2011 Top Procedures

Type of Procedures

AVG. Professional Fees*

Avg. Hospital Fees*

Avg Anesthesia Fees*

Avg. Cost*

REMOVE CATARACT, INSERT LEN001

                                              1,120.00

               1,163.25

                   448.00

                      2,731.25

UPPER ENDOSCOPY

                                                 248.97

                   374.92

                     99.59

                         723.47

DIAGNOSTIC COLONOSCOPY

                                                 318.01

                   291.44

                   127.20

                         736.65

CYSTOSCOPY

                                                 164.17

                   268.23

                     65.67

                         498.07

DIAGNOSTIC LARYNGOSCOPY

                                                 130.75

 N/A

                     52.30

                         183.05

BIOPSY OF SKIN LESION

                                                   75.00

 N/A

                     30.00

                         105.00

AFTER CATARACT LASER SURGER

                                                 700.00

                   180.00

                   280.00

                      1,160.00

UPPER GI ENDOSCOPY, DIAGNOSTIC

                                                 221.76

                   302.81

                     88.70

                         613.27

COLONOSCOPY, LESION REMOVAL

                                                 478.84

                   312.86

                   191.54

                         983.24

TOTAL KNEE REPLACEMENT

                                              2,500.00

               1,500.00

                1,000.00

                      5,000.00

LASER SURGERY OF PROSTATE001

                                              1,108.88

               2,468.58

                   443.55

                      4,021.01

BIOPSY OF PROSTATE

                                                 150.90

                   292.21

                     60.36

                         503.47

LAPAROSCOPY, CHOLECYSTECTOMY

                                                 917.67

               3,028.33

                   367.07

                      4,313.07

Average Calculation:

The Average is calculated based on our USUAL and CUSTOMARY rates negotiated with the contracted providers

Definitions

Procedure Name

Type of surgery or procedure

Frequency of Service

Includes the number of procedures that has been performed

Average Professional Fees

Billed charges by medical professionals other than facilities.*It does not include anesthesia or hospital charges*

Average Hospital Fees

Room and Board, Surgical, medications, supplies and other ancillary charges provided by the hospital or facility

Average Anesthesia Fees

Professional fees of the anesthesiologists only.

Average Cost

The total cost of the procedure (surgery)

2011 Radiology

Procedure Name

Frequency of Service

 Avg. Billed Charges*

 Avg. Amount Paid by the Plan

CHEST X-RAY

2,001

 $                      27.98

 $                        22.00

ECG MONITOR/REPORT, 24 HRS

384

 $                   169.46

 $                     154.64

ECHO EXAM OF ABDOMEN

647

 $                   140.13

 $                     110.79

ECHO EXAM OF BREAST

642

 $                      98.18

 $                        78.16

ECHO EXAM OF EYE

512

 $                      92.71

 $                        78.80

ECHO EXAM OF HEART

1,388

 $                   132.07

 $                     116.39

ECHO EXAM OF PELVIS

563

 $                      90.42

 $                        64.01

ELECTROCARDIOGRAM COMPLETE

7,969

 $                      30.30

 $                        28.78

Hip, spine or central DEXA (Dual Energy X-Ray Absorptiometry) studies

413

 $                   120.15

 $                        94.63

X-RAY EXAM OF KNEE, 1 OR 2

518

 $                      36.38

 $                        28.61

X-RAY EXAM OF LOWER SPINE

376

 $                      64.75

 $                        50.68

Total

15,413

 $                1,002.54

 $                     827.47

* Average Calculation

The Average is calculated based on our USUAL and CUSTOMARY rates negotiated with the contracted providers

Definitions

Procedure Name

Type of surgery or procedure

Frequency of Service

Includes the number of procedures that has been performed

Average Billed Charges

Includes only the amount billed by the facility

Average Amount Paid by the PCABP

The amount paid is based on the Negotiated Cost negotiated with the contracted providers

2011 Treatment Therapies

Treatment  Name

 AVG. Professional Fees per session*

 AVG. Facility Fees per session*

 Avg.Drug Fees per session*

 Avg. Cost per Session*

Chemotherapy

 $               990.21

 N/A

 $                      930.17

 $            1,920.38

Outpatient Dialysis Treatment

 $                  60.00

 $               197.03

 $                        14.45

 $               271.48

Radiation Therapy

 N/A

 $               508.76

 N/A

 $               508.76

*Average Calculation:

The Average is calculated based on our USUAL and CUSTOMARY rates negotiated with the contracted providers

Average Facility Fees

Includes the supplies and other ancillary charges provided by the hospital or facility

Average Professional Fees

Billed charges by medical professionals other than facilities.*It does not include anesthesia or hospital charges*

Average Drug Fees

Includes the billed charge of the specialized drugs used during treatment

N/A

Not Applicable