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 6/30/2021. 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

Intermountain Medical Center

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

$1,379
$2,272

39% lower than market

Semi-Private Room

$1,379
$2,290

40% lower than market

Intensive Care Unit

$2,339
$4,754

51% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]

$673
$598

12% higher than market

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43239]

$921
$1,979

53% lower than market

Biopsy of the large bowel using an endoscope (colonoscopy) [CPT 45380]

$971
$2,479

61% lower than market

Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]

$96
$87

9% higher than market

Blood test, clotting time [CPT 85610]

$61
$50

22% higher than market

Blood test, comprehensive group of blood chemicals [CPT 80053]

$161
$121

33% higher than market

Blood test, lipids (cholesterol and triglycerides) [CPT 80061]

$101
$110

9% lower than market

Blood test, thyroid stimulating hormone (TSH) [CPT 84443]

$83
$122

32% lower than market

CT scan head or brain [CPT 70450]

$1,187
$1,298

9% lower than market

CT scan of abdomen and pelvis with contrast [CPT 74177]

$2,870
$2,682

7% higher than market

CT scan pelvis with contrast [CPT 72193]

$1,475
$1,795

18% lower than market

Coagulation assessment blood test, plasma or whole blood [CPT 85730]

$89
$69

29% higher than market

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]

$94
$72

30% higher than market

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43235]

$783
$1,506

48% lower than market

Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk [CPT 45378]

$1,003
$1,864

46% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$476
$425

12% higher than market

Diagnostic mammography of one breast [CPT 77065]

$403
$323

25% higher than market

Group psychotherapy [CPT 90853]

$112
$399

72% lower than market

Injection of substance into spinal canal of lower back or sacrum [CPT 62322]

$631
$4,151

85% lower than market

Injection of substance into spinal canal of lower back or sacrum using imaging guidance [CPT 62323]

$631
$1,645

62% lower than market

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level [CPT 64483]

$750
$2,084

64% lower than market

Kidney function blood test panel [CPT 80069]

$119
$104

15% higher than market

Liver function blood test panel [CPT 80076]

$116
$95

22% higher than market

MRI scan of brain before and after contrast [CPT 70553]

$2,785
$3,544

21% lower than market

MRI scan of leg joint [CPT 73721]

$1,728
$1,823

5% lower than market

MRI scan of lower spinal canal [CPT 72148]

$2,171
$2,272

4% lower than market

Manual urinalysis test with examination using microscope, non-automated [CPT 81000]

$61
$41

48% higher than market

PSA (prostate specific antigen) measurement, free [CPT 84154]

$172
$133

29% higher than market

PSA (prostate specific antigen) measurement, total [CPT 84153]

$130
$125

4% higher than market

Psychotherapy, 30 minutes [CPT 90832]

$119
$87

36% higher than market

Psychotherapy, 45 minutes [CPT 90834]

$213
$339

37% lower than market

Psychotherapy, 60 minutes [CPT 90837]

$255
$638

60% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$3,512
$8,159

57% lower than market

Removal of one knee cartilage using an endoscope [CPT 29881]

$1,597
$5,649

72% lower than market

Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare [CPT 45385]

$1,799
$2,424

26% lower than market

Repair of groin hernia patient age 5 years or older [CPT 49505]

$1,950
$6,856

72% lower than market

Screening mammography of both breasts [CPT 77067]

$397
$343

16% higher than market

Shaving of shoulder bone using an endoscope [CPT 29826]

$2,223
$5,861

62% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab [CPT 95810]

$3,076
$3,691

17% lower than market

Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes [CPT 97110]

$107
$81

32% higher than market

Ultrasound of abdomen, complete [CPT 76700]

$759
$689

10% higher than market

Ultrasound pelvis through vagina [CPT 76830]

$414
$632

35% lower than market

X-ray of lower and sacral spine, minimum of 4 views [CPT 72110]

$591
$513

15% higher than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

Critical care delivery critically ill or injured patient [CPT 99292]

$676
$1,344

50% lower than market

Critical care delivery critically ill or injured patient, first 30-74 minutes [CPT 99291]

$1,811
$3,756

52% lower than market

Emergency department visit, low to moderately severe problem [CPT 99282]

$403
$510

21% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$596
$899

34% lower than market

Emergency department visit, problem of high severity [CPT 99284]

$1,117
$1,453

23% lower than market

Emergency department visit, problem with significant threat to life or function [CPT 99285]

$1,522
$2,130

29% lower than market

Emergency department visit, self limited or minor problem [CPT 99281]

$135
$283

53% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THE

Description

Our Charge
Market Charge

Variance

Application of electrical stimulation to 1 or more areas, each 15 minutes [CPT 97032]

$71
$78

9% lower than market

Application of hot wax bath to 1 or more areas [CPT 97018]

$60
$69

13% lower than market

Evaluation of occupational therapy established plan of care, typically 60 minutes [CPT 97167]

$261
$355

27% lower than market

Evaluation of occupational therapy, typically 30 minutes [CPT 97165]

$209
$215

3% lower than market

Evaluation of occupational therapy, typically 45 minutes [CPT 97166]

$233
$254

8% lower than market

Evaluation of physical therapy, typically 20 minutes [CPT 97161]

$184
$194

5% lower than market

Evaluation of physical therapy, typically 30 minutes [CPT 97162]

$211
$236

11% lower than market

Evaluation of physical therapy, typically 45 minutes [CPT 97163]

$236
$266

11% lower than market

Re-evaluation of occupational therapy established plan of care, typically 30 minutes [CPT 97168]

$209
$207

Approximately equal to market

Walking training to 1 or more areas, each 15 minutes [CPT 97116]

$95
$86

10% higher than market

Evaluation of speech sound production [CPT 92522]

$232
$286

19% lower than market

Evaluation of speech sound production with evaluation of language comprehension and expression [CPT 92523]

$472
$432

9% higher than market

Evaluation of swallowing function [CPT 92610]

$260
$367

29% lower than market

Treatment of speech, language, voice, communication, and/or hearing processing disorder [CPT 92507]

$240
$254

6% lower than market

Treatment of swallowing and/or oral feeding function [CPT 92526]

$260
$279

7% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device [CPT 94664]

$112
$260

57% lower than market

Heart rhythm tracing of 48-hour EKG [CPT 93225]

$94
$316

70% lower than market

Initiation and management of continued pressured respiratory assistance by mask or breathing tube [CPT 94660]

$434
$603

28% lower than market

Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration [CPT 94060]

$305
$432

29% lower than market

Measurement and graphic recording of total and timed exhaled air capacity [CPT 94010]

$107
$189

44% lower than market

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$186
$206

10% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Measurement of oxygen saturation in blood using ear or finger device [CPT 94760]

$78
$75

4% higher than market

Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen [CPT 94640]

$129
$147

13% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

3D radiographic procedure [CPT 76376]

$266
$527

50% lower than market

Abdominal ultrasound of pregnant uterus (less than 14 weeks 0 days) single or first fetus [CPT 76801]

$181
$657

73% lower than market

Acute digestive tract blood loss imaging [CPT 78278]

$1,489
$1,476

1% higher than market

Bone and/or joint imaging [CPT 78300]

$1,075
$1,591

32% lower than market

Bone and/or joint imaging, 3 phase study [CPT 78315]

$1,688
$1,914

12% lower than market

Bone and/or joint imaging, whole body [CPT 78306]

$1,520
$1,596

5% lower than market

Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]

$243
$413

41% lower than market

Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine), including assessment of vertebral fracture [CPT 77085]

$214
$503

58% lower than market

Bone density measurement of the core or extremities (e.g., radius, wrist, heel) [CPT 77081]

$109
$333

67% lower than market

CT scan abdomen [CPT 74150]

$1,421
$1,384

3% higher than market

CT scan abdomen before and after contrast [CPT 74170]

$1,350
$2,070

35% lower than market

CT scan abdomen with contrast [CPT 74160]

$1,537
$1,806

15% lower than market

CT scan head or brain before and after contrast [CPT 70470]

$1,661
$1,848

10% lower than market

CT scan head or brain with contrast [CPT 70460]

$1,313
$1,770

26% lower than market

CT scan leg [CPT 73700]

$1,156
$1,292

11% lower than market

CT scan leg with contrast injection [CPT 73701]

$1,194
$1,924

38% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$2,274
$2,142

6% higher than market

CT scan of abdomen and pelvis before and after contrast [CPT 74178]

$3,100
$3,341

7% lower than market

CT scan of abdominal and pelvic blood vessels with contrast [CPT 74174]

$2,358
$2,463

4% lower than market

CT scan of abdominal aorta and both leg arteries with contrast [CPT 75635]

$1,768
$2,110

16% lower than market

CT scan of abdominal blood vessels with contrast [CPT 74175]

$1,569
$1,754

11% lower than market

CT scan of arm [CPT 73200]

$971
$1,345

28% lower than market

CT scan of arm blood vessels with contrast [CPT 73206]

$1,205
$2,050

41% lower than market

CT scan of arm with contrast [CPT 73201]

$1,194
$1,775

33% lower than market

CT scan of blood vessel of head with contrast [CPT 70496]

$1,536
$1,992

23% lower than market

CT scan of blood vessels in chest with contrast [CPT 71275]

$1,880
$2,002

6% lower than market

CT scan of face [CPT 70486]

$1,349
$1,335

1% higher than market

CT scan of face before and after contrast [CPT 70488]

$1,688
$3,492

52% lower than market

CT scan of face with contrast [CPT 70487]

$1,566
$1,801

13% lower than market

CT scan of lower leg blood vessels with contrast [CPT 73706]

$1,776
$2,212

20% lower than market

CT scan of lower spine [CPT 72131]

$1,492
$1,542

3% lower than market

CT scan of lower spine with contrast [CPT 72132]

$1,664
$2,147

22% lower than market

CT scan of middle spine [CPT 72128]

$1,492
$1,468

2% higher than market

CT scan of neck [CPT 70490]

$1,349
$1,335

1% higher than market

CT scan of neck before and after contrast [CPT 70492]

$1,749
$2,199

20% lower than market

CT scan of neck blood vessels with contrast [CPT 70498]

$1,566
$2,136

27% lower than market

CT scan of neck with contrast [CPT 70491]

$1,385
$1,688

18% lower than market

CT scan of pelvis before and after contrast [CPT 72194]

$1,710
$2,400

29% lower than market

CT scan of upper spine [CPT 72125]

$1,421
$1,533

7% lower than market

CT scan of upper spine with contrast [CPT 72126]

$1,545
$2,073

25% lower than market

CT scan pelvis [CPT 72192]

$1,205
$1,348

11% lower than market

Complete X-ray study of abdomen with single X-ray of chest [CPT 74022]

$380
$424

11% lower than market

Complete ultrasound of arm or leg [CPT 76881]

$338
$488

31% lower than market

Diagnostic CT scan of chest before and after contrast [CPT 71270]

$2,005
$2,357

15% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$1,754
$1,827

4% lower than market

Digital tomography of both breasts [CPT 77062]

$67
$61

9% higher than market

Doppler ultrasound study of heart blood flow, valves, and chambers [CPT 93320]

$497
$450

10% higher than market

Fluoroscopic guidance for injection into spine or muscle next to spine [CPT 77003]

$487
$564

14% lower than market

Fluoroscopic guidance for insertion of needle [CPT 77002]

$274
$349

22% lower than market

Fluoroscopic guidance for insertion, replacement or removal of central venous access device [CPT 77001]

$361
$393

8% lower than market

Imaging for bone length assessment [CPT 77073]

$329
$407

19% lower than market

Imaging guidance for procedure, up to 1 hour [CPT 76000]

$361
$545

34% lower than market

Imaging of liver and bile duct system [CPT 78226]

$1,614
$1,606

Approximately equal to market

Imaging of liver and bile duct system with use of drugs [CPT 78227]

$1,710
$1,706

Approximately equal to market

Imaging of parathyroid [CPT 78070]

$1,220
$1,189

3% higher than market

Imaging of urinary tract with injection of contrast into a vein [CPT 74400]

$755
$691

9% higher than market

MRA scan of head blood vessels [CPT 70544]

$1,689
$2,167

22% lower than market

MRA scan of neck blood vessels [CPT 70547]

$1,724
$1,754

2% lower than market

MRA scan of neck blood vessels with contrast [CPT 70548]

$1,734
$3,253

47% lower than market

MRI of both breasts [CPT 77047]

$595
$2,512

76% lower than market

MRI scan bones of the eye, face, and/or neck [CPT 70540]

$1,762
$3,004

41% lower than market

MRI scan bones of the eye, face, and/or neck before and after contrast [CPT 70543]

$2,539
$3,689

31% lower than market

MRI scan brain [CPT 70551]

$2,534
$2,226

14% higher than market

MRI scan of abdomen [CPT 74181]

$2,344
$2,360

1% lower than market

MRI scan of abdomen before and after contrast [CPT 74183]

$2,550
$3,119

18% lower than market

MRI scan of arm before and after contrast [CPT 73220]

$2,047
$3,638

44% lower than market

MRI scan of arm joint [CPT 73221]

$2,292
$2,026

13% higher than market

MRI scan of arm joint before and after contrast [CPT 73223]

$2,300
$4,409

48% lower than market

MRI scan of arm joint with contrast [CPT 73222]

$2,519
$2,645

5% lower than market

MRI scan of blood vessels of abdomen [CPT 74185]

$2,239
$2,043

10% higher than market

MRI scan of brain with contrast [CPT 70552]

$2,501
$2,606

4% lower than market

MRI scan of leg [CPT 73718]

$1,943
$1,866

4% higher than market

MRI scan of leg before and after contrast [CPT 73720]

$2,354
$3,218

27% lower than market

MRI scan of lower spinal canal before and after contrast [CPT 72158]

$2,775
$3,598

23% lower than market

MRI scan of lower spinal canal with contrast [CPT 72149]

$2,329
$2,404

3% lower than market

MRI scan of middle spinal canal [CPT 72146]

$2,171
$2,319

6% lower than market

MRI scan of middle spinal canal before and after contrast [CPT 72157]

$2,775
$3,555

22% lower than market

MRI scan of pelvis [CPT 72195]

$1,975
$2,346

16% lower than market

MRI scan of pelvis before and after contrast [CPT 72197]

$2,347
$3,509

33% lower than market

MRI scan of pelvis with contrast [CPT 72196]

$1,975
$1,864

6% higher than market

MRI scan of upper spinal canal [CPT 72141]

$2,171
$2,297

5% lower than market

MRI scan of upper spinal canal before and after contrast [CPT 72156]

$2,530
$3,569

29% lower than market

Management of radiation therapy simulation, simple [CPT 77280]

$421
$1,067

61% lower than market

Nuclear medicine imaging of thyroid [CPT 78013]

$804
$1,196

33% lower than market

Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging [CPT 78800]

$1,159
$3,219

64% lower than market

Nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in whole body, 2 or more days imaging [CPT 78804]

$2,344
$4,436

47% lower than market

Nuclear medicine study of blood circulation in the lungs [CPT 78580]

$1,103
$1,233

11% lower than market

Nuclear medicine study of bone and/or joint

$1,684
$1,806

7% lower than market

Nuclear medicine study of heart wall motion at rest or stress with evaluation of blood ejection from heart, single study, gated equilibrium [CPT 78472]

$1,598
$2,671

40% lower than market

Nuclear medicine study of kidney with assessment of blood flow and function, with drugs, single study [CPT 78708]

$1,468
$1,310

12% higher than market

Nuclear medicine study of kidney with assessment of blood flow and function, with or without drugs, multiple studies [CPT 78709]

$1,535
$1,445

6% higher than market

Nuclear medicine study of vessels of heart using drugs or exercise multiple studies [CPT 78452]

$3,109
$3,797

18% lower than market

Nuclear medicine study of vessels of heart using drugs or exercise single study [CPT 78451]

$1,644
$3,051

46% lower than market

Nuclear medicine study with CT imaging skull base to mid-thigh [CPT 78815]

$5,736
$6,160

7% lower than market

Radiation therapy consultation per week [CPT 77336]

$235
$820

71% lower than market

Radiation treatment delivery, complex [CPT 77412]

$257
$1,031

75% lower than market

Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery [CPT 74300]

$624
$729

14% lower than market

Radiological supervision and interpretation X-ray of urinary bladder and urethra, before and after dye injection [CPT 74450]

$493
$533

8% lower than market

Radiological supervision and interpretation X-ray of urinary bladder and urethra, emptying [CPT 74455]

$539
$488

10% higher than market

Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views [CPT 74430]

$461
$712

35% lower than market

Radiological supervision and interpretation of CT guidance for needle insertion [CPT 77012]

$965
$1,417

32% lower than market

Radiological supervision and interpretation of imaging of vein of one arm or leg [CPT 75820]

$893
$1,787

50% lower than market

Radiological supervision and interpretation of placement of long small bowel tube procedure [CPT 74340]

$493
$708

30% lower than market

SPECT nuclear medicine localization of tumor or inflammation or study of distribution of radioactive tracer in single area, 1 day of imaging [CPT 78803]

$1,684
$1,771

5% lower than market

Screening digital tomography of both breasts [CPT 77063]

$41
$83

51% lower than market

Stomach emptying study [CPT 78264]

$1,340
$1,297

3% higher than market

Thyroid imaging with vascular flow [CPT 78014]

$1,312
$1,338

2% lower than market

Thyroid uptake measurements [CPT 78012]

$355
$451

21% lower than market

Ultrasound and monitoring of heart of fetus [CPT 76818]

$880
$796

11% higher than market

Ultrasound behind abdominal cavity [CPT 76770]

$703
$641

10% higher than market

Ultrasound examination and continuous monitoring of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report [CPT 93351]

$516
$2,315

78% lower than market

Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]

$1,408
$1,683

16% lower than market

Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with interpretation and report [CPT 93350]

$1,087
$2,076

48% lower than market

Ultrasound guidance for accessing into blood vessel [CPT 76937]

$212
$438

52% lower than market

Ultrasound of chest [CPT 76604]

$179
$458

61% lower than market

Ultrasound of one breast, complete [CPT 76641]

$505
$639

21% lower than market

Ultrasound of pelvis, complete, not pregnancy related [CPT 76856]

$595
$600

1% lower than market

Ultrasound of pelvis, limited, not pregnancy related [CPT 76857]

$345
$478

28% lower than market

Ultrasound of scrotum [CPT 76870]

$542
$562

4% lower than market

Ultrasound re-evaluation of pregnant uterus, per fetus [CPT 76816]

$420
$449

7% lower than market

Ultrasound scan of vena cava or groin graft or vessel blood flow [CPT 93978]

$690
$755

9% lower than market

Ultrasound study of arteries and arterial grafts of both arms [CPT 93930]

$1,018
$895

14% higher than market

Ultrasound study of arteries and arterial grafts of both legs [CPT 93925]

$989
$867

14% higher than market

Ultrasound study of arteries and arterial grafts of one arm or limited [CPT 93931]

$651
$554

17% higher than market

Ultrasound study of arteries and arterial grafts of one leg or limited [CPT 93926]

$627
$623

1% higher than market

X-Ray Upper Digestive Tract with Contrast

$862
$1,055

18% lower than market

X-Ray Upper GI with Small Bowel Films

$780
$1,005

22% lower than market

X-ray lower and sacral spine including bending views minimum 6 views [CPT 72114]

$434
$597

27% lower than market

X-ray of abdomen, 1 view [CPT 74018]

$254
$228

11% higher than market

X-ray of abdomen, 2 views [CPT 74019]

$296
$333

11% lower than market

X-ray of abdomen, minimum of 3 views [CPT 74021]

$296
$524

44% lower than market

X-ray of ankle, 2 views [CPT 73600]

$259
$261

1% lower than market

X-ray of ankle, minimum of 3 views [CPT 73610]

$268
$352

24% lower than market

X-ray of bones of face, less than 3 views [CPT 70140]

$328
$315

4% higher than market

X-ray of bones of face, minimum of 3 views [CPT 70150]

$520
$437

19% higher than market

X-ray of bones of nose, minimum of 3 views [CPT 70160]

$296
$279

6% higher than market

X-ray of both collar bones [CPT 73050]

$382
$369

3% higher than market

X-ray of both hips with pelvis, 2 views [CPT 73521]

$423
$413

2% higher than market

X-ray of both sides of the ribs, 3 views [CPT 71110]

$382
$459

17% lower than market

X-ray of breast bone, minimum of 2 views [CPT 71120]

$266
$339

22% lower than market

X-ray of chest, 1 view [CPT 71045]

$243
$236

3% higher than market

X-ray of chest, 2 views [CPT 71046]

$295
$277

6% higher than market

X-ray of chest, 3 views [CPT 71047]

$328
$478

31% lower than market

X-ray of chest, minimum of 4 views [CPT 71048]

$328
$379

14% lower than market

X-ray of collar bone [CPT 73000]

$329
$308

7% higher than market

X-ray of elbow, 2 views [CPT 73070]

$225
$249

10% lower than market

X-ray of elbow, minimum of 3 views [CPT 73080]

$296
$366

19% lower than market

X-ray of esophagus with single contrast [CPT 74220]

$526
$608

14% lower than market

X-ray of femur, minimum 2 views [CPT 73552]

$265
$270

2% lower than market

X-ray of fingers, minimum of 2 views [CPT 73140]

$248
$230

8% higher than market

X-ray of foot, 2 views [CPT 73620]

$258
$256

1% higher than market

X-ray of foot, minimum of 3 views [CPT 73630]

$333
$330

1% higher than market

X-ray of forearm, 2 views [CPT 73090]

$304
$297

2% higher than market

X-ray of hand, 2 views [CPT 73120]

$255
$334

24% lower than market

X-ray of hand, minimum of 3 views [CPT 73130]

$350
$331

6% higher than market

X-ray of heel, minimum of 2 views [CPT 73650]

$308
$270

14% higher than market

X-ray of hip with pelvis, 2-3 views [CPT 73502]

$315
$348

10% lower than market

X-ray of knee, 1 or 2 views [CPT 73560]

$281
$278

1% higher than market

X-ray of knee, 3 views [CPT 73562]

$328
$367

11% lower than market

X-ray of knee, 4 or more views [CPT 73564]

$335
$551

39% lower than market

X-ray of large bowel with air contrast [CPT 74280]

$746
$857

13% lower than market

X-ray of large bowel with contrast [CPT 74270]

$552
$698

21% lower than market

X-ray of lower and sacral spine, 2 or 3 views [CPT 72100]

$321
$373

14% lower than market

X-ray of lower leg, 2 views [CPT 73590]

$327
$310

5% higher than market

X-ray of mandible, less than 4 views [CPT 70100]

$235
$261

10% lower than market

X-ray of mandible, minimum of 4 views [CPT 70110]

$361
$428

16% lower than market

X-ray of middle spine, 2 views [CPT 72070]

$372
$318

17% higher than market

X-ray of middle spine, 3 views [CPT 72072]

$426
$394

8% higher than market

X-ray of paranasal sinus, complete, minimum of 3 views [CPT 70220]

$361
$407

11% lower than market

X-ray of paranasal sinus, less than 3 views [CPT 70210]

$239
$265

10% lower than market

X-ray of pelvis, 1 or 2 views [CPT 72170]

$312
$291

7% higher than market

X-ray of pelvis, minimum of 2 views [CPT 72220]

$382
$329

16% higher than market

X-ray of pelvis, minimum of 3 views [CPT 72190]

$355
$402

12% lower than market

X-ray of ribs of one side of body, 2 views [CPT 71100]

$281
$293

4% lower than market

X-ray of ribs on one side of body including the chest, minimum of 3 views [CPT 71101]

$400
$372

7% higher than market

X-ray of sacroiliac joints, less than 3 views [CPT 72200]

$329
$284

16% higher than market

X-ray of shoulder blade [CPT 73010]

$382
$346

10% higher than market

X-ray of shoulder, 1 view [CPT 73020]

$228
$275

17% lower than market

X-ray of shoulder, minimum of 2 views [CPT 73030]

$351
$363

3% lower than market

X-ray of skull, complete, minimum of 4 views [CPT 70260]

$520
$542

4% lower than market

X-ray of skull, less than 4 views [CPT 70250]

$328
$415

21% lower than market

X-ray of soft tissue of neck [CPT 70360]

$212
$266

21% lower than market

X-ray of spine of neck, 2 or 3 views [CPT 72040]

$266
$333

20% lower than market

X-ray of spine, 1 view [CPT 72020]

$271
$253

7% higher than market

X-ray of toes, minimum of 2 views [CPT 73660]

$244
$224

9% higher than market

X-ray of upper arm, minimum of 2 views [CPT 73060]

$319
$329

3% lower than market

X-ray of upper digestive tract with single contrast [CPT 74240]

$493
$712

31% lower than market

X-ray of upper spine, 4 or 5 views [CPT 72050]

$427
$437

2% lower than market

X-ray of upper spine, 6 or more views [CPT 72052]

$526
$511

3% higher than market

X-ray of wrist, 2 views [CPT 73100]

$250
$314

20% lower than market

X-ray of wrist, minimum of 3 views [CPT 73110]

$333
$353

6% lower than market

X-ray survey of forearm or wrist bone density [CPT 77075]

$657
$827

21% 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.