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 2016
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 Nurse Visit $130 Low-to-Moderate Level Visit $220 Moderate Level Visit $316 Moderate-to-High Level Visit $478 High Level Visit $594 Doctor's Office Visit for an Established Patient Nurse Visit $62 Low-to-Moderate Level Visit $131 Moderate Level Visit $215 Moderate-to-High Level Visit $315 High Level Visit $420 Doctor's Office Visit - Specialist Consultation Nurse Visit $142 Low-to-Moderate Level Visit $264 Moderate Level Visit $360 Moderate-to-High Level Visit $530 High Level Visit $644
- Eye Exams
Common Charges for Eye Exams Service Estimated Charge Eye Exams New Patient Intermediate Eye Exam $263 New Patient Comprehensive Eye Exam $476 Established Patient Intermediate Eye Exam $278 Established Patient Comprehensive Eye Exam $399 Eye Refraction for Vision Correction $58
- Physical/Occupational Therapy
Common Charges for Physical/Occupational Therapy Service Estimated Charge Physical/Occupational Therapy Physical Therapy Evaluation $269 Physical Therapy Re-evaluation $163 Occupational Therapy Evaluation $329 Occupational Therapy Re-evaluation $212 Electric Stimulation Therapy, Treatment Only $54 Physical Therapy Ultrasound, Treatment Only $48 Physical Therapy Exercises, Treatment Only $106 Physical Therapy ‐ Manual therapy $99
- Allergy Injections
Common Charges for Allergy Injections Service Estimated Charge Allergy Injections Allergy shot ‐ single injection $40 Allergy shot ‐ two or more injections $46
- Diagnostic Imaging
Common Charges for Diagnostic Imaging Service Estimated Charge Diagnostic Imaging Abdomen CT Scan $741 Abdomen CT Scan with and without dye $1,366 Abdomen CT Scan, including dye $1,185 Abdomen X-ray $101 Abdomen/Pelvis CT scan $950 Abdomen/Pelvis CT scan with and without dye $1,710 Abdomen/Pelvis CT scan, including dye $1,457 Abdominal ultrasound $595 Abdominal ultrasound, limited $458 Ankle X-ray (3+ views) $144 Bone density scan (dexa scan) $211 Brain MRI with and without dye $2,404 Brain MRI without dye $1,849 Breast MRI with and without dye $2,663 Breathing Test $156 Bronchography $150 Cardiac Stress Test, complete $322 Cervical Spine MRI without dye $1,626 Cervical Spine X-ray, minimum 4-5 views $203 Chest X-ray (One views) $96 Chest x-ray (two views) $126 Digital Mammogram, bilateral $704 Digital Mammogram, unilateral $555 Digital Mammogram, screening $579 Doppler Echo, add-on $182 Echo Color Flow, add-on $83 Elbow X-ray, complete $144 Electrocardiogram (ECG) $73 Femur X-ray, 2 views $120 Finger X-ray $147 Foot X-ray (complete) $135 Hand X-ray, complete $140 Hearing Threshold Evaluation $143 Hearing Tone Screen $54 Hip X-ray $116 Hip X-ray, complete $168 Knee MRI without dye $1,177 Knee X-ray 3 views $161 Knee X-ray one or two views $132 Knee X-ray, bilateral $154 Knee X-ray, complete, 4+ views $188 Lumbar Spine MRI without dye $1,608 Lumbar spine x-ray (two or three views) $151 Middle-Ear Function Test $55 Pelvic ultrasound exam, complete $528 Pelvis CT Scan $729 Pelvis CT Scan, including dye $1,167 Pelvis MRI $1,826 Pelvis X-ray, AP view only $122 Radiologic Stress Test $2,127 Scan of Extracranial Arteries $1,040 Shoulder X-ray complete $130 Stress Test w/ Doppler $782 Stress Test w/ Echo $961 Toe X-ray, minimum 2 views $132 Transvaginal ultrasound $308 Ultrasound breast complete $448 Ultrasound breast limited $365 Upper Extremity Joint MRI without dye $1,177 Wrist X-ray, 2 views $137 Wrist X-ray, complete $163
- Pregnancy & Prenatal Tests
Common Charges for Pregnancy & Prenatal Tests Service Estimated Charge Pregnancy & Prenatal Tests Fetal non-stress test $187 Pregnancy ultrasound, first trimester $528 Pregnancy ultrasound, after first trimester $623 Obstetric ultrasound, limited $379 Obstetric ultrasound, after first trimester $497 Obstetric ultrasound, transvaginal $427 Urine Pregnancy Test $13
- Lab Tests
Common Charges for Lab Tests Service Estimated Charge Lab Tests ABO Blood Typing Test $16 Acute Hepatitis Panel $262 Alkaline Phosphatase Test $28 Allergen-specific IgE Antibody Test $29 Alpha-Fetoprotein (AFP) Test $92 Amylase Test $36 Antinuclear Antibodies (ANA) Test $66 Bacterial Culture $47 Bacterial Culture, urine Test $44 Basic Metabolic Panel $47 Bilirubin Test $28 Blood Clot Test $22 Blood Folic Acid Test $81 Blood Serology (RPR) Test $23 Blood Sugar Test, monitoring $13 Calcium test $28 Carcinoembryonic Antigen Test (CEA) $104 Chickenpox Test $71 Chlamydia Test $193 Cholesterol Test $24 Chorionic Gonadotropin (hCG) Test $83 Complete Blood Count $43 Comprehensive Metabolic Panel $58 Cortisol Test $90 C-Reactive Protein (CRP) Test $28 Creatine Test $36 Creatinine Test $28 DHEA-S Test $122 Fecal Occult Blood Screening Test $18 Feces Bacteria Culture Test $52 Ferritin Test $75 Flu Test $51 Gamma Glutamyltransferase Test $40 Gammaglobulin IgE Test $91 Glucose Test $22 Gonorrhea Test $193 Hemoglobin A1c Test $53 Hemoglobin Test $13 Hepatitis B Antibody Test $59 Hepatitis B Antigen Test $57 Hepatitis C Antibody Test $78 Hepatitis C Test $236 High Sensitivity CRP Test $71 HIV-1/HIV-2 Test $75 Insulin Test $63 Iron Test $36 Lactate Dehydrogenase (LDH) Test $33 LDL Cholesterol Test $52 Lipase Test $38 Lipid Panel Test $74 Liver Function Panel $45 Magnesium Test $37 Pap Smear Test $111 Parathyroid Hormone Test $227 Phosphorus Test $26 Potassium Test $25 Prolactin Test $107 Prostate-Specific Antigen (PSA) Test $101 Protein, Urine Test $20 Rapid Strep Group A Test $51 Rheumatoid Arthritis Factor Test $31 Renal Function Panel $48 RH (D) Blood Typing Test $16 Screening Culture $36 Sedimentation Rate Test $20 Sodium Test $26 Testosterone Test $142 Thyroglobulin Test $87 Thyroid Peroxidase (TPO) Test $80 Thyroid Stimulating Hormone (TSH) Test $92 Thyroxine, free $50 Thyroxine, total $38 Transferase Alanine Amino (ALT) Test $29 Transferase Aspartate Amino (AST) Test $28 Triglycerides Test $32 Triidothyronine, free Test $93 Triidothyronine, total Test $78 Urea Nitrogen Test $22 Uric Acid Test $25 Urine Test $17 Urine Test, dipstick only $14 Vitamin B-12 Test $83
- Office Procedures
Common Charges for Office Procedures Service Estimated Charge Office Procedures Abscess Incision and Drainage $467 Apply Short-Arm Cast $354 Bronchodilation $270 Control Nosebleed, simple $381 Fluid Removal from Intermediate Joint $246 Fluid Removal from Major Joint $230 Fluid Removal from Small Joint $180 Impacted Earwax Removal $165 Inhalation Treatment $83 Injection, tendon or ligament $225 Skin Biopsy $344 Skin Lesion Destruction $228
Common Charges for Vaccines Service Estimated Charge Vaccines Chickenpox $178 Diphtheria, Tetanus, and Pertussis (DTaP) $46 Diphtheria, Tetanus, Pertussis, Hib and Polio (DTaP-Hib-IPV) $101 Flu $19 Flu - High Dose $38 Flu - Nasal Mist $30 Hepatitis A - Adult $120 Hepatitis A - Pediatric $53 Hepatitis B - Adult $96 Hepatitis B - Pediatric $76 HPV $254 Measles, Mumps, and Rubella (MMR) $100 Measles, Mumps, Rubella and Chickenpox (MMRV) $278 Meningitis $203 Pneumonia - 13 valent $259 Pneumonia - 23 valent $123 Polio (IPV) $49 Rotavirus $135 Shingles $313 Tetanus, Diphtheria, and Pertussis (Tdap) $73
New Patient Visit: A new patient is someone who has not been seen by this specialty at any Sutter Gould 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.