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 3/31/18. 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

$1,379
$2,049

33% lower than market

Semi-Private Room

$1,379
$1,836

25% lower than market

Intensive Care Unit

$2,339
$3,746

38% lower than market

INPATIENT LABOR AND DELIVERY CHARGES

The following list does not include charges for anesthesia, drugs, or supplies or charges outside the delivery room (i.e., room & board) required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.

Description

Our Charge
Market Charge

Variance

Normal vaginal delivery without complications

$7,067
$10,788

34% lower than market

Cesarean Section without complications

$15,075
$15,451

2% 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

$120
$225

47% lower than market

Emergency Department Visit - Level 2

$365
$390

6% lower than market

Emergency Department Visit - Level 3

$540
$894

40% lower than market

Emergency Department Visit - Level 4

$1,053
$1,487

29% lower than market

Emergency Department Visit - Level 5

$1,434
$2,111

32% lower than market

Hospital observation care discharge

$173
$149

16% higher than market

Hospital observation care typically 30 minutes

$214
$191

12% higher than market

Hospital observation care typically 50 minutes

$291
$319

9% lower than market

Hospital observation care typically 70 minutes per day

$356
$410

13% lower than market

Hospital observation or inpatient care low severity; 40 minutes per day

$360
$312

15% higher than market

Hospital observation or inpatient care moderate severity; 50 minutes per day'

$429
$387

11% higher than market

Prolonged inpatient or observation hospital service first hour

$163
$153

6% higher than market

Subsequent observation care; typically 25 minutes per day

$153
$135

13% higher than market

Subsequent observation care; typically 35 minutes per day

$208
$176

18% higher 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

$89
$93

4% lower than market

Physical Therapy; standard evaluation

$173
$176

2% lower than market

PT Evaluation - Moderate Complexity

$201
$229

12% lower than market

PT to Re-Educate Brain to Muscle Function (15 min)

$101
$85

19% higher than market

Physical Therapy 1 or More Regions (15 min)

$78
$72

7% higher than market

Physical Therapy Exercise; 15 Minutes

$94
$80

17% higher 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

$197
$231

15% lower 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

Holter Testing - 48-Hour EKG

$90
$267

67% lower than market

Routine EKG - Minimum 12 Leads

$179
$249

28% lower than market

Spirometry - medicated breathing procedure

$290
$419

31% lower than market

Stress Test

$678
$565

20% higher than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Speech Therapy

$65
$240

73% 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

Acute Hepatitis Panel

$240
$238

1% higher than market

Alcohols

$105
$98

7% higher than market

Alpha-Fetoprotein (AFP) Level; Serum

$148
$134

10% higher than market

Ammonia Level

$160
$138

16% higher than market

Anabolic steroids, 1 or 2

$175
$203

14% lower than market

Analgesics; non-opioid, 1 or 2

$160
$162

2% lower than market

Analysis test for Hepatitis C virus

$375
$421

11% lower than market

Arterial Blood Gases Measurement

$150
$136

10% higher than market

Bacterial Blood Culture

$128
$143

11% lower than market

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

$114
$122

6% lower than market

Bacterial Culture for Aerobic Isolates

$65
$73

11% lower than market

Bacterial urine culture, quantitative colony count

$81
$68

19% higher than market

Bacterial culture for anaerobic isolates

$85
$75

13% higher than market

Bacterial urine culture, isolation and identification of each isolate

$78
$96

19% lower than market

Basic Metabolic Panel

$91
$81

13% higher than market

Blood Creatinine

$53
$54

1% lower than market

Blood Typing; ABO

$54
$50

8% higher than market

Blood Typing; Rh (D)

$40
$44

9% lower than market

Blood Unit Compatibility Test, Antiglobulin Technique

$196
$188

4% higher than market

Body fluid cell count with cell identification

$175
$158

11% higher than market

Carcinoembryonic Antigen (CEA) Protein Level

$145
$134

8% higher than market

Clinical pathology consultation

$12
$12

Approximately equal to market

Coagulation Function Measurement, D-dimer, quantitative

$144
$180

20% lower than market

Comprehensive Metabolic Panel

$125
$108

16% higher than market

Creatine Kinase

$133
$134

1% lower than market

Creatine Kinase Level

$128
$157

19% lower than market

Creatinine clearance measurement to test for kidney function

$110
$125

12% lower than market

Crystal identification from tissue or body fluid

$85
$78

8% higher than market

Cyanocobalamin (Vitamin B-12)

$130
$118

10% higher than market

Detection Test for Chlamydia, Amplified Probe Technique

$100
$105

4% lower than market

Detection Test for Hepatitis C Virus, Includes Reverse Transcription

$275
$429

36% lower than market

Detection Test for Neisseria Gonorrhoeae

$90
$109

18% lower than market

Detection test for Staphylococcus aureus (bacteria)

$82
$95

19% lower than market

Detection test for clostridium difficile toxins (stool pathogen)

$65
$99

34% lower than market

Detection test for giardia, immunoassay technique

$70
$139

49% lower than market

Detection test for multiple organisms, amplified probe technique

$475
$637

25% lower than market

Estradiol (hormone) level

$225
$209

7% higher than market

Estrogen analysis, total

$175
$164

6% higher than market

Ferritin

$74
$109

36% lower than market

Folic Acid Level

$110
$98

12% higher than market

Gonadotropin Analysis

$75
$70

7% higher than market

Hemoglobin A1c

$84
$87

4% lower than market

Hemoglobin Measurement

$25
$33

25% lower than market

Hepatitis C Antibody Measurement

$120
$112

8% higher than market

IgE (immune system protein) level

$137
$124

11% higher than market

Immunologic Analysis for Detection of Tumor Antigen, Immunoassay - Quantitative, CA 125

$137
$130

5% higher than market

Immunologic analysis technique on body fluid, Immunofixation electrophoresis

$130
$172

24% lower than market

Insulin Measurement, Total

$78
$90

13% lower than market

Iron Binding Capacity

$86
$73

18% higher than market

Iron Level

$42
$60

30% lower than market

Kidney Function Blood Test Panel

$114
$101

14% higher than market

Lactate Dehydrogenase

$44
$53

17% lower than market

Lactic Acid

$65
$104

37% lower than market

Lipase

$94
$85

10% higher than market

Lipid Panel

$96
$91

5% higher than market

Liver Enzyme (SGOT) Level

$30
$27

11% higher than market

Liver Enzyme (SGPT) Level

$30
$27

11% higher than market

Liver Panel

$111
$93

19% higher than market

Magnesium Level

$65
$61

7% higher than market

Measurement C-reactive protein

$102
$90

13% higher than market

Microscopic Examination of White Blood Cells with Manual Count

$38
$46

18% lower than market

Microsomal Antibodies Measurement

$125
$112

12% higher than market

Myoglobin (muscle protein) level

$114
$104

9% higher than market

Organic acid level

$175
$163

7% higher than market

PSA Measurement, Total

$125
$113

11% higher than market

PSA Measurement, Free

$165
$158

4% higher than market

Parathormone

$125
$186

33% lower than market

Phosphate Level

$52
$44

19% higher than market

Platelets; pheresis; leukocytes reduced; each unit

$1,793
$1,680

7% higher than market

Prealbumin Level

$113
$104

9% higher than market

Prolactin (Milk Producing Hormone) Level

$65
$110

41% lower than market

Protein Measurement; Serum

$117
$102

14% higher than market

Protein measurement; body fluid

$85
$78

9% higher than market

Prothrombin Time

$58
$52

11% higher than market

Red Blood Cell Concentration Measurement

$30
$32

6% lower than market

Red Blood Cells; Leukocytes Reduced; Each Unit

$625
$606

3% higher than market

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

$63
$60

4% higher than market

Red blood cells; each unit

$390
$378

3% higher than market

Screening Test for Autoimmune Disorder

$82
$87

6% lower than market

Screening Test for Red Blood Cell Antibodies

$101
$109

8% lower than market

Screening test for antibody to noninfectious agent

$99
$134

26% lower than market

Screening test for mononucleosis (mono)

$68
$64

6% higher than market

Sex hormone binding globulin (protein) level

$110
$101

9% higher than market

Special Stain for Microorganism, Gram or Glemsa Stain

$54
$57

6% lower than market

Stool Culture

$91
$137

33% lower than market

Stool analysis for blood

$48
$81

41% lower than market

Stool lactoferrin (immune system protein) analysis

$86
$138

38% lower than market

Streptoccus

$79
$109

28% lower than market

Tacrolimus Level

$205
$193

6% higher than market

Test for Influenza Virus

$58
$69

16% lower than market

Testosterone Level, Free

$142
$154

8% lower than market

Testosterone Level, Total

$120
$160

25% lower than market

Thyroid Hormone; T3 Measurement; Total

$108
$103

5% higher than market

Thyroid Hormone; T3 Measurement; Free

$78
$97

19% lower than market

Thyroid Stimulating Hormone (TSH)

$79
$116

32% lower than market

Thyroid stimulating immune globulins (thyroid related protein) level

$255
$250

2% higher than market

Thyroxine

$78
$102

24% lower than market

Thyroxine Measurement

$58
$55

5% higher than market

Total Protein Level; Urine

$64
$56

15% higher than market

Troponin

$128
$155

18% lower than market

Uric Acid Level; Blood

$54
$42

28% higher than market

Urinalysis; Manual Test

$27
$38

29% lower than market

Urine Microalbumin Level

$34
$54

38% lower than market

Urine Osmolality Measurement

$82
$90

8% lower than market

Urine Sodium Level

$45
$47

5% lower than market

Valproic Acid Level

$115
$109

5% higher than market

Vancomycin Level

$129
$123

5% higher than market

Vitamin B-1 (thiamine) level

$105
$101

4% higher than market

Vitamin D-3 Level

$125
$168

25% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/<

$212
$212

Approximately equal to market

Physical Therapy; electric stimulation therapy

$47
$93

49% lower than market

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

$86
$100

14% lower than market

External shock to heart to regulate heart beat

$773
$1,996

61% lower than market

Heart rhythm symptom-related interpretation of 24-hour EKG monitoring up to 30 days

$83
$77

7% higher than market

Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle

$145
$188

23% lower than market

Hydration Infusion into a Vein

$91
$242

62% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$400
$431

7% lower than market

Infusion (Additional) for Therapy; Diagnosis or Prevention

$208
$238

13% lower than market

Infusion into a Vein for Therapy; Diagnosis; or Prevention

$84
$185

55% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$373
$549

32% lower than market

Injection Beneath the Skin for Therapy; Diagnosis; or Prevention

$56
$121

54% lower than market

Moderate sedation services - initial 15 minutes; patient age 5 or older

$184
$303

39% lower than market

Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle

$179
$249

28% lower than market

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

$143
$248

43% lower than market

Sleep Monitoring with CPAP

$3,251
$3,915

17% lower than market

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

$2,957
$3,528

16% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$192
$196

2% lower than market

Training in use of orthotics (supports; braces; or splints) for arms; legs and/or trunk each 15 minu

$86
$84

3% higher than market

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

$84
$268

69% lower than market

Wheelchair management; each 15 minutes

$75
$93

19% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Anesthesia for closed manipulation of spine

$199
$199

Approximately equal to market

Anesthesia for examination of uterus using an endoscope

$199
$199

100% lower than market

Anesthesia for open or endoscopic procedure on bones of forearm; wrist; or hand

$212
$189

100% lower than market

Anesthesia for procedure in lower abdomen including urinary tract

$212
$212

100% lower than market

Anesthesia for procedure in upper abdomen including use of an endoscope

$212
$191

100% lower than market

Anesthesia for procedure to correct abnormal heart rhythm

$212
$180

100% lower than market

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

$62
$66

6% lower than market

Injection of anesthetic agent underarm (axillary) nerve

$212
$410

48% lower than market

Injection of anesthetic agent; brachial (arm) nerve bundle

$429
$672

36% lower than market

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

$1,156
$1,836

37% lower than market

Injection(s) of joint with fluoroscopy or CT; cervical or thoracic, single level

$2,076
$2,220

6% lower than market

Technetium tc-99m mebrofenin; diagnostic; per study dose; up to 15 millicuries

$173
$231

25% lower than market

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

$605
$711

15% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$41
$106

61% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$188
$254

26% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$188
$192

2% 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

Arterial Puncture

$21
$99

79% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of Short Arm Splint

$248
$354

30% lower than market

Biopsy of Large Bowel; Using an Endoscope

$1,517
$1,766

14% lower than market

Biopsy of the Esophagus; Stomach; Using an Endoscope

$1,176
$1,252

6% lower than market

Colonscopy

$1,517
$1,782

15% lower than market

Control Nose Bleed - Simple Case

$261
$354

26% lower than market

Creation of sling around bladder canal (urethra) to control leakage

$1,667
$4,575

64% lower than market

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

$622
$1,090

43% lower than market

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

$1,255
$1,509

17% lower than market

Insertion of Indwelling Bladder Catheter

$182
$279

35% lower than market

Insertion of Needle into Vein to Collect Blood

$25
$24

5% higher than market

Percutaneous vertebroplasty (bone biopsy included when performed); 1 vertebral body; unilateral or bilateral injection; inclusive of all imaging guidance, each additional cervicothoracic or lumbosacral vertebral body (List se

$1,432
$1,390

3% higher than market

Release and/or relocation of median nerve of hand

$1,397
$2,863

51% lower than market

Removal of (2 centimeters or greater) tissue growth beneath the skin of face and scalp

$812
$812

Approximately equal to market

Removal of deep bone implant

$3,300
$3,219

3% higher than market

Removal of fluid from chest cavity

$304
$310

2% lower than market

Removal of gallbladder with X-ray study of bile ducts using endoscope

$4,026
$7,541

47% lower than market

Removal of malignant growth (2.1 to 3.0 centimeters) of the face; ears; eyelids; nose; or lips

$279
$433

36% lower than market

Repair of wound (2.6 to 7.5 centimeters) of forehead; cheeks; chin; mouth; neck; underarms; genitals

$553
$673

18% lower than market

Repair of wound (20.1 to 30.0 centimeters) of the scalp; underarms; trunk; arms; and/or legs

$672
$672

Approximately equal to market

Transfusion of Blood or Blood Products

$836
$879

5% lower than market

Ultrasound measurement of bladder capacity after voiding

$188
$241

22% lower than market

Vaginal repair of pelvic ligaments

$1,208
$3,217

62% lower than market

Simple wound repair of face; including ears, 2.5 cm or less

$322
$493

35% lower than market

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

$276
$415

34% 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 Blood Flow Outside the Brain

$1,008
$845

19% higher than market

Ultrasound Heart

$1,367
$1,670

18% lower than market

Ultrasound Veins of One Arm or Leg

$690
$577

19% higher than market

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries; 3 or more levels

$908
$864

5% higher than market

Breast Ultrasound - Limited

$458
$457

Approximately equal to market

CT Abdomen & Pelvis with Contrast

$2,870
$2,766

4% higher than market

CT Abdomen & Pelvis with and without Contrast

$3,100
$3,004

3% higher than market

CT Abdomen & Pelvis without Contrast

$1,250
$2,044

39% lower than market

CT Abdomen with Contrast

$1,537
$1,278

20% higher than market

CT Abdomen with and without Contrast

$1,350
$1,297

4% higher than market

CT Angiogram Abdomen with and without Contrast

$1,569
$1,728

9% lower than market

CT Angiogram Chest with and without Contrast

$1,880
$1,941

3% lower than market

CT Angiogram Neck with and without Contrast

$1,566
$2,207

29% lower than market

CT Chest with Contrast

$1,754
$1,780

1% lower than market

CT Chest with and without Contrast

$2,005
$1,885

6% higher than market

CT Chest without Contrast

$1,537
$1,284

20% higher than market

CT Face without Contrast

$1,349
$1,377

2% lower than market

CT Head Brain without Contrast

$1,187
$1,281

7% lower than market

CT Neck with Contrast

$1,385
$1,720

20% lower than market

CT Neck without Contrast

$1,349
$1,293

4% higher than market

CT Spine Cervical without Contrast

$1,421
$1,532

7% lower than market

CT Spine Lumbar without Contrast

$1,492
$1,508

1% lower than market

CT scan bone mineral density study 1 or more sites

$205
$187

9% higher than market

Cardiac Nuclear Stress Testing

$2,988
$3,611

17% lower than market

Chest X-Ray, 2 Views

$295
$276

7% higher than market

Chest X-Ray, Single View

$243
$228

6% higher than market

Diagnostic mammography; bilateral

$432
$426

1% higher than market

Diagnostic mammography; unilateral

$384
$331

16% higher than market

Fluoroscopic guidance for insertion of needle

$236
$330

28% lower than market

Fluoroscopic guidance for spine or spinal canal injection

$442
$470

6% lower than market

Imaging guidance for procedure; up to 1 hour

$361
$556

35% lower than market

Imaging of Abdomen, 2 Views

$296
$302

2% lower than market

Imaging of Abdomen, Single View

$254
$224

13% higher than market

Imaging of Liver and Bile Duct System with Use of Drugs

$1,350
$1,313

3% higher than market

MRI Abdomen without Contrast

$2,344
$2,255

4% higher than market

MRI Arm Joint without Contrast

$2,035
$1,990

2% higher than market

MRI Brain with and without Conrast

$2,785
$3,474

20% lower than market

MRI Brain without Contrast

$2,300
$2,263

2% higher than market

MRI Leg Joint without Contrast

$1,694
$1,589

7% higher than market

MRI Leg without Contrast

$1,904
$1,991

4% lower than market

MRI Spine Cervical with and without Contrast

$2,530
$3,294

23% lower than market

MRI Spine Cervical without Contrast

$2,129
$1,900

12% higher than market

MRI Spine Lumbar without Contrast

$2,129
$1,813

17% higher than market

Radiologic examination; chest, 3 views

$328
$312

5% higher than market

Screening Mammography; Bilateral

$378
$329

15% higher than market

Screening digital breast tomosynthesis; bilateral

$38
$84

55% lower than market

Ultrasound Abdomen - Complete

$688
$666

3% higher than market

Ultrasound Abdomen - Limited

$569
$504

13% higher than market

Ultrasound Behind Abdominal Cavity - Complete

$565
$556

2% higher than market

Ultrasound Head Neck

$550
$511

8% higher than market

Ultrasound Joint Soft Tissue - Complete

$322
$416

23% lower than market

Ultrasound Pelvis

$566
$553

2% higher than market

Ultrasound Pelvis through Vagina

$394
$599

34% lower than market

Ultrasound Scrotum

$516
$529

2% lower than market

X-Ray Ankle; 2 Views

$259
$295

12% lower than market

X-Ray Ankle; 3 Views

$268
$306

12% lower than market

X-Ray Elbow; 2 Views

$225
$209

8% higher than market

X-Ray Elbow; 3 Views

$296
$329

10% lower than market

X-Ray Femus; 2 Views

$265
$255

4% higher than market

X-Ray Fingers; 2 Views

$248
$224

11% higher than market

X-Ray Foot; 2 Views

$258
$230

12% higher than market

X-Ray Foot; 3 Views

$333
$310

8% higher than market

X-Ray Forearm; 2 Views

$304
$291

5% higher than market

X-Ray Hip and Pelvis; 2 Views

$315
$330

5% lower than market

X-Ray Knee; 3 Views

$328
$346

5% lower than market

X-Ray Lower Leg; 2 Views

$327
$302

8% higher than market

X-Ray Lower Sacral Spine; 2-3 Views

$321
$384

16% lower than market

X-Ray Lower Sacral Spine; 4 or More Views

$591
$525

12% higher than market

X-Ray Middle Spine; 3 Views

$372
$311

20% higher than market

X-Ray Neck Spine; 2-3 Views

$266
$343

23% lower than market

X-Ray Pelvis; 1-2 Views

$312
$287

9% higher than market

X-Ray Pelvis; 3 Views

$355
$313

13% higher than market

X-Ray Ribs One Side; 2 Views

$281
$327

14% lower than market

X-Ray Shoulder; 2 Views

$351
$340

3% higher than market

X-Ray Toes; 2 Views

$244
$237

3% higher than market

X-Ray Upper Arm; 2 Views

$319
$320

Approximately equal to market

X-Ray Wrist; 3 Views

$333
$280

19% higher than market

X-Ray of Middle Spine, 3 Views

$426
$406

5% higher than market

X-ray Ribs One Side; Minimum 3 Views

$400
$409

2% lower than market

X-ray lower and sacral spine including bending views minimum 6 views

$434
$516

16% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat without complications

$6,123
$14,618

58% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$28,421
$27,470

3% higher than market

Heart Failure with complications

$16,041
$22,813

30% lower than market

Heart failure & shock without complications

$10,283
$16,533

38% lower than market

Other circulatory system diagnoses with complications

$6,863
$24,446

72% lower than market

Peripheral vascular disorders with complications

$14,183
$33,776

58% lower than market

Syncope & collapse

$4,166
$20,577

80% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Appendectomy w complicated principal diag with complications

$39,789
$44,045

10% lower than market

Laparoscopic cholecystectomy with major complications

$40,986
$51,510

20% lower than market

Major small & large bowel procedures with complications

$20,989
$64,050

67% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$10,893
$24,382

55% lower than market

Blood Infection with major complications

$14,261
$42,049

66% lower than market

Digestive System Bleeding with complications

$12,752
$26,198

51% lower than market

Disorders of liver except malig;cirr;alc hepa without complications

$5,887
$15,312

62% lower than market

Disorders of pancreas except malignancy with complications

$15,648
$20,555

24% lower than market

Disorders of pancreas except malignancy with major complications

$20,055
$35,007

43% lower than market

Disorders of pancreas except malignancy without complications

$11,232
$13,986

20% lower than market

Fever

$9,532
$27,143

65% lower than market

G.I. obstruction with major complications

$21,573
$35,158

39% lower than market

G.I. obstruction without complications

$4,628
$14,483

68% lower than market

General symptoms of illness such as fever; pain; shortness of breath

$10,514
$15,762

33% lower than market

Major hematol/immun diag exc sickle cell crisis & coagul with major complications

$11,166
$31,780

65% lower than market

Nutritional & misc metabolic disorders with major complications

$11,789
$26,658

56% lower than market

Nutritional or Metabolic Disorders without major complications

$8,797
$17,465

50% lower than market

Red blood cell disorders with major complications

$16,994
$36,753

54% lower than market

Signs & symptoms with major complications

$25,926
$34,475

25% lower than market

Skin ulcers with major complications

$21,229
$44,715

53% lower than market

Stomach Disorder without complications

$7,541
$18,687

60% lower than market

INPATIENT NEUROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Intracranial hemorrhage or cerebral infarction without complications

$10,161
$21,519

53% lower than market

Stroke with complications

$27,514
$25,870

6% higher than market

Stroke with major complications

$18,216
$46,493

61% lower than market

INPATIENT ONCOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Digestive malignancy with complications

$4,691
$21,662

78% lower than market

Digestive malignancy with major complications

$14,796
$31,553

53% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Amputation for musculoskeletal system & connective tissue with complications

$41,460
$49,038

15% lower than market

Bilateral or multiple major joint procs of lower extremity without major complications

$86,066
$83,963

3% higher than market

Hip & femur procedures except major joint with complications

$42,319
$52,414

19% lower than market

Hip & femur procedures except major joint without complications

$32,873
$42,013

22% lower than market

Knee or Hip replacement without major complications

$50,467
$55,801

10% lower than market

Knee procedures w pdx of infection without complications

$34,843
$34,123

2% higher than market

Lower extremity & humerus procedure except hip; foot; and femur with complications

$45,104
$59,563

24% lower than market

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

$48,082
$66,267

27% lower than market

Major joint replacement or reattachment of lower extremity with major complications

$51,125
$75,919

33% lower than market

Revision of hip or knee replacement with complications

$66,163
$102,895

36% lower than market

INPATIENT ORTHOPEDICS CHARGES

Description

Our Charge
Market Charge

Variance

Bone diseases & arthropathies without major complications

$7,182
$18,207

61% lower than market

Fractures of hip & pelvis without major complications

$9,180
$17,765

48% lower than market

Fractures of hip; pelvis & thigh with major complications

$7,691
$30,181

75% lower than market

Other musculoskeletal system & connective tissue diagnoses with complications

$7,608
$32,112

76% lower than market

Pathological fractures & musculoskelet & conn tiss malig with compications

$9,236
$28,035

67% lower than market

Signs & symptoms of musculoskeletal system & connective tissue without major complications

$9,305
$17,934

48% lower than market

Tendonitis; myositis & bursitis with major complications

$16,699
$35,247

53% lower than market

Tendonitis; myositis & bursitis without major complications

$8,261
$20,724

60% lower than market

INPATIENT PSYCHIATRY CHARGES

Description

Our Charge
Market Charge

Variance

Acute adjustment reaction & psychosocial dysfunction

$8,885
$22,228

60% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Bronchitis or asthma without complications

$4,890
$13,281

63% lower than market

Chronic Lung Disease with complications

$10,708
$23,236

54% lower than market

Chronic Lung Disease with major complications

$16,765
$27,963

40% lower than market

Chronic Lung Disease without complications

$5,296
$13,927

62% lower than market

Pneumonia with complications

$11,873
$16,729

29% lower than market

Pneumonia with major complications

$12,313
$31,733

61% lower than market

Pneumonia without complications

$8,983
$15,872

43% lower than market

Pulmonary embolism with major complications

$20,383
$31,572

35% lower than market

Pulmonary embolism without major complications

$9,737
$17,622

45% lower than market

Respiratory signs & symptoms

$8,847
$17,883

51% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Inflammation of the male reproductive system withou major complications

$8,866
$18,725

53% lower than market

Kidney failure with complications

$13,882
$23,060

40% lower than market

Kidney failure with major complications

$7,945
$38,449

79% lower than market

Kidney & urinary Infection with major complications

$19,437
$21,442

9% lower than market

Kidney & urinary Infection without complications

$8,553
$17,579

51% lower than market

Major bladder procedures without complications

$34,906
$39,307

11% lower than market

BAESS AND INFORMATION

How You Can Help

Thank you for choosing Owensboro Health 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.