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Content

Sutter Gould Medical Foundation Charges for Frequently Used Doctor Services

The services below expand to show charges for frequently used services provided by Sutter Gould Medical Foundation. If you can’t find the service you are looking for, please call (866) 961-8539.

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 $128
Low-to-Moderate Level Visit $216
Moderate Level Visit $310
Moderate-to-High Level Visit $470
High Level Visit $581
Doctor's Office Visit for an Established Patient
Low-Level Visit $73
Low-to-Moderate Level Visit $132
Moderate Level Visit $208
Moderate-to-High Level Visit $309
High Level Visit $414
Doctor's Office Visit - Specialist Consultation
Low-Level Visit $132
Low-to-Moderate Level Visit $246
Moderate Level Visit $336
Moderate-to-High Level Visit $496
High Level Visit $605

 

CloseDoctor's Office Visit

OpenEye Exams

Eye Exams

Common Charges for Eye Exams
ServiceEstimated Charge
Eye Exams
New Patient Intermediate Eye Exam $238
New Patient Comprehensive Eye Exam $433
Established Patient Intermediate Eye Exam $251
Established Patient Comprehensive Eye Exam $361
Eye Refraction for Vision Correction $49

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) $279
Occupational Therapy Evaluation (Moderate Level Visit) $279
Occupational Therapy Evaluation (High Level Visit) $279
Occupational Therapy Re-evaluation $185
Electric Stimulation Therapy, Treatment Only $54
Physical Therapy Evaluation (Low Level Visit) $288
Physical Therapy Evaluation (Moderate Level Visit) $288
Physical Therapy Evaluation (High Level Visit) $288
Physical Therapy Re-evaluation $197
Physical Therapy Exercises, Treatment Only $105
Physical Therapy Ultrasound, Treatment Only $45
Physical Therapy ‐ Manual therapy $98

 

ClosePhysical/Occupational Therapy

OpenAllergy Injections

Allergy Injections

Common Charges for Allergy Injections
ServiceEstimated Charge
Allergy Injections
Allergy shot ‐ single injection $35
Allergy shot ‐ two or more injections $40

 

CloseAllergy Injections

OpenDiagnostic Imaging

Diagnostic Imaging

Common Charges for Diagnostic Imaging
ServiceEstimated Charge
Diagnostic Imaging
Abdomen CT Scan $653
Abdomen CT Scan with and without dye $1,189
Abdomen CT Scan, including dye $1,033
Abdomen X-ray $90
Abdomen/Pelvis CT scan $841
Abdomen/Pelvis CT scan with and without dye $1,493
Abdomen/Pelvis CT scan, including dye $1,275
Abdominal ultrasound $522
Abdominal ultrasound, limited $401
Ankle X-ray (3+ views) $127
Auditory Threshold Evaluation $133
Bone density scan (dexa scan) $185
Brain MRI with and without dye $2,089
Brain MRI without dye $1,602
Breast MRI $2,298
Breast MRI with CAD $2,384
Breathing Test (spirometry) $137
Bronchography $133
Cardiac Stress Test, complete $289
Cervical Spine MRI without dye $1,415
Cervical Spine X-ray, minimum 4-5 views $180
Chest CT Scan $778
Chest CT scan, including dye $972
Chest X-ray (One views) $87
Chest X-ray (two views) $114
Diagnostic mammography, including CAD unilateral $666
Diagnostic mammography, including CAD bilateral $845
Doppler Color Flow, add-on $73
Duplex scan of Extracranial Arteries $896
Echocardiogram, doppler $163
Elbow X-ray, complete $127
Electrocardiogram (ECG) $72
Femur X-ray (1 view) $139
Femur X-ray (2+ views) $163
Finger X-ray $129
Foot X-ray, complete $119
Hand X-ray, complete $122
Head CT Scan $611
Hip X-ray (1 view) $147
Hip X-ray (2-3 views) $207
Hip X-ray (4+ views) $258
Knee MRI without dye $1,028
Knee X-ray 3 views $142
Knee X-ray one or two views $116
Knee X-ray, bilateral $135
Knee X-ray, complete, 4+ views $166
Lumbar Spine MRI without dye $1,397
Lumbar spine x-ray (two or three views) $134
Pelvic ultrasound exam, complete $463
Pelvis CT Scan $642
Pelvis CT Scan, including dye $1,016
Pelvis MRI $1,581
Pelvis X-ray, AP view only $108
Radiologic Stress Test $1,841
Screening mammography, bilateral including CAD $684
Shoulder X-ray, complete $115
Sinus CT Scan $845
Stress Test w/ Doppler, complete $690
Stress Test w/ Echocardiogram, real-time image $850
Toe X-ray, minimum 2 views $116
Tone Screening Test
$48
Transvaginal ultrasound $276
Tympanometry $52
Ultrasound breast, complete $393
Ultrasound breast, limited $323
Upper Extremity Joint MRI without dye $1,028
Wrist X-ray, 2 views $120
Wrist X-ray, complete $144

 

CloseDiagnostic Imaging

OpenPregnancy & Prenatal Tests

Pregnancy & Prenatal Tests

Common Charges for Pregnancy & Prenatal Tests
ServiceEstimated Charge
Pregnancy & Prenatal Tests
Fetal non-stress test $172
Pregnancy ultrasound, first trimester $469
Pregnancy ultrasound, after first trimester $549
Obstetric ultrasound, limited $335
Obstetric ultrasound, after first trimester $439
Obstetric ultrasound, transvaginal $379
Urine Pregnancy Test $15

 

ClosePregnancy & Prenatal Tests

OpenLab Testing

Lab Testing

Common Charges for Lab Tests
ServiceEstimated Charge
Lab Testing
ABO Blood Typing Test $18
Acute Hepatitis Panel $276
Alkaline Phosphatase, serum $30
Allergen-specific IgE Antibody Test $31
Alpha-Fetoprotein-Serum $98
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 $150
Assay of Thyroxine, total $40
Assay of Triidothyronine, total $82
Assay of Urea Nitrogen $24
Bacterial Culture, other source $51
Bacterial Culture, urine $48
Basic Metabolic Panel $51
Bilirubin Test, total $30
Blood Folic Acid Serum $86
Blood Serology, qualitative $25
Blood Sugar Test, monitoring $15
Carcinoembryonic Antigen $110
Chlamydia $203
Chorionic Gonadotropin Test $88
Complete Blood Count $46
Comprehensive Metabolic Panel $62
Cortisol, total $96
C-Reactive Protein $30
Creatine Kinase $38
Creatinine $30
Dehydrepiandrosterone Sulfate $129
Fecal Blood Occult $20
Feces Culture, bacteria $56
Gamma Glutamyltransferase $43
Gammaglobulin IgE $97
Glucose Test $24
Gonorrhea Test $203
Hemoglobin Test $15
Hemoglobin A1c Test $57
Hepatic Function Panel $49
Hepatitis B Surface Antibody Test $63
Hepatitis B Surface Antigen Test $61
Hepatitis C Antibody Test $82
Hepatitis C Test $249
High Sensitivity C-Reactive Protein Test $75
HIV-1/HIV-2 Single Assay Test $79
Influenza Test $55
Insulin Test, total $67
Lactate Dehydrogenase Test $35
LDL Cholesterol Test $56
Lipase Test $40
Lipid Panel Test $78
Pap Smear $117
Parathyroid Hormone, intact $239
Potassium Test $27
Prolactin Test $113
Prostate-Specific Antigen (PSA) Test $107
Prothrombin Time $24
Rheumatoid Arthritis Factor Test $33
Renal Function Panel $52
RH (D) Blood Typing Test $18
Screening Culture $38
Sedimentation Rate Test $22
Sodium, serum $28
Strep Group A $55
Thyroglobulin Antibody Test $93
Thyroid Peroxidase Antibody Test $85
Thyroid Stimulating Hormone Test $98
Thyroxine $54
Total Cholesterol Test $26
Total Protein, urine $22
Transferase Alanine Amino (ALT) Test $31
Transferase Aspartate Amino (AST) Test $30
Triglycerides Test $34
Triidothyronine, free $99
Uric Acid Test $27
Urinalysis $19
Urine Test $19
Urine Test, dipstick only $16
Urine Test, microanalysis only $19
Varicella-Zoster Antibody Test $75
Vitamin B-12 Test $88

 

CloseLab Testing

OpenOffice Procedures

Office Procedures

Common Charges for Office Procedures
ServiceEstimated Charge
Office Procedures
Apply Short-Arm Cast $317
Arthrocentesis $212
Bronchodilation $236
Control Nosebleed, simple $347
Impacted Cerumen Removal $151
Incision and Drainage $422
Inhalation Treatment $72
Injection, tendon $208
Injection/Aspiration, intermediate joint/bursa $230
Injection/Aspiration, small joint/bursa $167
Tangential Skin Biopsy $306
Punch Skin Biopsy $365
Incisional Skin Biopsy $442
Skin Lesion Destruction $203

 

CloseOffice Procedures

OpenVaccines

Vaccines

Common Charges for Vaccines
ServiceEstimated Charge
Vaccines
Diphtheria, Tetanus, and Pertussis (DTaP) $50
Diphtheria, Tetanus, and Pertussis (DTaP-Hib-IPV) $107
Flu $20
Flu - High Dose $55
Flu - Nasal Mist $25
H Papilloma Vaccine, 2 or 3 dose $391
Hepatitis A $57
Hepatitis A - Adult $127
Hepatitis B - Adult $102
Hepatitis B - Pediatric $80
Measles, Mumps, and Rubella (MMR) $106
Measles, Mumps, Rubella (MMRV) $293
Meningococcal $214
Pneumococcal, 13 valent $272
Pneumococcal, 23 valent $219
Polio $53
Rotavirus $143
Tetanus, Diphtheria, and Pertussis (TdaP) $77
Varicella Virus $188
Zoster $330

 

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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Urgent Care

After-hours, weekend and holiday services.

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Convenient walk-in care clinics for your non-urgent health needs.

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