Procedure Pricing

In order to enable you to have more information for educated health care decisions, Revere Health has provided the following cost information. It does not represent our billed charges which are set based on insurance contract models and rates, but reflect actual “off the street” rates. While insurance company contracts determine the actual rate of payment for services for their enrollees, which vary by plan and company, the rates below reflect what an individual without insurance would pay with our 30% prompt pay discount. Without treating you, it’s difficult to know which level of service may apply to an office visit. Also, the average patient experience results in some additional testing or services that could also be a part of your overall fees. We’re happy to discuss with you the specifics of your services to better enable you to decide the best option for services. In doing so, we’re confident you won’t find higher quality or more cost-effective service. Prices reflected are as they are today, and are updated periodically.

Auditory Surgery
Remove impacted ear wax
$84.00
Mammography
Comp screen mammogram add-on
$22.40
Computer dx mammogram add-on
$22.40
Cardiovascular Surgery
Capillary blood draw
$6.30
Draw blood off venous device
$39.90
Routine venipuncture
$7.00
Chemotherapy
Chemo hormon antineopl sq/im
$67.90
Chemo iv infus each addl seq
$140.00
Chemo iv infusion 1 hr
$282.80
Chemo iv infusion addl hr
$60.90
Chemo iv push addl drug
$122.50
Irrig drug delivery device
$49.00
Critical Care
Critical care first hour
$385.70
Diagnostic Ultrasound
Echo exam of abdomen
$208.60
Echo guide for biopsy
$383.60
Ob us < 14 wks single fetus
$255.50
Ob us detailed sngl fetus
$380.10
Ob us follow-up per fetus
$228.90
Transvaginal us non-ob
$244.30
Us exam abdo back wall comp
$261.10
Us exam abdom complete
$275.10
Us exam breast(s)
$187.60
Us exam of head and neck
$231.00
Us exam pelvic complete
$243.60
Us exam pelvic limited
$197.40
Digestive Surgery
Colonoscopy and biopsy
$1251.00
Diagnostic colonoscopy
$1048.00
EGD
$788.00
Lesion removal colonoscopy
$1411.00
EGD with Biopsy
$911.00
EGD with esophageal dilation
$2025.00
Facility fee is separate. Prices depend on the extent of the procedure necessary.
Female Genital Surgery
Insert intrauterine device
$112.00
Hospital Inpatient
Hospital discharge day
$123.90
Hospital discharge day
$83.30
Initial hospital care
$238.00
Initial hospital care
$161.70
Subsequent hospital care
$46.20
Subsequent hospital care
$121.10
Subsequent hospital care
$84.00
Hydration, Diagnostic Inject, Infusion and Chemoth
Ther/proph/diag inj iv push
$107.80
Ther/proph/diag inj sc/im
$44.80
Ther/proph/diag iv inf addon
$42.70
Ther/proph/diag iv inf init
$137.20
Tx/pro/dx inj new drug addon
$44.10
Tx/proph/dg addl seq iv inf
$64.40
Immunization Administration for Vaccines/Toxoids
Immunization admin
$16.80
Immunization admin each add
$11.20
Injections
Adenosine injection
$88.20
Betamethasone acet&sod phosp
$9.10
Bevacizumab injection
$65.10
Ceftriaxone sodium injection
$23.80
Daptomycin injection
$0.70
Darbepoetin alfa non-esrd
$9.10
Dexamethasone sodium phos
$6.30
Diphenhydramine hcl injectio
$2.80
Docetaxel injection
$30.10
Drugs unclassified injection
$1389.50
Filgrastim 480 mcg injection
$446.60
Fluorouracil injection
$4.20
Hyalgan/supartz inj per dose
$103.60
Infliximab injection
$99.40
Injection pegfilgrastim 6mg
$3082.80
Iron sucrose injection
$0.70
Levonorgestrel iu contracept
$861.70
LOCM 200-299mg/ml iodine1ml
$9.80
LOCM 300-399mg/ml iodine1ml
$0.70
Methylprednisolone 40 MG inj
$4.90
Palonosetron hcl
$33.60
Promethazine hcl injection
$2.80
Rituximab injection
$828.80
Testosterone cypionat 200 MG
$13.30
Trastuzumab injection
$102.90
Triamcinolone acet inj NOS
$1.40
Vitamin b12 injection
$8.40
Zoledronic acid
$237.30
Maternity Care and Delivery
Fetal non-stress test
$68.60
Obstetrical care
$2821.00
Musculoskeletal Surgery
Application of forearm cast
$123.20
Apply forearm splint
$95.90
Arthroscop rotator cuff repr
$1635.90
Drain/inject joint/bursa
$79.80
Drain/inject joint/bursa
$86.10
Drain/inject joint/bursa
$114.80
Inj tendon sheath/ligament
$85.40
Inj trigger point 1/2 muscl
$78.40
Knee arthroscopy/surgery
$1030.40
Knee arthroscopy/surgery
$924.00
Knee arthroscopy/surgery
$1498.00
Knee arthroscopy/surgery
$962.50
Removal of support implant
$891.10
Shoulder arthroscopy/surgery
$1001.00
Shoulder arthroscopy/surgery
$1005.90
Total knee arthroplasty
$2793.70
Neurology/Neuromuscular
H-reflex test
$99.40
Motor nerve conduction test
$124.60
Muscle test 2 limbs
$227.50
Muscle test nonparaspinal
$107.10
Polysomnography 4 or more
$1112.30
Polysomnography w/cpap
$1227.10
Sense nerve conduction test
$93.80
Nuclear Medicine
Ht muscle image spect mult
$925.40
Office/Outpatient
Office/outpatient visit est
$165.20
Office/outpatient visit est
$49.00
Office/outpatient visit est
$23.80
Office/outpatient visit est
$83.30
Office/outpatient visit est
$122.50
Office/outpatient visit new
$191.10
Office/outpatient visit new
$124.60
Office/outpatient visit new
$85.40
Office/outpatient visit new
$237.30
Office/outpatient visit new
$49.70
Organ or Disease Oriented Panels
Comprehen metabolic panel
$17.50
General health panel
$60.90
Hepatic function panel
$14.00
Lipid panel
$22.40
Metabolic panel total ca
$14.00
Renal function panel
$14.70
Physical Medicine and Rehabilitation
Aquatic therapy/exercises
$47.60
Manual therapy
$33.60
Physical therapy treatment
$11.90
Pt evaluation
$86.80
Therapeutic exercises
$36.40
Ultrasound therapy
$14.70
Whirlpool therapy
$25.20
Pulmonary
Measure blood oxygen level
$42.00
Radiologic Guidance
Fluoroguide for spine inject
$125.30
Needle localization by xray
$147.70
Surgical Pathology
Path consult intraop 1 bloc
$142.80
Tissue exam by pathologist
$121.10
Urinary Surgery
Cystoscopy
$316.40
Electro-uroflowmetry first
$148.40
Us urine capacity measure
$28.00
Bone/Joint Studies
DEXA bone density axial
$189.70
Cardiovascular
Ablate heart dysrhythm focus
$1548.40
Cardiovascular stress test
$25.20
Cardiovascular stress test
$147.00
Cardioversion electric ext
$420.70
Electrocardiogram complete
$32.90
Electrocardiogram report
$14.70
Electrophys map 3d add-on
$703.50
Icd device interrogate
$109.90
Insert intracoronary stent
$1667.40
Pm device eval in person
$63.70
Pm device progr eval dual
$100.10
Pm/icd remote tech serv
$51.80
Tte w/doppler complete
$369.60
Chemistry
Alanine amino (ALT) (SGPT)
$8.40
Assay bld/serum cholesterol
$7.00
Assay glucose blood quant
$6.30
Assay of amylase
$11.20
Assay of blood lipoprotein
$16.80
Assay of blood/uric acid
$7.70
Assay of calcium
$8.40
Assay of ck (cpk)
$11.20
Assay of creatinine
$8.40
Assay of ferritin
$23.10
Assay of free thyroxine
$14.70
Assay of insulin
$18.90
Assay of iron
$11.20
Assay of lipase
$11.20
Assay of lipoprotein
$14.00
Assay of magnesium
$11.20
Assay of parathormone
$69.30
Assay of prolactin
$32.20
Assay of protein urine
$6.30
Assay of psa total
$30.80
Assay of triglycerides
$9.80
Assay of urine creatinine
$7.00
Assay test for blood fecal
$20.30
Assay thyroid stim hormone
$28.00
Assay triiodothyronine (t3)
$8.40
Blood folic acid serum
$24.50
Carcinoembryonic antigen
$31.50
Chorionic gonadotropin test
$10.50
Free assay (FT-3)
$28.70
Glucose test
$7.70
Glucose tolerance test (GTT)
$14.70
Glycosylated hemoglobin test
$16.10
Glycosylated hemoglobin test
$16.10
Gonadotropin (FSH)
$30.80
Iron binding test
$14.70
Lactate (LD) (LDH) enzyme
$9.80
Microalbumin quantitative
$9.80
Natriuretic peptide
$56.70
Transferase (AST) (SGOT)
$8.40
Vitamin B-12
$25.20
Vitamin d 25 hydroxy
$49.70
$
Consultations
Inpatient consultation
$189.00
Office consultation
$102.90
Office consultation
$140.70
Office consultation
$207.90
Office consultation
$254.80
Diagnostic Radiology
Cardiac mri for morph w/dye
$1179.50
Chest x-ray
$60.90
Ct abdomen w/dye
$649.60
Ct abdomen w/o & w/dye
$857.50
Ct maxillofacial w/o dye
$511.00
Ct pelvis w/dye
$573.30
Ct thorax w/dye
$605.50
Mri angio chest w or w/o dye
$1078.00
Mri brain w/o & w/dye
$1409.10
Mri jnt of lwr extre w/o dye
$964.60
Mri joint upr extrem w/o dye
$947.10
Mri lumbar spine w/o & w/dye
$1387.40
Mri lumbar spine w/o dye
$907.90
Mri neck spine w/o dye
$907.20
X-ray exam knee 4 or more
$83.30
X-ray exam of abdomen
$49.00
X-ray exam of ankle
$64.40
X-ray exam of collar bone
$56.00
X-ray exam of elbow
$55.30
X-ray exam of finger(s)
$63.00
X-ray exam of foot
$62.30
X-ray exam of forearm
$54.60
X-ray exam of hand
$54.60
X-ray exam of hand
$63.00
X-ray exam of hip
$53.20
X-ray exam of hip
$76.30
X-ray exam of knee 1 or 2
$60.20
X-ray exam of knee 3
$72.10
X-ray exam of knees
$68.60
X-ray exam of lower leg
$54.60
X-ray exam of lower spine
$79.80
X-ray exam of neck spine
$77.00
X-ray exam of pelvis
$53.90
X-ray exam of shoulder
$60.90
X-ray exam of wrist
$61.60
X-ray exam of wrist
$71.40
Dialysis
Esrd srv 4 visits p mo 20+
$387.80
Hemodialysis one evaluation
$102.20
Orthotics
Afo ankle gauntlet
$65.10
Cast sup sht arm adult fbrgl
$48.30
LO sag stays/panels pre-fab
$61.60
Non-pneum walk boot prefab
$159.60
Obtaining screen pap smear
$46.90
Wrist cock-up non-molded
$62.30
Hematology and Coagulation Testing
Complete cbc automated
$9.80
Complete cbc w/auto diff wbc
$9.10
Hematocrit
$5.60
Hemoglobin
$4.20
Prothrombin time
$6.30
Rbc sed rate nonautomated
$6.30
Thromboplastin time partial
$9.80
Hospital Observation
Observation care discharge
$84.00
Imaging - Radiological Guidance
Gad-base MR contrast NOS 1ml
$7.70
Tc99m sestamibi
$124.60
TL201 thallium
$35.00
Immunology
C-reactive protein
$8.40
Microsomal antibody
$24.50
Rheumatoid factor quant
$9.80
TB intradermal test
$13.30
Integumentary Surgery
Biopsy skin lesion
$122.50
Destroy premlg lesions 15+
$232.40
Destruct b9 lesion 1-14
$129.50
Destruct premalg les 2-14
$11.90
Destruct premalg lesion
$95.90
Mohs 1 stage h/n/hf/g
$802.90
Mohs addl stage
$478.10
Shave skin lesion
$111.30
Skin tissue rearrangement
$1325.80
Skin tissue rearrangement
$1435.70
Microbiology
Strep a assay w/optic
$20.30
Nervous System Surgery
Carpal tunnel surgery
$737.80
Inj foramen epidural add-on
$248.50
Inj foramen epidural l/s
$513.80
Inject spine l/s (cd)
$347.20
Non-Invasive Vascular Diagnostic Study
Extremity study
$291.20
Nursing Facility
Nursing fac care subseq
$79.80
Nursing fac care subseq
$105.00
Ophthalmology
Eye exam & treatment
$195.30
Eye exam established pat
$134.40
Eye exam new patient
$235.20
Ophthalmic biometry
$135.80
Refraction
$78.40
Otorhinolaryngologic Service
Comprehensive hearing test
$65.10
Preventive Medicine
Per pm reeval est pat inf
$92.40
Prev visit est age 1-4
$102.90
Prev visit est age 18-39
$112.70
Prev visit est age 40-64
$123.20
Prev visit new age 18-39
$131.60
Radiation Oncology
Radiation physics consult
$144.20
Radiation treatment delivery
$451.50
Radiation treatment delivery
$509.60
Radiation tx delivery imrt
$1000.30
Radiation tx management x5
$361.20
Stereoscopic x-ray guidance
$213.50
Special Services/Reports
Med serv eve/wkend/holiday
$17.50
Specimen handling
$9.80
Urinalysis
Urinalysis auto w/o scope
$4.20
Urinalysis auto w/scope
$10.50
Urinalysis nonauto w/o scope
$4.20
Urinalysis volume measure
$4.90
Urine pregnancy test
$10.50
Vaccines, Toxoids
Dtap-hep b-ipv vaccine im
$91.70
Dtap-hep b-ipv vaccine im
$9.80
Hep a vacc ped/adol 2 dose
$60.90
Pneumococcal vacc 13 val im
$121.80
Pneumococcal vacc 7 val im
$95.90
Pneumococcal vaccine
$47.60
Rotovirus vacc 3 dose oral
$77.00
Tdap vaccine >7 im
$41.30

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