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Kaiser Permanente Sample Fee List NORTHERN CALIFORNIA
Finding a health care plan that meets your needs is an important part of staying healthy. To help you decide who to partner with as you choose a health care plan, we’ve created a Kaiser Permanente Sample Fee List so you can see the charges for many of Kaiser Permanente’s services. Understanding how much you might spend on health care helps give you peace of mind—so you can concentrate on the things in life you enjoy. This list shows estimated member charges for some commonly used medical services—such as office visits, lab tests, X-rays, and prescription medicines—when provided at Kaiser Permanente medical centers, medical offices, pharmacies, and other facilities. If you choose to become a Kaiser Permanente member, the charges for services may be different when you receive care or services from a provider at a non–Kaiser Permanente facility, even if the provider is under contract to provide services for Kaiser Permanente members. As a Kaiser Permanente member, the amount of charges you pay out of your own pocket will depend on your plan coverage and on factors such as whether or not your provider is a Kaiser Permanente practitioner. Additionally, your benefit plan may cover services at different levels of copayment or coinsurance. As you consider partnering with us for your health care, you can use this list to help you:
• Estimate your out-of-pocket medical spending for the coming year based on the care and
services you expect to use from our facilities.
• Plan for unexpected health care costs.
• Review your options during open enrollment.
• Estimate the funds you may need for your health savings account, health reimbursement
account or flexible spending account, if applicable.
For more information about our charges or about a service that’s not listed, contact our Deductible Products Service Team at 1-800-390-3507, Monday through Friday, from 7 a.m. to 5 p.m.
These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California ESTIMATED CHARGE Office visits (outpatient)
Office visit that includes a problem-focused history, exam, and simple
Office visit that includes an expanded problem-focused history, exam, and
simple medical decision for a new patient
Office visit that includes a detailed history, exam, and low complex medical
Office visit that includes a comprehensive history, exam, and moderately
complex medical decision for a new patient
Office visit that includes a comprehensive history, exam, and highly
complex medical decision for a new patient
Office visit by a non-physician provider for a minimal problem for an
Office visit that includes a problem-focused history, exam, and simple
medical decision for an established patient
Office visit that includes an expanded problem-focused history, exam, and
low complex medical decision for an established patient
Office visit that includes a detailed history, exam, and moderately complex
medical decision for an established patient
Office visit that includes a comprehensive history, exam, and highly
complex medical decision for an established patient
Office visits (wellness)
Well-baby office visit, new patient (under 1 year)*
Well-child office visit, new patient (1–11 years)*
Well-child office visit, well-adult office visit new patient (12–39 years)*
Well-adult office visit, new patient (40–64 years)*
Well-adult office visit, new patient (65 and older)*
Well-baby office visit, established patient (under 1 year)*
Well-child office visit, established patient (1–11 years)*
Well-child office visit, established patient (12–17 years)*
*These services are typically covered at a copayment level and not subject to the deductible.
For information about your coverage, please see your Evidence of Coverage. Emergency care by a physician (excluding other fees such as X-rays, lab tests, or additional procedures)
Emergency care by a physician, extensive
These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California ESTIMATED CHARGE Psychotherapy visits Eye examinations
Eye exam, routine visit, established patient
Eye exam and treatment, established patient
Hearing services
Hearing screening test (pure tone, air only)
Physical therapy services
Electric stimulation therapy, treatment only
Physical therapy exercises, treatment only
Physical therapy, hot and cold application, treatment only
Physical therapy, ultrasound, treatment only
Vaccines and other injections These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California ESTIMATED CHARGE Vaccines and other injections(continued)
Therapeutic injection (administration only, does not include medication)*
Therapeutic IV injection (administration only, does not include medication)*
*These services are typically covered at a copayment level and not subject to the deductible.
For information about your coverage, please see your Evidence of Coverage. Tests and procedures
Colonoscopy and removal of abnormal tissue using cautery
Colonoscopy and removal of abnormal tissue using snare technique
Colonoscopy and removal of colon tissue for examination
Draining fluid from around swollen joint
Sigmoidoscopy and removal of tissue for examination
Surgically destroying an abnormal area of skin
X-rays, CT scans, and other imaging studies
CT scan of stomach area, without dye $525
These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California ESTIMATED CHARGE X-rays, CT scans, and other imaging studies(continued)
Review of CT scan of the head or brain $425
Laboratory tests These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California ESTIMATED CHARGE Laboratory tests (continued)
Laboratory chemistry test for creatine kinase $15
These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California
Charge per prescription for top 50 medications DRUG DESCRIPTION QUANTITY ESTIMATED CHARGE
Amoxicillin 400mg/5ml suspension 100ml bottle
Amoxicillin 500mg capsule (generic Amoxil)
Azithromycin 250mg tablet (generic Zithromax)
Cephalexin 500mg capsule (generic Keflex)
Ciprofloxacin hydrochloride 500mg tablet (generic Cipro)
Cyclobenzaprine 10mg tablet (generic Flexeril)
Doxycycline hyclate 100mg tablet (generic Vibratab)
Fluoxetine hydrochloride 10mg capsule (generic Prozac)
Fluoxetine hydrochloride 20mg capsule (generic Prozac)
Fluticasone propionate 50mcg nasal spray solution, 16 gram
Glipizide 5mg tablet (generic Glucotrol)
Glipizide 10mg tablet (generic Glucotrol)
Guaifenesin with Codeine syrup 240ml bottle
Hydrochlorothiazide 25mg tablet (generic Esidrix)
Hydrocodone/Acetaminophen 10/325mg tablet
Hydrocodone/Acetaminophen 5/500mg tablet
Levothroid 100mcg tablet (generic Synthroid)
Lisinopril 5mg tablet (generic Prinivil or Zestril)
Lisinopril 10mg tablet (generic Prinivil or Zestril)
Lisinopril 20mg tablet (generic Prinivil or Zestril)
Lisinopril 40mg tablet (generic Prinivil or Zestril)
These estimated member charges are valid as of January 2009 and are subject to change without notice. Kaiser Permanente Estimated Charges Northern California DRUG DESCRIPTION (continued) QUANTITY ESTIMATED CHARGE
Lovastatin 40mg tablet (generic Mevacor)
Metformin hydrochloride 500mg tablet (generic Glucophage)
Naproxen 500mg tablet (generic Naprosyn)
Nasarel 0.025% nasal spray solution, 25gm inhaler
Novolin N 100 u/ml (NPH insulin), 10ml vial
Omeprazole 20mg capsule (generic Prilosec)
Prednisone 20mg tablet (generic Deltasone)
SMZ-TMP double-strength 800/160mg tablet
Trazodone hydrochloride 50mg tablet (generic Desyrel)
Triamterene/Hydrochlorothiazide 75/50mg tablet
Zolpidem tartrate 10mg tablet (generic Ambien)
These estimated member charges are valid as of January 2009 and are subject to change without notice.
PACKAGE LEAFLET: INFORMATION FOR THE USER HAWTHORN LIQUID EXTRACT VALENTIS 1:1 oral drops, solution Crataegi extractum fluidum Read all of this leaflet carefully because it contains important information for you. This medicine is available without prescription. However, you still need to use Hawthorn liquid extract Valentis carefully to get the best results from it. Keep
ENGLISH SUMMARY The report contains two chapters; the first one gives an economic outlook for the Danish economy and the second one an analysis of Danish labour market policy Chapter I: Economic outlook The economic situation in Europe is still dominated by lack of confidence in public finances in a number of countries and weak developments in demand and production. Initia- tives f
Kaiser Permanente Sample Fee List