Patient Price Information List

Disclaimer: Bear Lake Memorial 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, Bear Lake Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 9/30/2019. Bear Lake Memorial Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Bingham Memorial Hospital

Blackfoot

ID

Cache Valley Hospital North

Logan

UT

Caribou Memorial Hospital

Soda Springs

ID

Cassia Regional Medical Center

Burley

ID

Eastern Idaho Reg Med Ctr

Idaho Falls

ID

Franklin County Medical Center

Preston

ID

LDS Hospital

Murray

UT

Logan Regional Hospital

Logan

UT

Madison Memorial Hospital

Rexburg

ID

Minidoka Memorial Hospital

Rupert

ID

Ogden Regional Medical Center

Ogden

UT

Portneuf Medical Center

Pocatello

ID

Primary Childrens Medical Center

Salt Lake City

UT

Star Valley Medical Center

Afton

WY

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,339
$2,324

42% lower than market

Semi-Private Room

$1,339
$2,370

44% lower than market

Intensive Care Unit

$2,294
$4,470

49% lower than market

Coronary Care Unit

$2,249
$6,845

67% 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

$127
$251

49% lower than market

Emergency Department Visit - Level 2

$384
$445

14% lower than market

Emergency Department Visit - Level 3

$567
$773

27% lower than market

Emergency Department Visit - Level 4

$1,085
$1,197

9% lower than market

Emergency Department Visit - Level 5

$1,477
$1,971

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

$95
$83

14% higher than market

PT Evaluation - Moderate Complexity

$211
$231

9% lower than market

Physical Therapy Exercise, 15 Minutes

$107
$82

31% higher than market

Physical Therapy, standard evaluation - 20 minutes

$184
$192

5% 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

Occupational Therapy, standard evaluation - 30 minutes

$209
$202

3% 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

$179
$203

12% lower than market

Spirometry - medicated breathing procedure

$305
$432

30% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Swallow Treatment

$260
$239

9% higher 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

Alcohols

$111
$110

1% higher than market

Bacterial Blood Culture

$128
$135

6% lower than market

Bacterial Culture for Aerobic Isolates

$65
$72

9% lower than market

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

$114
$115

Approximately equal to market

Bacterial urine culture

$78
$87

11% lower than market

Bacterial urine culture; quantitative colony count

$81
$71

14% higher than market

Blood Typing, ABO

$54
$48

12% higher than market

Blood Typing, Rh (D)

$40
$43

7% lower than market

Blood Unit Compatibility Test; Antiglobulin Technique

$196
$229

14% lower than market

Blood creatinine level

$53
$52

2% higher than market

Blood test, basic group of blood chemicals

$91
$80

14% higher than market

Blood test, clotting time

$58
$48

21% higher than market

Blood test, comprehensive group of blood chemicals

$155
$110

40% higher than market

Blood test, lipids (cholesterol and triglycerides)

$96
$103

7% lower than market

Blood test, thyroid stimulating hormone (TSH)

$79
$114

31% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$144
$138

4% higher than market

Complete blood cell count - automated differential WBC count

$89
$70

27% higher than market

COVID-19 test

$64
$64

Approximately equal to market

Creatine kinase level (cardiac enzyme) - Muscle/Brain

$128
$122

5% higher than market

Cyanocobalamin (vitamin B-12) level

$130
$120

8% higher than market

Detection test for clostridium difficile toxins (stool pathogen)

$65
$97

33% lower than market

Detection test for multiple types influenza virus

$124
$247

50% lower than market

Drug Test(s) by Chemistry Analyzer

$374
$311

20% higher than market

Ferritin (blood protein) level

$74
$113

34% lower than market

Folic acid; serum

$110
$105

5% higher than market

Hemoglobin A1C level

$99
$88

12% higher than market

Hemoglobin Measurement

$25
$33

25% lower than market

Hepatitis C Antibody Measurement

$120
$123

3% lower than market

Iron Binding Capacity

$86
$72

19% higher than market

Iron level

$42
$62

33% lower than market

Kidney Function Blood Test Panel

$114
$99

15% higher than market

Lactic acid level

$65
$110

41% lower than market

Lipase (fat enzyme) level

$94
$79

19% higher than market

Liver function blood test panel

$111
$90

24% higher than market

Magnesium Level

$65
$66

2% lower than market

Manual urinalysis test with examination using microscope

$58
$39

48% higher than market

Microscopic Examination of White Blood Cells with Manual Count

$41
$55

26% lower than market

PSA (prostate specific antigen) measurement

$125
$119

5% higher than market

PSA Measurement; Free

$165
$129

28% higher than market

Parathormone

$125
$192

35% lower than market

Coagulation assessment blood test

$85
$61

40% higher than market

Phosphate level

$52
$47

11% higher than market

Prostate Cancer Screening Test

$25
$110

77% lower than market

Red Blood Cell Concentration Measurement

$30
$30

3% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$657
$635

3% higher than market

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

$63
$55

13% higher than market

Screening Test for Red Blood Cell Antibodies

$101
$92

10% higher than market

Special Stain for Microorganism; Gram or Glemsa Stain

$71
$59

19% higher than market

Stool analysis for blood

$48
$83

43% lower than market

Testosterone (hormone) level

$120
$154

22% lower than market

Troponin (protein) analysis

$128
$124

3% higher than market

Uric acid level, blood

$54
$45

19% higher than market

Urinalysis, Manual Test

$62
$33

89% higher than market

Urine microalbumin (protein) level

$34
$78

57% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Application of blood vessel compression or decompression device to 1 or more areas

$92
$90

2% higher than market

Application of mechanical traction to 1 or more areas

$62
$64

3% lower than market

Hydration Infusion into a Vein

$105
$174

40% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$420
$378

11% higher than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$219
$220

1% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$112
$152

27% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$392
$421

7% lower than market

Infusion of chemotherapy into a vein

$163
$237

31% lower than market

Infusion of different chemotherapy drug or substance into a vein up to 1 hour

$222
$208

7% higher than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$98
$117

16% lower than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session

$151
$232

35% lower than market

Sleep Monitoring with CPAP

$3,316
$4,044

18% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab

$3,016
$3,641

17% lower than market

Unattended sleep study with recording of heart rate, oxygen, respiratory airflow and effort

$677
$576

17% higher than market

Vein Infusion for Therapy, Prevention or Diagnosis, Concurrent with Another Infusion

$110
$238

54% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital observation care discharge

$184
$155

19% higher than market

Hospital observation care typically 50 minutes

$306
$287

7% higher than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Anesthesia for lower abdominal hernia repair

$212
$503

58% lower than market

Anesthesia for open or endoscopic procedure on elbow

$212
$236

10% lower than market

Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified

$212
$178

19% higher than market

Anesthesia for vaginal biopsy of cervix, uterine lining, or external genitalia

$212
$245

14% lower than market

Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domic

$324
$364

11% lower than market

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)

$62
$89

31% lower than market

External EKG recording for more than 48 hours up to 21 days

$90
$344

74% lower than market

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

$642
$853

25% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Chemotherapy Infustion - Up to 1 Hour

$526
$641

18% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$211
$206

2% higher than market

Injection, fosaprepitant, 1 mg

$7
$7

1% higher than market

Injection, irinotecan, 20 mg

$55
$49

12% higher than market

Injection, oxaliplatin, 0.5 mg

$1
$3

74% lower than market

OUTPATIENT RESPIRATORY THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Nebulizer Treatment

$121
$141

14% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Technetium tc-99m sestamibi, diagnostic, per study dose

$636
$620

3% higher than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Biopsy of Large Bowel, Using an Endoscope

$1,548
$2,160

28% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$1,211
$2,006

40% lower than market

Colonscopy

$1,548
$1,993

22% lower than market

Destruction of lower or sacral spinal facet joint nerves using imaging guidance

$2,092
$5,447

62% lower than market

Destruction of lower or sacral spinal facet joint nerves with imaging guidance

$1,082
$2,019

46% lower than market

Epidural Injection Lumbar

$601
$1,578

62% lower than market

Epidural Injection Thoracic

$601
$1,684

64% lower than market

Injection procedure into sacroiliac joint for anesthetic or steroid

$421
$1,128

63% lower than market

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

$639
$1,089

41% lower than market

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, each additional level

$342
$1,405

76% lower than market

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

$601
$1,694

65% lower than market

Injection of substance into spinal canal or lower back using imaging

$601
$1,663

64% lower than market

Insertion of Central Venous Catheter for Infusion

$1,324
$2,306

43% lower than market

Insertion of Indwelling Bladder Catheter

$193
$326

41% lower than market

Insertion of Needle into Vein to Collect Blood

$25
$24

4% higher than market

Lumbar Joint Injection

$642
$2,196

71% lower than market

Removal of Polyps in Large Bowel, Using an Endoscope

$1,763
$1,894

7% lower than market

Removal of deep bone implant

$4,620
$6,144

25% lower than market

Repair of groin hernia patient age 5 years or older

$1,912
$5,689

66% lower than market

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

$290
$475

39% lower than market

Ultrasound measurement of bladder capacity after voiding

$188
$288

35% 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 Abdomen & Pelvis with Contrast

$2,870
$2,603

10% higher than market

CT Abdomen & Pelvis without Contrast

$2,274
$2,046

11% higher than market

CT Angiogram Chest with and without Contrast

$1,880
$1,967

4% lower than market

CT Chest with Contrast

$1,754
$1,726

2% higher than market

CT Chest without Contrast

$1,537
$1,318

17% higher than market

CT Face without Contrast

$1,349
$1,217

11% higher than market

CT Head Brain without Contrast

$1,187
$1,206

2% lower than market

CT Pelvis with Contrast

$1,475
$1,693

13% lower than market

CT Spine Cervical without Contrast

$1,421
$1,466

3% lower than market

Chest X-Ray; 2 Views

$295
$265

11% higher than market

Chest X-Ray; Single View

$243
$221

10% higher than market

Diagnostic mammography, bilateral

$476
$396

20% higher than market

Diagnostic mammography, unilateral

$403
$311

30% higher than market

Imaging guidance for procedure, up to 1 hour

$361
$566

36% lower than market

Imaging of Abdomen; 2 Views

$296
$314

6% lower than market

MRI Brain with and without Conrast

$2,785
$3,363

17% lower than market

MRI Brain without Contrast

$2,534
$2,109

20% higher than market

MRI Leg Joint without Contrast

$1,728
$1,744

1% lower than market

MRI Spine Cervical without Contrast

$2,171
$2,176

Approximately equal to market

MRI Spine Lumbar without Contrast

$2,171
$2,090

4% higher than market

Myocardial Perfusion, Tomographic

$3,048
$3,630

16% lower than market

Screening Mammography, Bilateral, with CAD

$397
$318

25% higher than market

Screening digital breast tomosynthesis, bilateral

$41
$78

47% lower than market

Ultrasound Abdomen - Complete

$759
$674

12% higher than market

Ultrasound Behind Abdominal Cavity - Complete

$703
$589

19% higher than market

Ultrasound Heart

$1,408
$1,681

16% lower than market

Ultrasound Pelvis through Vagina

$414
$586

29% lower than market

Ultrasound Pregnant Uterus > 14 Weeks Pregnant

$673
$621

8% higher than market

Ultrasound guidance for accessing into blood vessel

$212
$365

42% lower than market

X-Ray Ankle, 3 Views

$268
$306

13% lower than market

X-Ray Elbow, 3 Views

$296
$316

7% lower than market

X-Ray Femus, 2 Views

$265
$245

8% higher than market

X-Ray Fingers, 2 Views

$248
$228

8% higher than market

X-Ray Foot, 3 Views

$333
$294

13% higher than market

X-Ray Hip and Pelvis, 2 Views

$315
$346

9% lower than market

X-Ray Knee, 1-2 Views

$281
$254

11% higher than market

X-Ray Knee, 3 Views

$328
$331

1% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$321
$362

11% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$591
$498

19% higher than market

X-Ray Middle Spine, 3 Views

$372
$308

21% higher than market

X-Ray Neck Spine, 2-3 Views

$266
$323

18% lower than market

X-Ray Pelvis, 1-2 Views

$312
$291

7% higher than market

X-Ray Pelvis, 3 Views

$355
$365

3% lower than market

X-Ray Ribs One Side, 2 Views

$281
$283

1% lower than market

X-Ray Shoulder, 2 Views

$351
$345

2% higher than market

X-Ray Wrist, 3 Views

$333
$315

6% higher than market

X-ray Ribs One Side, Minimum 3 Views

$400
$359

11% higher than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Total Knee or Hip Replacement

$49,803
$50,009

Approximately equal to market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Pneumonia with complications

$15,017
$18,404

18% lower than market

BASES AND INFORMATION

How You Can Help

Thank you for choosing Bear Lake Memorial Hospital for your healthcare needs. As part of our commitment to delivering EXCELLENT service, we want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Bear Lake Memorial 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-payment or deductible amount. You are responsible for paying co-payments required by your insurance provider and Bear Lake Memorial Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.

• 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 Bear Lake Memorial 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 (208) 847-4428.

If you need more information about the price of a future service, please contact our Price Hotline at (208) 847-4428 . 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 http://www.blmhospital.com/. Bear Lake Memorial Hospital offers secure online payment.

Bear Lake Memorial Hospital also offers pre-registration and appointment requests through a secure online form at http://www.blmhospital.com/. Patients may pre-register for surgeries, admissions, outpatient procedures and tests at least three business days in advance. Patients may also pre-register for maternity services up to three months prior to their expected delivery date.

Financial Assistance

We are pleased to offer financial assistance to patients with limited resources and inadequate medical insurance coverage. Eligibility is determined by total family income/assets. The patient must agree to apply for other assistance available to pay hospital charges (Medicaid, Medicare, private insurance) before being discharged.

Bear Lake Memorial Hospital's Charity Care Policy

Bear Lake Memorial Hospital provides high quality care to everyone, regardless of their ability to pay.

Bear Lake Memorial Hospital's charity care policy includes:

• Substantial charity care guidelines that provide free care for individuals and families who earn less than 200 percent of the federal poverty level.

• Sliding scale fees to provide substantially discounted care for individuals and families who are between 200 and 400 percent of the federal poverty level.

• Hardship policy for those patients who would not otherwise qualify for charity care but have unique circumstances.

In many cases, Bear Lake Memorial Hospital offers interest free loans for up to one year to assist patients.

For more information, please contact our Customer Call Center at (208) 847-4428.