $10600 Tonsils and Adenoids $2550 - $5486 Myringotomy (Ear Tubes) $1450 - $2028 Blepharoplasty (Eyelid Surgery) $4650 - $6500 Septoplasty $3780 - $5500 Knee Arthroscopy $3500 - $7200 ACL Repair $18105 - $22350 Image Guided FESS $9955 - $16315 F. F. Thompson Family/Specialty Practices - Office Visits Office Visit - New Patient - Level 1 $72.00 Office Visit - New Patient - Level 2 $124.00 Office Visit - New Patient - Level 3 $179.00 Office Visit - New Patient - Level 4 $274.00 Office Visit - New Patient - Level 5 $344.00
Office Visit - Established Patient - Level 1 $33.00 Office Visit - Established Patient - Level 2 $72.00 Office Visit - Established Patient - Level 3 $120.00 Office Visit - Established Patient - Level 4 $179.00 Office Visit - Established Patient - Level 5 $242.00 Preventive Visit - New Patient - Under 1 YR $184.00 Preventive Visit - New Patient - 1-4 YRS $193.00 Preventive Visit - New Patient - 5-11 YRS $200.00 Preventive Visit - New Patient - 12-17 YRS $227.00 Preventive Visit - New Patient - 18-39 YRS $220.00 Preventive Visit - New Patient - 40-64 YRS $255.00 Preventive Visit - New Patient - 65 YRS and Over $276.00 Preventive Visit - Established Patient - Under 1 YR $165.00 Preventive Visit - Established Patient - 1-4 YRS $177.00 Preventive Visit - Established Patient - 5-11 YRS $176.00 Preventive Visit - Established Patient - 12-17 YRS $193.00 Preventive Visit - Established Patient - 18-39 YRS $198.00 Preventive Visit - Established Patient - 40-64 YRS $212.00 Preventive Visit - Established Patient - 65 YRS and Over $228.00 Facility Office Outpatient Visit $129.00 Case Management - Rheumatology $35.00 Hospitalist - Hospital Visits Hospitalist Inpatient Care Visits Inpatient - Initial Care - Low $170.00 Inpatient - Initial Care - Moderate $228.00 Inpatient - Initial Care - High $312.00 Inpatient - Subsequent Care - Low $66.00 Inpatient - Subsequent Care - Moderate $122.00 Inpatient - Subsequent Care - High $175.00 Inpatient - Admit/Discharge Same Day - Low $208.00 Inpatient - Admit/Discharge Same Day - Moderate $273.00 Inpatient - Admit/Discharge Same Day - High $339.00 Inpatient - Discharge - Low $122.00 Inpatient - Discharge - Moderate $180.00
Hospitalist Observation Care Visits Observation - Initial Care - Low $168.00 Observation - Initial Care - Moderate $228.00 Observation - Initial Care - High $312.00 Observation - Subsequent Care - Low $66.00 Observation - Subsequent Care - Moderate $122.00 Observation - Subsequent Care - High $177.00 Observation - Admit/Discharge Same Day - Low $225.00 Observation - Admit/Discharge Same Day - Moderate $284.00 Observation - Admit/Discharge Same Day - High $366.00 Observation - Discharge $122.00