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 (Basic Metabolic Panel) $34.00 CMP (Comprehensive Metabolic Panel $46.00 TSH $73.00 T4 $31.00 T4 Free $40.00 T3 Total $64.00 T3 Free $75.00 Iron $29.00 Iron Binding (TIBC) $39.00 Ferritin $62.00 CBC $29.00 CBC w/ Diff $34.00 Hemoglobin A1C $43.00 Blood Typing $84.00 Semen Analysis $51.00 Urine Culture (Negative) $35.00 Urine Culture (Positive) $108.00 MMR Titer $115.00 Vitamin D $61.00 Vitamin B12 $66.00 Pap Smear $81.00-$97.00 Stool Culture $208.00 Strep (Throat Culture) $30.00 Rapid Strep $51.00 PSA Screening $81.00 Protime (INR) $18.00 PPD $22.00 ESR Sed Rate $10.00 HPV $132.00 Pregnancy Tests: Quantitative (Blood) $67.00 Qualitative $33.00 Urine $28.00
Diagnostic Imaging All diagnostic imaging services will receive a separate bill from URMC Radiology for Professional Reading of the image Mammo Digital Screening (Bilateral) $493 Mammo Digital Screening (Bilateral) with 3D Tomo $575 Mammo Digital Diagnostic (Bilateral) $563 Mammo Digital Diagnostic (Bilateral) with 3D Tomo $645 Mammo Digital (Unilateral) $461 Mammo Digital (Unilateral) with 3D Tomo $543 Dexascan $362 Chest Xray $264 Abdominal Xray $264 Hysterosalpinography (HSG) $914 Hysterosalpinography (Total Procedure) $1,517-$1562 Ultrasound, Breast Limited (Unilateral) $289 Ultrasound, Breast Limited (Bilateral) $337 Ultrasound, Breast Complete (Unilateral) $289 Ultrasound, Breast Complete (Bilateral) $337 Ultrasound, Pelvic Complete $499 Ultrasound, Pelvic Complete with Transvaginal $998 CT Scan, Head/Brain without Dye $935 CT Scan, Head/Brain with Dye $1368-$1385 CT Scan, Abdomen and Pelvis without Dye $1,424 CT Scan, Abdomen and Pelvis with Dye $2077 - $2094 MRI Scan, Any (Unilateral) without Contrast $1,934 MRI Scan, Any (Bilateral) without Contrast $2,514 MRI Scan, Any (Unilateral) with Contrast $2462 - $2558 MRI Scan, Any (Bilateral) with Contrast $3167 - $3275 MRI Scan, Any (Unilateral) with and without Contrast $3079 - $3163 MRI Scan, Any (Bilateral) with and without Contrast $3967 - $4070 Cardiology For charges not including Professional - Professional billed by Finger Lakes Cardiology EKG (includes Professional ) $206 Stress Test (does NOT include Professional ) $719 Stress Echo (does NOT include Professional ) $1787 - $2506 Cardiac Rehab $175 Sleep Clinic
Sleep Study - Normal (includes Professional ) $3,727 Sleep Study - CPAP (includes Professional ) $3,776 Home Sleep Test $1,423 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 $2004 - $3790 Colonoscopy (Screening) $1645 - $2300 Colonoscopy (Diagnostic) $1940 - $3700 Note: Colonoscopies can range from $1645 - $3700 or higher depending on what the procedure finds during the scope (ex: polyps and biopsy) EGD $1894 - $2654 Inguinal Hernia $5640 - $9879 Inguinal Hernia Laparoscopic $8350 - $13100 Carpal Tunnel $1759 - $2757 Gallbladder (Lap Chole) $5570 - $12943 PPV Vitrectomy (Eye Surgery) $7895 - $11900 Tonsils and Adenoids $3129 - $5733 Myringotomy (Ear Tubes) $1530 - $2120 Blepharoplasty (Eyelid Surgery) $4100 - $7425 Septoplasty $3950 - $5748 Knee Arthroscopy $3690 - $7200 ACL Repair $21776 - $26883 Image Guided FESS $9250 - $21500 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 $230.00 Inpatient - Initial Care - High $341.00 Inpatient - Subsequent Care - Low $66.00 Inpatient - Subsequent Care - Moderate $122.00 Inpatient - Subsequent Care - High $175.00 Inpatient - Admit/Discharge Same Day - Low $225.00 Inpatient - Admit/Discharge Same Day - Moderate $284.00 Inpatient - Admit/Discharge Same Day - High $366.00 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