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Content

Palo Alto Medical Foundation Charges for Frequently Used Doctor Services

The services below expand to show charges for frequently used services provided by Palo Alto Medical Foundation. If you can’t find the service you are looking for, please call (888) 398-5677.

OpenDoctor's Office Visit

Doctor's Office Visit

Common Charges for Doctor's Office Visit
ServiceEstimated Charge
Doctor's Office Visit for a New Patient
Low-Level Visit $136
Low-to-Moderate Level Visit $230
Moderate Level Visit $330
Moderate-to-High Level Visit $500
High Level Visit $622
Doctor's Office Visit for an Established Patient
Low-Level Visit $64
Low-to-Moderate Level Visit $137
Moderate Level Visit $225
Moderate-to-High Level Visit $329
High Level Visit $440
Doctor's Office Visit - Specialist Consultation
Low-Level Visit $148
Low-to-Moderate Level Visit $276
Moderate Level Visit $376
Moderate-to-High Level Visit $554
High Level Visit $674

CloseDoctor's Office Visit

OpenEye Exams

Eye Exams

Common Charges for Eye Exams
ServiceEstimated Charge
Eye Exams
New Patient Intermediate Eye Exam $275
New Patient Comprehensive Eye Exam $487
Established Patient Intermediate Eye Exam $290
Established Patient Comprehensive Eye Exam $408
Eye Refraction for Vision Correction $60

 

CloseEye Exams

OpenPhysical/Occupational Therapy

Physical/Occupational Therapy

Common Charges for Physical/Occupational Therapy
ServiceEstimated Charge
Physical/Occupational Therapy
Occupational Therapy Evaluation (Low Level Visit) $281
Occupational Therapy Evaluation (Moderate Level Visit) $281
Occupational Therapy Evaluation (High Level Visit) $281
Occupational Therapy Re-evaluation $186
Electric Stimulation Therapy, Treatment Only $56
Physical Therapy Evaluation (Low Level Visit) $290
Physical Therapy Evaluation (Moderate Level Visit) $290
Physical Therapy Evaluation (High Level Visit) $290
Physical Therapy Re-evaluation $198
Physical Therapy Exercises, Treatment Only $110
Physical Therapy Ultrasound, Treatment Only $50
Physical Therapy ‐ Manual therapy $103

 

ClosePhysical/Occupational Therapy

OpenAllergy Injections

Allergy Injections

Common Charges for Allergy Injections
ServiceEstimated Charge
Allergy Injections
Allergy shot ‐ single injection $42
Allergy shot ‐ two or more injections $48

CloseAllergy Injections

OpenDiagnostic Imaging

Diagnostic Imaging

Common Charges for Diagnostic Imaging
ServiceEstimated Charge
Diagnostic Imaging
Abdomen CT Scan $775
Abdomen CT Scan with and without dye $1,428
Abdomen CT Scan, including dye $1,239
Abdomen X-ray $129
Abdomen/Pelvis CT scan $994
Abdomen/Pelvis CT scan with and without dye $1,788
Abdomen/Pelvis CT scan, including dye $1,525
Abdominal ultrasound $623
Abdominal ultrasound, limited $480
Ankle X-ray (3+ views) $150
Auditory Threshold Evaluation $149
Bone density scan (dexa scan) $221
Brain MRI with and without dye $2,514
Brain MRI without dye $1,935
Breast MRI $2,727
Breast MRI with CAD $2,792
Breathing Test (spirometry) $164
Bronchography $156
Cardiac Stress Test, complete $336
Cervical Spine MRI without dye $1,700
Cervical Spine X-ray, minimum 4-5 views $213
Chest CT Scan $931
Chest CT scan, including dye $1,167
Chest X-ray (One views) $91
Chest X-ray (two views) $144
Diagnostic mammography, including CAD unilateral $641
Diagnostic mammography, including CAD bilateral $814
Doppler Color Flow, add-on $87
Duplex scan of Extracranial Arteries $1,088
Echocardiogram, doppler $190
Elbow X-ray, complete $150
Electrocardiogram (ECG) $77
Femur X-ray (1 view) $111
Femur X-ray (2+ views) $131
Finger X-ray $153
Foot X-ray, complete $141
Hand X-ray, complete $146
Head CT Scan $730
Hip X-ray (1 view) $122
Hip X-ray (2-3 views) $169
Hip X-ray (4+ views) $208
Knee MRI without dye $1,231
Knee X-ray 3 views $169
Knee X-ray one or two views $138
Knee X-ray, bilateral $162
Knee X-ray, complete, 4+ views $196
Lumbar Spine MRI without dye $1,682
Lumbar spine x-ray (two or three views) $157
Pelvic ultrasound exam, complete $552
Pelvis CT Scan $763
Pelvis CT Scan, including dye $1,221
Pelvis MRI $1,910
Pelvis X-ray, AP view only $128
Radiologic Stress Test $2,225
Screening mammography, bilateral including CAD $661
Shoulder X-ray, complete $136
Sinus CT Scan $1,011
Stress Test w/ Doppler, complete $818
Stress Test w/ Echocardiogram, real-time image $1,005
Toe X-ray, minimum 2 views $138
Tone Screening Test
$56
Transvaginal ultrasound $322
Tympanometry $57
Ultrasound breast, complete $468
Ultrasound breast, limited $381
Upper Extremity Joint MRI without dye $1,231
Wrist X-ray, 2 views $143
Wrist X-ray, complete $171

 

CloseDiagnostic Imaging

OpenPregnancy & Prenatal Tests

Pregnancy & Prenatal Tests

Common Charges for Pregnancy & Prenatal Tests
ServiceEstimated Charge
Pregnancy & Prenatal Tests
Fetal non-stress test $195
Pregnancy ultrasound, first trimester $552
Pregnancy ultrasound, after first trimester $651
Obstetric ultrasound, limited $397
Obstetric ultrasound, after first trimester $519
Obstetric ultrasound, transvaginal $447
Urine Pregnancy Test $13

 

ClosePregnancy & Prenatal Tests

OpenLab Testing

Lab Testing

Common Charges for Lab Tests
ServiceEstimated Charge
Lab Testing
ABO Blood Typing Test $16
Acute Hepatitis Panel $274
Alkaline Phosphatase, serum $30
Allergen-specific IgE Antibody Test $31
Alpha-Fetoprotein-Serum $96
Amylase Test, serum $38
Antinuclear Antibodies, direct $70
Assay of Calcium $30
Assay of Ferritin $79
Assay of Iron $38
Assay of Magnesium $39
Assay of Phosphorus $28
Assay of Testosterone, total $148
Assay of Thyroxine, total $40
Assay of Triidothyronine, total $82
Assay of Urea Nitrogen $24
Bacterial Culture, other source $49
Bacterial Culture, urine $46
Basic Metabolic Panel $48
Bilirubin Test, total $30
Blood Folic Acid Serum $85
Blood Serology, qualitative $25
Blood Sugar Test, monitoring $13
Carcinoembryonic Antigen $108
Chlamydia $168
Chorionic Gonadotropin Test $87
Complete Blood Count $44
Comprehensive Metabolic Panel $60
Cortisol, total $94
C-Reactive Protein $30
Creatine Kinase $38
Creatinine $30
Dehydrepiandrosterone Sulfate $128
Fecal Blood Occult $18
Feces Culture, bacteria $54
Gamma Glutamyltransferase $42
Gammaglobulin IgE $95
Glucose Test $24
Gonorrhea Test $168
Hemoglobin Test $13
Hemoglobin A1c Test $55
Hepatic Function Panel $47
Hepatitis B Surface Antibody Test $61
Hepatitis B Surface Antigen Test $59
Hepatitis C Antibody Test $82
Hepatitis C Test $246
High Sensitivity C-Reactive Protein Test $75
HIV-1/HIV-2 Single Assay Test $77
Influenza Test $53
Insulin Test, total $65
Lactate Dehydrogenase Test $35
LDL Cholesterol Test $54
Lipase Test $40
Lipid Panel Test $76
Pap Smear $114
Parathyroid Hormone, intact $237
Potassium Test $27
Prolactin Test $111
Prostate-Specific Antigen (PSA) Test $105
Prothrombin Time $24
Rheumatoid Arthritis Factor Test $33
Renal Function Panel $50
RH (D) Blood Typing Test $16
Screening Culture $38
Sedimentation Rate Test $20
Sodium, serum $28
Strep Group A $53
Thyroglobulin Antibody Test $91
Thyroid Peroxidase Antibody Test $84
Thyroid Stimulating Hormone Test $94
Thyroxine $52
Total Cholesterol Test $26
Total Protein, urine $20
Transferase Alanine Amino (ALT) Test $31
Transferase Aspartate Amino (AST) Test $30
Triglycerides Test $34
Triidothyronine, free $97
Uric Acid Test $27
Urinalysis $17
Urine Test $17
Urine Test, dipstick only $14
Urine Test, microanalysis only $17
Varicella-Zoster Antibody Test $75
Vitamin B-12 Test $85

 

CloseLab Testing

OpenOffice Procedures

Office Procedures

Common Charges for Office Procedures
ServiceEstimated Charge
Office Procedures
Apply Short-Arm Cast $370
Arthrocentesis $240
Bronchodilation $276
Control Nosebleed, simple $399
Impacted Cerumen Removal $169
Incision and Drainage $489
Inhalation Treatment $87
Injection, tendon $235
Injection/Aspiration, intermediate joint/bursa $258
Injection/Aspiration, small joint/bursa $188
Tangential Skin Biopsy $353
Punch Skin Biopsy $426
Incisional Skin Biopsy $515
Skin Lesion Destruction $233

 

CloseOffice Procedures

OpenVaccines

Vaccines

Common Charges for Vaccines
ServiceEstimated Charge
Vaccines
Diphtheria, Tetanus, and Pertussis (DTaP) $49
Diphtheria, Tetanus, and Pertussis (DTaP-Hib-IPV) $108
Flu $20
Flu - High Dose $55
Flu - Nasal Mist $25
H Papilloma Vaccine, 2 or 3 dose $538
Hepatitis A $59
Hepatitis A - Adult $135
Hepatitis B - Adult $98
Hepatitis B - Pediatric $80
Measles, Mumps, and Rubella (MMR) $112
Measles, Mumps, Rubella (MMRV) $312
Meningococcal $218
Pneumococcal, 13 valent $271
Pneumococcal, 23 valent $135
Polio $53
Rotavirus $141
Tetanus, Diphtheria, and Pertussis (TdaP) $77
Varicella Virus $200
Zoster $327

 

CloseVaccines

Disclaimer

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. Charges for lab tests and vaccines do not include specimen collection fees or fees associated with administering vaccines.

Cost Estimator Tool

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