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 3/31/18. 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
$1,130

34% 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
$311

5% higher than market

Emergency Department Visit - Level 2

$500
$371

35% higher than market

Emergency Department Visit - Level 3

$700
$671

4% higher than market

Emergency Department Visit - Level 4

$1,000
$1,157

14% 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

Antibody Screen

$101
$309

67% lower than market

Automated white blood cell count

$23
$27

15% lower than market

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

$79
$219

64% lower than market

Bacterial Culture, Any Source Blood

$81
$135

40% lower than market

Bacterial urine culture; quantitative colony count

$74
$54

37% higher than market

Bacterial urine culture; isolation and identification of each isolate

$75
$169

56% lower than market

Basic Metabolic Panel

$78
$163

52% lower than market

Blood Typing, ABO

$28
$97

71% lower than market

Blood Typing, Rh (D)

$66
$73

9% lower than market

Body fluid cell count with cell identification

$70
$103

32% lower than market

Complete Blood Count

$72
$78

8% lower than market

Complete Blood Count/Differential

$60
$94

36% lower than market

Comprehensive Metabolic Panel

$97
$215

55% lower than market

Creatine Kinase

$60
$102

41% lower than market

Creatine Kinase Level

$106
$125

15% lower than market

Creatinine clearance measurement to test for kidney function

$86
$155

45% lower than market

Crystal identification from tissue or body fluid

$67
$87

23% lower than market

Culture for acid-fast bacilli

$99
$137

28% lower than market

Cyanocobalamin (Vitamin B-12)

$139
$124

12% higher than market

Electrolyte Panel

$65
$147

56% lower than market

Glucose Level on Body Fluid

$37
$47

21% lower than market

Gonadotropin Analysis

$52
$111

53% lower than market

Hemoglobin A1c

$88
$101

13% lower than market

Hemoglobin Measurement

$22
$36

39% lower than market

Lipid Panel

$117
$160

27% lower than market

Liver Panel

$75
$431

83% lower than market

Measurement C-reactive protein

$47
$89

47% lower than market

Microscopic Examination of White Blood Cells with Manual Count

$32
$36

12% lower than market

Partial Thromblostatin Time, Activated

$55
$70

21% lower than market

Prothrombin Time

$37
$38

3% lower than market

Red Blood Cell Concentration Measurement

$22
$49

55% lower than market

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

$49
$90

45% lower than market

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

$32
$36

11% lower than market

Screening Test for Red Blood Cell Antibodies

$40
$108

63% lower than market

Screening test for Pathogenic Organisms

$40
$47

14% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$30
$62

51% lower than market

Streptoccus

$54
$78

31% lower than market

Thyroid Stimulating Hormone (TSH)

$155
$236

34% lower than market

Thyroxine Measurement

$45
$105

57% lower than market

Troponin

$90
$149

40% lower than market

Urea Nitrogren

$36
$50

27% lower than market

Uric Acid Level, Blood

$57
$83

31% lower than market

Urinalysis with Examination, using Microscope

$29
$53

45% lower than market

Urinalysis, Automated Test

$21
$28

24% lower than market

Urine Pregnancy Test

$44
$57

23% lower than market

Vancomycin Level

$125
$127

2% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Injection, Adrenalin, Epinephrine, 0.1 mg

$1
$2

48% lower than market

Injection, Cefazolin Sodium, 500 mg

$4
$19

79% lower than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$3
$2

30% higher than market

Injection, Diphenhydramine HCL, up to 50 mg

$13
$15

10% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$8
$16

50% lower than market

Injection, Hydralazine hcl, Up to 20 mg

$21
$53

60% lower than market

Injection, Hydromorphone, Up to 4 mg

$7
$14

51% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$12
$9

28% higher than market

Injection, Levofloxacin, 250 mg

$14
$36

60% lower than market

Injection, Lorazepam, 2 mg

$4
$16

78% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$5
$10

47% lower than market

Injection, Midazolam Hydrochloride, per 1 mg

$2
$6

72% lower than market

Injection, Morphine Sulfate, up to 10 mg

$9
$15

40% lower than market

Injection, Ondansetron Hydrochloride, per 1 mg

$1
$4

70% lower than market

Injection, Promethazine HCL, up to 50 mg

$4
$18

77% lower than market

Injection, Vancomycin HCL, 500 mg

$10
$37

73% lower than market

Injection, hydrocortisone sodium succinate, up to 100 mg

$65
$45

42% higher than market

Injection, meperidine hydrochloride, per 100 mg

$10
$15

33% lower than market

Injection, naloxone hydrochloride, per 1 mg

$76
$50

53% higher than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$11
$11

Approximately equal to market

Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg

$33
$28

17% higher than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Aspiration and/or injection: small joint/bursa

$470
$1,984

76% lower than market

Aspiration and/or injection: large joint/bursa

$250
$405

38% lower than market

Correction of toe joint deformity

$1,000
$1,807

45% lower than market

Extensive removal of shoulder joint tissue using an endoscope

$2,000
$5,500

64% lower than market

Incision of tendon covering

$2,500
$4,066

39% lower than market

Injection of dye for X-ray imaging of shoulder joint

$250
$331

25% lower than market

Injection(s) of diagnostic or therapeutic substance(s)

$1,292
$1,217

6% higher than market

Injection(s) of diagnostic or therapeutic substance(s), w/o neurolytic substances, with imaging guidance

$1,345
$1,176

14% higher than market

Insertion of Central Venous Catheter for Infusion

$100
$2,200

95% lower than market

Insertion of Needle into Vein to Collect Blood

$10
$45

78% lower than market

Insertion of spinal neurostimulator pulse generator or receiver

$2,000
$3,163

37% lower than market

Joint procedure using an endoscope

$2,000
$2,758

27% lower than market

Open treatment of broken of lower forearm bone or growth plate separation with insertion of hardware

$2,500
$10,359

76% 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

$8,500
$8,832

4% lower than market

Laminectomy with exploration and/or decompression of spinal cord, 1 or 2 vertebral segments; thoracic

$1,750
$1,750

Approximately equal to market

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

$4,000
$8,564

53% lower than market

Partial removal of breast

$2,500
$5,325

53% lower than market

Partial removal of collar bone at shoulder using an endoscope

$2,500
$2,787

10% lower than market

Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [eg, spinal or lateral recess stenosis]), single vertebral segment; lumbar

$2,750
$12,321

78% lower than market

Laminotomy (hemilaminectomy), single interspace; lumbar

$5,500
$10,910

50% lower than market

Release and/or relocation of median nerve of hand

$2,500
$4,856

49% lower than market

Release and/or relocation of ulnar nerve at elbow

$2,000
$5,740

65% lower than market

Removal of 1 or more breast growth, open procedure

$2,500
$3,573

30% lower than market

Removal of both knee cartilages using an endoscope

$4,000
$4,918

19% lower than market

Removal of breast growth, open procedure

$2,500
$3,379

26% lower than market

Removal of deep bone implant

$2,750
$7,064

61% lower than market

Repair of anterior cruciate ligament of knee with assistance of an endoscope

$2,750
$2,750

Approximately equal to market

Repair of shoulder rotator cuff using an endoscope

$2,750
$6,912

60% lower than market

Shaving of shoulder bone using an endoscope

$2,750
$4,429

38% lower than market

Simple wound repair of scalp, neck, external genitalia; 2.5 cm or less

$275
$403

32% 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

Ultrasound Veins of One Arm or Leg

$510
$720

29% lower than market

CT Arm with Contrast

$1,046
$1,132

8% lower than market

CT Arm without Contrast

$1,246
$1,612

23% lower than market

CT Chest without Contrast

$798
$1,805

56% lower than market

CT Head Brain without Contrast

$798
$2,225

64% lower than market

CT Leg without Contrast

$798
$1,275

37% lower than market

CT Pelvis without Contrast

$798
$1,443

45% lower than market

CT Spine Cervical without Contrast

$798
$1,760

55% lower than market

CT Spine Lumbar with Contrast

$1,046
$2,051

49% lower than market

CT Spine Lumbar without Contrast

$798
$1,953

59% lower than market

CT Spine Thoracic without Contrast

$798
$1,755

55% lower than market

Chest X-Ray; 2 Views

$178
$172

3% higher than market

Chest X-Ray; Single View

$133
$202

34% lower than market

Fluoroscopic guidance for insertion of needle

$178
$454

61% lower than market

Fluoroscopic guidance for spine or spinal canal injection

$178
$372

52% lower than market

Imaging guidance for procedure, up to 1 hour

$178
$385

54% lower than market

MRA Head without Contrast

$1,650
$2,323

29% lower than market

MRI Arm Joint without Contrast

$1,650
$2,232

26% lower than market

MRI Brain with and without Conrast

$2,050
$4,373

53% lower than market

MRI Brain without Contrast

$1,650
$3,382

51% lower than market

MRI Leg Joint with and without Contrast

$2,050
$2,194

7% lower than market

MRI Leg Joint without Contrast

$1,650
$1,905

13% lower than market

MRI Pelvis without Contrast

$1,650
$1,500

10% higher than market

MRI Spin Lumbar with and without Contrast

$2,050
$2,670

23% lower than market

MRI Spine Cervical with and without Contrast

$2,050
$2,895

29% lower than market

MRI Spine Cervical without Contrast

$1,650
$2,058

20% lower than market

MRI Spine Lumbar without Contrast

$1,650
$2,159

24% lower than market

MRI Spine Thoracic with and without Contrast

$2,050
$3,204

36% lower than market

MRI Spine Thoracic without Contrast

$1,650
$1,882

12% lower than market

Ultrasound Guidance for Insertion of Needle

$288
$435

34% lower than market

X-Ray Ankle, 3 Views

$178
$320

44% lower than market

X-Ray Elbow, 2 Views

$178
$215

17% lower than market

X-Ray Hip and Pelvis, 2 Views

$178
$160

11% higher than market

X-Ray Knee, 1-2 Views

$213
$265

19% lower than market

X-Ray Knee, 3 Views

$213
$177

20% higher than market

X-Ray Lower Sacral Spine, 2-3 Views

$178
$312

43% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$178
$418

57% lower than market

X-Ray Middle Spine, 3 Views

$178
$252

29% lower than market

X-Ray Neck Spine, 2-3 Views

$178
$284

37% lower than market

X-Ray Upper Spine, 4-5 Views

$178
$423

58% lower than market

X-Ray Wrist, 3 Views

$250
$275

9% lower than market

X-ray of spine, 1 view

$178
$292

39% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Breast biopsy, local excision & other breast procedures without complications

$13,422
$27,406

51% lower than market

Wnd debrid & skn grft exc hand, for musculo-conn tiss dis with complications

$35,407
$52,310

32% lower than market

INPATIENT NEUROSURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Back and neck procedure except spinal fusion with complications

$16,815
$48,291

65% lower than market

Back and neck procedure except spinal fusion without complications

$13,749
$32,579

58% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Cervical spinal fusion with complications

$31,520
$69,241

54% lower than market

Cervical spinal fusion without complications

$30,047
$55,568

46% lower than market

Foot procedures with complications

$25,844
$30,985

17% lower than market

Hip & femur procedures except major joint with complications

$28,558
$41,211

31% lower than market

Hip & femur procedures except major joint without complications

$23,910
$33,926

30% lower than market

Knee or Hip replacement without major complications

$39,315
$40,639

3% lower than market

Knee procedures without pdx of infection with major complications

$23,394
$49,511

53% lower than market

Knee procedures without pdx of infection without complications

$20,929
$31,734

34% lower than market

Major joint & limb reattachment procedure of upper extremity with major complications

$52,444
$48,923

7% higher than market

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

$17,021
$36,393

53% lower than market

Revision of hip or knee replacement with complications

$79,532
$65,301

22% higher than market

Revision of hip or knee replacement without complications

$68,612
$53,303

29% higher than market

Spinal fusion other than the neck without major complications

$45,330
$86,451

48% lower 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.