Patient Price Information List

Disclaimer: Arkansas Surgical Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, Arkansas Surgical Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2020. Arkansas Surgical Hospital charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Baptist Health Med Ctr-North Little Rock

North Little Rock

AR

Baptist Health Medical Center-Little Rock

Little Rock

AR

CHI St. Vincent Infirmary

Little Rock

AR

CHI St. Vincent North

Sherwood

AR

University Arkansas Medical Sciences (UAMS)

Little Rock

AR

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$750
$1,409

47% lower than market

Semi-Private Room

$745
$1,380

46% lower than market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with Level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Description

Our Charge
Market Charge

Variance

Emergency Department Visit - Level 1

$325
$509

36% lower than market

Emergency Department Visit - Level 2

$500
$677

26% lower than market

Emergency Department Visit - Level 3

$700
$1,097

36% lower than market

Emergency Department Visit - Level 4

$1,000
$1,325

25% lower than market

OUTPATIENT PHYSICAL THERAPY CHARGES

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Gait Training - 15 Minutes

$116
$102

14% higher than market

Physical Therapy Exercise, 15 Minutes

$50
$160

69% lower than market

Physical Therapy, standard evaluation - 20 minutes

$150
$260

42% lower than market

OUTPATIENT OCCUPATIONAL THERAPY CHARGES

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Therapeutic Activities Involving Functional Activities (15 min)

$133
$125

6% higher than market

OUTPATIENT PULMONARY THERAPY CHARGES

The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Routine EKG - Minimum 12 Leads

$85
$196

57% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY CHARGES

The following charges reflect our most common laboratory procedures. For all lab specimens collected via blood draw, the venipuncture will be charged separately.

Description

Our Charge
Market Charge

Variance

Albumin (protein) level

$45
$67

33% lower than market

Antihuman globulin test (Coombs test); direct, each antiserum

$49
$150

67% lower than market

Bacterial Culture, Any Source Blood

$81
$130

38% lower than market

Bacterial Culture, Any Source Except Urine, Blood, or Stool

$79
$200

61% lower than market

Bacterial urine culture

$75
$187

60% lower than market

Bacterial urine culture; quantitative colony count

$74
$80

8% lower than market

Blood Typing, ABO

$94
$260

64% lower than market

Blood Typing, Rh (D)

$66
$129

49% lower than market

Blood test, basic group of blood chemicals

$78
$305

74% lower than market

Blood test, clotting time

$37
$59

37% lower than market

Blood test, comprehensive group of blood chemicals

$97
$656

85% lower than market

Blood test, lipids (cholesterol and triglycerides)

$117
$317

63% lower than market

Blood test, thyroid stimulating hormone (TSH)

$155
$229

32% lower than market

Body fluid cell count with cell identification

$70
$100

30% lower than market

Complete blood cell count - automated differential WBC count

$60
$104

42% lower than market

Complete blood cell count - automated test with out Differential

$72
$84

14% lower than market

Creatinine clearance measurement to test for kidney function

$86
$174

51% lower than market

Culture for acid-fast bacilli

$99
$142

30% lower than market

Fungal culture (mold or yeast) of skin, hair, or nail

$53
$69

23% lower than market

Gonadotropin (reproductive hormone) analysis

$52
$87

40% lower than market

Hemoglobin A1C level

$88
$138

36% lower than market

Hemoglobin Measurement

$22
$39

43% lower than market

Liver function blood test panel

$75
$325

77% lower than market

Measurement C-reactive protein

$47
$87

46% lower than market

Microscopic Examination of White Blood Cells with Manual Count

$32
$48

34% lower than market

Coagulation assessment blood test

$55
$84

35% lower than market

Red Blood Cell Concentration Measurement

$22
$44

50% lower than market

Red blood cell sedimentation rate, to detect inflammation; non-automated

$32
$43

26% lower than market

Screening test for Pathogenic Organisms

$40
$68

41% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$30
$62

52% lower than market

Streptoccus

$54
$81

33% lower than market

Troponin (protein) analysis

$90
$147

39% lower than market

Urea nitrogen level to assess kidney function

$36
$55

35% lower than market

Urinalysis with Examination, using Microscope

$29
$53

46% lower than market

Urinalysis, Automated Test

$21
$35

40% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Electronic analysis and programming of implanted simple spinal cord or peripheral neurostimulator ge

$500
$2,391

79% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$52
$155

66% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Epidural Injection Lumbar

$1,345
$1,215

11% higher than market

Epidural Injection Thoracic

$1,292
$1,973

34% lower than market

Injection of anesthetic agent, other peripheral nerve or branch

$960
$2,884

67% lower than market

Injection(s) of joint with fluoroscopy or CT; lumbar or sacral; third and additional levels

$730
$783

7% lower than market

Removal of growth of peripheral nerve

$2,000
$3,661

45% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Injection, Adrenalin, Epinephrine, 0.1 mg

$2
$5

50% lower than market

Injection, Cefazolin Sodium, 500 mg

$4
$19

79% lower than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$1
$2

55% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$13
$18

26% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$8
$21

59% lower than market

Injection, Hydralazine hcl, Up to 20 mg

$17
$53

68% lower than market

Injection, Hydromorphone, Up to 4 mg

$7
$21

68% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$5
$15

70% lower than market

Injection, Lorazepam, 2 mg

$5
$21

77% lower than market

Injection, Morphine Sulfate, up to 10 mg

$10
$21

52% lower than market

Injection, Promethazine HCL, up to 50 mg

$4
$8

47% lower than market

Injection, ciprofloxacin for intravenous infusion, 200 mg

$10
$39

74% lower than market

Injection, diazepam, up to 5 mg

$66
$55

19% higher than market

Injection, meperidine hydrochloride, per 100 mg

$11
$23

51% lower than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$10
$10

2% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Joint device (implantable)

$2,310
$5,509

58% lower than market

Lead, neurostimulator (implantable)

$19,800
$25,121

21% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Alignment of knee joint under anesthesia

$2,500
$2,864

13% lower than market

Anchoring of biceps tendon

$2,000
$5,967

66% lower than market

Aspiration and/or injection: large joint/bursa

$250
$643

61% lower than market

Carpal Tunnel Release

$2,500
$7,346

66% lower than market

Hammer Toe Correction

$1,000
$5,156

81% lower than market

Implantation of nerve end into bone or muscle

$500
$1,505

67% lower than market

Implantation of spinal neurostimulator electrodes

$2,500
$5,884

58% lower than market

Implantation or replacement of programmable spinal canal drug infusion pump

$2,000
$6,440

69% lower than market

Implantation, revision, or repositioning of spinal canal medication catheter

$2,000
$6,548

69% lower than market

Injection of dye for X-ray imaging and/or CT of lower spinal canal

$250
$657

62% lower than market

Injection of dye for X-ray imaging of shoulder joint

$250
$396

37% lower than market

Injection(s) of joint with fluoroscopy or CT; lumbar or sacral; second level

$932
$1,145

19% lower than market

Injection of anesthetic and/or steroid into lower spine nerve root using imaging

$1,402
$1,502

7% lower than market

Insertion of Needle into Vein to Collect Blood

$10
$36

73% lower than market

Insertion of spinal neurostimulator pulse generator or receiver

$2,000
$6,441

69% lower than market

Removal of one knee cartilage using an endoscope

$2,500
$9,604

74% lower than market

Laminectomy

$4,000
$14,877

73% lower than market

Laminectomy with exploration and/or decompression of spinal cord and/or cauda equina, without facetectomy, foraminotomy or discectomy (eg, spinal stenosis), 1 or 2 vertebral segments

$7,000
$15,413

55% lower than market

Laminotomy (hemilaminectomy), single interspace; lumbar

$8,500
$17,070

50% lower than market

Lumbar Joint Injection

$2,263
$1,985

14% higher than market

Lymph node imaging during surgery

$1,000
$4,550

78% lower than market

Partial removal of bone with release of spinal cord or spinal nerves in upper or lower spine

$2,000
$8,381

76% lower than market

Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine

$5,500
$16,855

67% lower than market

Partial removal of breast

$2,500
$4,795

48% lower than market

Partial removal of breast and underarm lymph nodes

$3,000
$11,149

73% lower than market

Partial removal of collar bone

$2,500
$5,775

57% lower than market

Partial removal of collar bone at shoulder using an endoscope

$3,000
$4,866

38% lower than market

Partial removal of spine bone with release of spinal cord and/or nerves

$2,000
$7,568

74% lower than market

Radical excision of bursa, synovia of wrist, or forearm tendon sheaths (eg, tenosynovitis, fungus, Tbc, or other granulomas, rheumatoid arthritis); flexors

$2,500
$3,254

23% lower than market

Release of lower spinal cord and/or nerves

$4,000
$9,677

59% lower than market

Release of shoulder biceps tendon using an endoscope

$1,000
$3,235

69% lower than market

Removal of 1 or more breast growth, open procedure

$2,500
$6,109

59% lower than market

Removal of bone joints between wrist and fingers

$5,500
$5,192

6% higher than market

Removal of both knee cartilages using an endoscope

$4,000
$8,221

51% lower than market

Removal of breast and underarm lymph nodes

$3,000
$9,159

67% lower than market

Removal of deep bone implant

$2,500
$10,397

76% lower than market

Removal of growth of tendon finger or hand

$2,500
$2,772

10% lower than market

Removal of shoulder joint tissue using an endoscope

$2,000
$5,820

66% lower than market

Removal or revision of neurostimulator pulse generator or receiver

$3,000
$7,690

61% lower than market

Repair of knee joint using an endoscope, abrasian arthroplasty

$1,500
$5,047

70% lower than market

Repair of ruptured musculotendinous cuff (eg, rotator cuff) open; chronic

$3,000
$9,971

70% lower than market

Repair of tendon, finger and/or hand

$2,500
$2,800

11% lower than market

Rotator Cuff Repair

$3,000
$8,052

63% lower than market

Shaving of shoulder bone using an endoscope

$2,000
$5,304

62% lower than market

Shoulder scope with debridement

$2,500
$4,948

49% lower than market

Tissue transfer repair of wound (10 sq centimeters or less) of the scalp, arms, and/or legs

$2,000
$5,294

62% lower than market

Total removal of breast

$3,750
$10,358

64% lower than market

Trigger Finger Release

$2,500
$6,048

59% lower than market

Ulnar Nerve Release

$2,000
$8,608

77% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL CHARGES

The following charges reflect our most common x-ray and radiological procedures. For all exams requiring contrast, the contrast will be charged separately.

Description

Our Charge
Market Charge

Variance

CT Arm with Contrast

$1,046
$1,894

45% lower than market

CT Arm without Contrast

$1,246
$1,744

29% lower than market

CT Head Brain without Contrast

$798
$2,268

65% lower than market

CT Leg without Contrast

$798
$1,429

44% lower than market

CT Spine Cervical with Contrast

$1,046
$2,029

48% lower than market

CT Spine Cervical without Contrast

$798
$2,035

61% lower than market

CT Spine Lumbar with Contrast

$1,046
$2,259

54% lower than market

CT Spine Lumbar without Contrast

$798
$2,137

63% lower than market

Chest X-Ray; Single View

$133
$231

42% lower than market

Fluoroscopic guidance for insertion of needle

$178
$920

81% lower than market

Imaging guidance for procedure, up to 1 hour

$178
$448

60% lower than market

MRI Arm Joint without Contrast

$1,650
$3,160

48% lower than market

MRI Brain with and without Conrast

$2,050
$5,355

62% lower than market

MRI Brain without Contrast

$1,650
$3,914

58% lower than market

MRI Leg Joint with and without Contrast

$2,050
$3,344

39% lower than market

MRI Leg Joint without Contrast

$1,650
$2,608

37% lower than market

MRI Spine Cervical without Contrast

$1,650
$2,858

42% lower than market

MRI Spine Lumbar with and without Contrast

$2,050
$4,033

49% lower than market

MRI Spine Lumbar without Contrast

$1,650
$2,886

43% lower than market

MRI Spine Thoracic without Contrast

$1,650
$2,866

42% lower than market

Radiological supervision and interpretation X-ray of shoulder joint

$300
$776

61% lower than market

Ultrasound Guidance for Insertion of Needle

$288
$518

44% lower than market

Ultrasound Veins of One Arm or Leg

$375
$648

42% lower than market

Ultrasound study of arteries and arterial grafts of one arm or limited

$375
$357

5% higher than market

X-Ray Hip and Pelvis, 2 Views

$178
$243

27% lower than market

X-Ray Knee, 1-2 Views

$213
$301

29% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$178
$353

50% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$178
$474

62% lower than market

X-Ray Neck Spine, 2-3 Views

$178
$333

46% lower than market

X-Ray Pelvis, 1-2 Views

$178
$277

36% lower than market

X-Ray Upper Spine, 4-5 Views

$178
$435

59% lower than market

X-ray of spine, 1 view

$178
$293

39% lower than market

INPATIENT NEUROSURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Back and neck procedure except spinal fusion with complications

$19,990
$46,478

57% lower than market

Back and neck procedure except spinal fusion without complications

$13,387
$34,555

61% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Cervical spinal fusion with complications

$34,280
$69,991

51% lower than market

Cervical spinal fusion without complications

$29,842
$60,671

51% lower than market

Knee procedures without pdx of infection without complications

$20,631
$33,004

37% lower than market

Local excision & removal int fix devices exc hip & femur without complications

$18,687
$38,296

51% lower than market

Other musculoskelet system & connective tissue O.R. procedure without complications

$14,444
$39,994

64% lower than market

Revision of hip or knee replacement with complications

$59,946
$78,243

23% lower than market

Soft tissue procedures without complications

$14,456
$30,714

53% lower than market

Spinal fusion other than the neck without major complications

$49,267
$78,034

37% lower than market

Total Knee or Hip Replacement

$39,293
$48,238

19% lower than market

Total Knee or Hip Revision

$61,327
$66,305

8% lower than market

Total Shoulder Replacement

$54,925
$51,622

6% higher than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Arkansas Surgical Hospital for your healthcare needs. At Arkansas Surgical Hospital, we are committed to making the billing process as patient-friendly as possible. Here are some ways you can help the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we will ask for a photo ID. If you have been seen at Arkansas Surgical Hospital, let us know if your personal information or insurance information has changed since your last visit.

• Please understand and follow the requirements of your health plan.

Be sure to know your benefits, obtain proper authorization for services and submit referral claim forms if necessary.Many insurance plans require patients to pay a co-pay, deductible and/or co-insurance amount. You are responsible for paying co-payments, deductibles and/or co-insurance required by your insurance provider and Arkansas Surgical Hospital is responsible for collection of them. Please prepare to pay in advance or at the time of your appointment for any co-payment, deductible and/or co-insurance payments.

• Please respond promptly to any requests from your insurance provider.

You may receive multiple bills for your hospital visit, including your family doctor, specialists, physicians to read x-rays, give anesthesia, or do blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Arkansas Surgical Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.

Questions about Price and Billing Information

Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.

To ask questions or get more information about a bill for services you've received, please contact our Customer Call Center at (501) 748-8000.

If you need more information about the price of a future service, please contact our Price Hotline at (501) 748-8000. A CPT code is strongly encouraged when you call. You can obtain the CPT code from the ordering physician.

Online Payment, Registration, & Scheduling

For the convenience of our patients, a number of online services are available at https://www.arksurgicalhospital.com. Arkansas Surgical Hospital offers secure online payment.

Arkansas Surgical Hospital will contact you 5-10 business days after your Surgeons or Provider has scheduled your surgery, test or procedure to complete the pre-registration process. In doing the pre-registration process, it will elevate time during the admission processes the day of you visit.