IV. Explanation of Fees
A. "In-network" vs."Out-of-network"
I do accept payments on your behalf from any private insurance company. For all procedures we contact your insurance company and pre-certify the surgery and bill your insurance company. If I have a contract to provide my services to an insurance company at a discount, I am “in-network”; if I do not, I am “out of (their) network”. If I am considered “in-network” for your health insurance company, please see Section B - Standard fee schedule. If I am “out-of-network" for your health insurance plan, please see Section C - Simplified fee schedule.
B. Standard fee schedule
Insurance discounts may be applicable. This option applies to patients who are covered by most Blue Cross Plans including out of state plans. I am “in-network” for these plans. You pay only what is required by your plan. I receive the portion of the rest of my standard fee schedule from your insurance plan. I have agreed to provide my services to them at a discount. Our office will let you know what your responsibility is according to your insurance contract. If I do not have a contract with your insurance company, I am “out-of-network” with your plan.
C. Simplified fee schedule
This schedule applies to Medicare, Medicaid, Tricare and Workers' Comp. With these insurers, you are responsible for my bill and cannot submit it to your government insurance plan or to most Medicare supplemental policies. This schedule also applies to any patient who has a private non-government insurance company for which I am “out-of-network”.
Office Visits |
Cost |
|---|---|
| New Problem: Usual | $150.00 |
| New Problem: Complex | $200.00 |
| Follow-up Visit: Usual | $ 50.00 |
| Follow-up Visit: Post-op (within 3 months) | Free |
| Follow-up Visit: Complex | $100.00 |
| Follow-up Visit: Lee Webb, NP | $ 25.00 |
| Injection or aspiration (any joint) | $ 50.00 |
X-rays
Depending on the nature of the evaluation and whether right and/or left sides are included, 3-13 images may be required. The total charge equals the number of images x $50. Typical examples are included below.
Type of X-ray |
Cost |
|---|---|
| X-ray per image | $50.00 |
| Hip: New evaluation (3 images) Hip: Follow-up, one side ( 2 images) Hip: Follow-up, two sides (3 images) |
$150.00 $100.00 $150.00 |
| Knee: New evaluation, one side (4 images) Knee: New evaluation, two sides (7 images) Knee: Long alignment, one side (3 images) Knee: Follow-up, one side (3 images) Knee: Follow-up, two sides (6 images) |
$200.00 $350.00 $150.00 $150.00 $300.00 |
| Other: generally require 2-3 images | $100.00 -- $150.00 |
| Retakes due to poor image quality | Free |
Surgical Fees
These fees will be quoted to you in advance of surgery and are firm quotes. If the operation becomes more complicated than I anticipated, no extra charges will apply. The operation types are grouped in only a few categories to keep it simple.
Type of Surgery |
Cost |
|---|---|
| Routine Surgery: First-time total hip replacement, total knee replacement, partial knee replacement or hip surface replacement (in most cases), Simple revision surgery, Hip impingement surgery | $6,000.00 |
| Difficult Surgery: Any of the surgeries above in severely obese (BMI≥35) patients or patients with underlying difficult deformities. Usual revision surgery | $8,000.00 |
| Complex Surgery: Custom implants Extensive revisions |
$10,000.00 |
| Minor Surgery: Hickman catheter removal |
$1,000.00 |
| Surgical Assistant | Included in fees above |
Complications may require repeat surgery, which will be billed separately. Revision surgery is more prone to complication. Treatment for an infection will often require two or more difficult and/or complex procedures. Some portion of surgical fees must be paid in advance. The amount depends on your insurance type.
Office visits, injections and x-rays are payable at the time of service. Credit card or Capital One financing is accepted. Late payment will result in a 20% surcharge.