Palo Alto Medical Foundation
Charges for Frequently Used Doctor Services
The services below have drop-down menus that show charges for frequently used services provided by Palo Alto Medical Foundation. The amounts you see are the most you would pay before any discounts that may be available to you. The charges also do not include any additional procedures that may be done as part of the visit.
Cost Estimator Tool
You can use our new online Cost Estimator tool to find out what medical care costs are for more than 225 most frequently used medical services. Select up to five services, and the location you would like to receive the service to see an estimate of your costs.
Charges for Common Services
Charges for lab tests and vaccines do not include specimen collection fees or fees associated with administering vaccines.
Last updated: April 2018
If you can’t find the service you are looking for, please call (888) 398-5677.
- Doctor's Office Visit
Common Charges for Doctor's Office Visit Service Estimated Charge Doctor's Office Visit for a New Patient Low-Level Visit $133 Low-to-Moderate Level Visit $225 Moderate Level Visit $323 Moderate-to-High Level Visit $489 High Level Visit $608 Doctor's Office Visit for an Established Patient Low-Level Visit $63 Low-to-Moderate Level Visit $134 Moderate Level Visit $220 Moderate-to-High Level Visit $322 High Level Visit $430 Doctor's Office Visit - Specialist Consultation Low-Level Visit $145 Low-to-Moderate Level Visit $270 Moderate Level Visit $368 Moderate-to-High Level Visit $542 High Level Visit $659
- Eye Exams
Common Charges for Eye Exams Service Estimated Charge Eye Exams New Patient Intermediate Eye Exam $269 New Patient Comprehensive Eye Exam $476 Established Patient Intermediate Eye Exam $284 Established Patient Comprehensive Eye Exam $399 Eye Refraction for Vision Correction $59
- Physical/Occupational Therapy
Common Charges for Physical/Occupational Therapy Service Estimated Charge Physical/Occupational Therapy Occupational Therapy Evaluation $275 Occupational Therapy Re-evaluation $182 Electric Stimulation Therapy, Treatment Only $55 Physical Therapy Evaluation $284 Physical Therapy Re-evaluation $194 Physical Therapy Exercises, Treatment Only $108 Physical Therapy Ultrasound, Treatment Only $49 Physical Therapy ‐ Manual therapy $101
- Allergy Injections
Common Charges for Allergy Injections Service Estimated Charge Allergy Injections Allergy shot ‐ single injection $41 Allergy shot ‐ two or more injections $47
- Diagnostic Imaging
Common Charges for Diagnostic Imaging Service Estimated Charge Diagnostic Imaging Abdomen CT Scan $758 Abdomen CT Scan with and without dye $1,397 Abdomen CT Scan, including dye $1,212 Abdomen X-ray $103 Abdomen/Pelvis CT scan $972 Abdomen/Pelvis CT scan with and without dye $1,749 Abdomen/Pelvis CT scan, including dye $1,491 Abdominal ultrasound $609 Abdominal ultrasound, limited $469 Ankle X-ray (3+ views) $147 Auditory Threshold Evaluation $146 Bone density scan (dexa scan) $216 Brain MRI with and without dye $2,459 Brain MRI without dye $1,892 Breast MRI with and without dye $2,724 Bronchography $153 Cardiac Stress Test, complete $329 Cervical Spine MRI without dye $1,663 Cervical Spine X-ray, minimum 4-5 views $208 Chest CT Scan $911 Chest CT scan, including dye $1,141 Chest X-ray (One views) $98 Chest X-ray (two views) $126 Doppler Color Flow, add-on $85 Duplex scan of Extracranial Arteries $1,064 Echocardiogram, doppler $186 Elbow X-ray, complete $147 Electrocardiogram (ECG) $75 Femur X-ray (1 view) $109 Femur X-ray (2+ views) $128 Finger X-ray $150 Foot X-ray, complete $138 Hand X-ray, complete $143 Head CT Scan $714 Hip X-ray (1 view) $119 Hip X-ray (2-3 views) $165 Hip X-ray (4+ views) $203 Knee MRI without dye $1,204 Knee X-ray 3 views $165 Knee X-ray one or two views $135 Knee X-ray, bilateral $158 Knee X-ray, complete, 4+ views $192 Lumbar Spine MRI without dye $1,645 Lumbar spine x-ray (two or three views) $154 Pelvic ultrasound exam, complete $540 Pelvis CT Scan $746 Pelvis CT Scan, including dye $1,194 Pelvis MRI $1,868 Pelvis X-ray, AP view only $125 Radiologic Stress Test $2,176 Shoulder X-ray, complete $133 Sinus CT Scan $989 Spirometry $160 Stress Test w/ Doppler, complete $800 Stress Test w/ Echocardiogram, real-time image $983 Toe X-ray, minimum 2 views $135 Tone Screening Test
$55 Transvaginal ultrasound $315 Tympanometry $56 Ultrasound breast, complete $458 Ultrasound breast, limited $373 Upper Extremity Joint MRI without dye $1,204 Wrist X-ray, 2 views $140 Wrist X-ray, complete $167
- Pregnancy & Prenatal Tests
Common Charges for Pregnancy & Prenatal Tests Service Estimated Charge Pregnancy & Prenatal Tests Fetal non-stress test $191 Pregnancy ultrasound, first trimester $540 Pregnancy ultrasound, after first trimester $637 Obstetric ultrasound, limited $388 Obstetric ultrasound, after first trimester $508 Obstetric ultrasound, transvaginal $437 Urine Pregnancy Test $13
- Lab Testing
Common Charges for Lab Tests Service Estimated Charge Lab Testing ABO Blood Typing Test $16 Acute Hepatitis Panel $268 Alkaline Phosphatase, serum $29 Allergen-specific IgE Antibody Test $30 Alpha-Fetoprotein-Serum $94 Amylase Test, serum $37 Antinuclear Antibodies, direct $68 Assay of Calcium $29 Assay of Ferritin $77 Assay of Iron $37 Assay of Magnesium $38 Assay of Phosphorus $27 Assay of Testosterone, total $145 Assay of Thyroxine, total $39 Assay of Triidothyronine, total $80 Assay of Urea Nitrogen $23 Bacterial Culture, other source $48 Bacterial Culture, urine $45 Basic Metabolic Panel $47 Bilirubin Test, total $29 Blood Folic Acid Serum $83 Blood Serology, qualitative $24 Blood Sugar Test, monitoring $13 Carcinoembryonic Antigen $106 Chlamydia $164 Chorionic Gonadotropin Test $85 Complete Blood Count $43 Comprehensive Metabolic Panel $59 Cortisol, total $92 C-Reactive Protein $29 Creatine Kinase $37 Creatinine $29 Dehydrepiandrosterone Sulfate $125 Fecal Blood Occult $18 Feces Culture, bacteria $53 Gamma Glutamyltransferase $41 Gammaglobulin IgE $93 Glucose Test $23 Gonorrhea Test $164 Hemoglobin Test $13 Hemoglobin A1c Test $54 Hepatic Function Panel $46 Hepatitis B Surface Antibody Test $60 Hepatitis B Surface Antigen Test $58 Hepatitis C Antibody Test $80 Hepatitis C Test $241 High Sensitivity C-Reactive Protein Test $73 HIV-1/HIV-2 Single Assay Test $77 Influenza Test $52 Insulin Test, total $64 Lactate Dehydrogenase Test $34 LDL Cholesterol Test $53 Lipase Test $39 Lipid Panel Test $74 Pap Smear $114 Parathyroid Hormone, intact $232 Potassium Test $26 Prolactin Test $109 Prostate-Specific Antigen (PSA) Test $103 Prothrombin Time $23 Rheumatoid Arthritis Factor Test $32 Renal Function Panel $49 RH (D) Blood Typing Test $16 Screening Culture $37 Sedimentation Rate Test $20 Sodium, serum $27 Strep Group A $52 Thyroglobulin Antibody Test $89 Thyroid Peroxidase Antibody Test $82 Thyroid Stimulating Hormone Test $92 Thyroxine $51 Total Cholesterol Test $25 Total Protein, urine $20 Transferase Alanine Amino (ALT) Test $30 Transferase Aspartate Amino (AST) Test $29 Triglycerides Test $33 Triidothyronine, free $95 Uric Acid Test $26 Urinalysis $17 Urine Test $17 Urine Test, dipstick only $14 Urine Test, microanalysis only $17 Varicella-Zoster Antibody Test $73 Vitamin B-12 Test $83
- Office Procedures
Common Charges for Office Procedures Service Estimated Charge Office Procedures Apply Short-Arm Cast $362 Arthrocentesis $235 Bronchodilation $270 Control Nosebleed, simple $390 Impacted Cerumen Removal $165 Incision and Drainage $478 Inhalation Treatment $85 Injection, tendon $230 Injection/Aspiration, intermediate joint/bursa $252 Injection/Aspiration, small joint/bursa $184 Skin Biopsy $344 Skin Lesion Destruction $228
Common Charges for Vaccines Service Estimated Charge Vaccines Diphtheria, Tetanus, and Pertussis (DTaP) $47 Diphtheria, Tetanus, and Pertussis (DTaP-Hib-IPV) $103 Flu $19 Flu - High Dose $38 Flu - Nasal Mist $31 H Papilloma Vaccine, 3 dose $260 Hepatitis A $54 Hepatitis A - Adult $123 Hepatitis B - Adult $96 Hepatitis B - Pediatric $78 Measles, Mumps, and Rubella (MMR) $102 Measles, Mumps, Rubella (MMRV) $284 Meningococcal $208 Pneumococcal, 13 valent $265 Pneumococcal, 23 valent $123 Polio $50 Rotavirus $138 Tetanus, Diphtheria, and Pertussis (Tdap) $73 Varicella Virus $182 Zoster $320
New Patient Visit: A new patient is someone who has not been seen by this specialty at any Palo Alto Medical Foundation location in the past three years.
Nurse Visit: Presenting problem is minor.
Low-to-Moderate Level Visit: Routine problem like a minor injury that may require an X-ray or a minor illness like a respiratory infection.
Moderate Level Visit: Several routine problems or a single problem, like abdominal pain, requiring multiple tests such as blood tests and X-rays.
Moderate-to-High Level Visit: Complicated problem or several problems requiring extensive exams and testing.
High Level Visit: One or more chronic illnesses with severe symptoms, a new problem requiring extensive testing or acute or chronic illness that may pose a threat to life or bodily function.
Ultrasound, limited: This test will only show fetal heart beat, placental location, fetal position, and/or amniotic fluid volume.
Please check with your health plan if you need help understanding your benefits for the service chosen. Uninsured patients may be eligible for discounts.