2

Fees

Fees

 

Notice: The Charges contained within this charge list are subject to change. Your bill, including actual or total charges, will vary based upon many factors including your medical and physical condition, any unknown medical conditions you may have, your diagnosis and recommended treatment protocols, and other factors such as length of time associated with the performance of the health care service or procedure or the provision of the health care good.You may be personally liable for payment for the health care service, good or procedure, depending on your health benefit plan coverage. You should contact your health benefit plan, if you have coverage, for accurate information regarding the plan structure, benefit coverage, deductibles, copayments, coinsurance, and other plan provisions, such as network availability, that may impact your out of pocket responsibility for payment for health care services, goods, or procedures, including those contained in this charge list.

last updated 05/23/2016
Procedure/Description Our Charge
Outpatient/Office Visit New (No referral) Straight Forward $114.00
Outpatient/Office Visit New (No referral) Low Complexity $165.00
Outpatient/Office Visit New (No referral) Moderate Complexity $252.00
Outpatient/Office Visit New (No referral) High Complexity $316.00
Outpatient/Office Visit New (Referral from physician) Straight Forward $137.00
Outpatient/Office Visit New (Referral from physician) Low Complexity $187.00
Outpatient/Office Visit New (Referral from physician) Moderate Complexity $280.00
Outpatient/Office Visit New (Referral from physician) High Complexity $342.00
Outpatient/Office Visit Established Straight Forward $66.00
Outpatient/Office Visit Established Low Complexity $111.00
Outpatient/Office Visit Established Moderate Complexity $164.00
Outpatient/Office Visit Established High Complexity $221.00
Initial Hospital Admission Visit Low Complexity $155.00
Initial Hospital Admission Visit Moderate Complexity $210.00
Initial Hospital Admission Visit High Complexity $310.00
Initial Hospital Consultation Visit Low Complexity $176.00
Initial Hospital Consultation Visit Moderate Complexity $256.00
Initial Hospital Consultation Visit High Complexity $309.00
Subsequent Hospital Visit Low Complexity $60.00
Subsequent Hospital Visit Moderate Complexity $110.00
Subsequent Hospital Visit High Complexity $159.00
Office Procedures
Chemical cauterization of tissue $121.00
Diagnostic Anoscopy $136.00
Diagnostic Proctosigmoidoscopy $189.00
Enucleation of external thrombosed hemorrhoid $272.00
Drainage of Pilonidal Abscess $275.00
Drainage of Peri‐Rectal Abscess $310.00
Excision of single external papilla or skin tag, anus $318.00
Chemical destruction of Condyloma $374.00
Excision of Condyloma $411.00
Rubber Band Ligation of Hemorrhoids (includes anoscopy) $414.00
Operating Room Procedures
Colonoscopy $583.00
Colonoscopy with biopsy $720.00
Multiple Hemorrhoid Ligations $485.00
Single Hemorrhoid Excision $784.00
Multiple Hemorrhoid Excisions $742.00
Anal sphincterotomy, fissurectomy $687.00
Fistulotomy, simple $787.00
Fistulotomy, complex $832.00
Placement of a seton $428.00
Complex treatment of Condyloma $820.00
Small Bowel Resection $1,919.00
Laparoscopic Colostomy Closure $2,618.00
Laparoscopic Left Colon Removal $2,859.00
Laparoscopic Right Colon Removal $2,100.00
Laparoscopic Hernia Repair $1,165.00
Laparoscopic Gallbladder Removal $1,030.00
Laparoscopic Appendectomy $942.00
Inguinal Hernia Repair $814.00
Subcutaneous Port Placement $1,813.00