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 3/31/2019. 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

$120
$251

52% lower than market

Emergency Department Visit - Level 2

$365
$445

18% lower than market

Emergency Department Visit - Level 3

$540
$770

30% lower than market

Emergency Department Visit - Level 4

$1,053
$1,157

9% lower than market

Emergency Department Visit - Level 5

$1,434
$1,971

27% 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

$89
$83

7% higher than market

PT Evaluation - Moderate Complexity

$201
$231

13% lower than market

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

$101
$82

23% higher than market

Physical Therapy 1 or More Regions (15 min)

$83
$83

Approximately equal to market

Physical Therapy Exercise, 15 Minutes

$94
$82

15% higher than market

Physical Therapy, standard evaluation - 20 minutes

$173
$192

10% 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

$197
$202

3% 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

$84
$276

70% lower than market

Routine EKG - Minimum 12 Leads

$179
$203

12% lower than market

Spirometry - medicated breathing procedure

$279
$432

35% lower than market

Stress Test with EKG tracing

$713
$835

15% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Speech Therapy

$65
$237

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

$87
$265

67% lower than market

Alcohols

$105
$110

5% lower than market

Alpha-Fetoprotein (AFP) Level, Serum

$139
$135

3% higher than market

Ammonia level

$160
$117

36% higher than market

Anabolic steroids; 1 or 2

$175
$208

16% lower than market

Analgesics, non-opioid; 1 or 2

$181
$122

48% higher than market

Analysis test for Hepatitis C virus

$188
$404

54% lower than market

Arterial Blood Gases Measurement

$150
$168

10% lower 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 culture for anaerobic isolates

$102
$93

9% higher than market

Bacterial urine culture

$78
$86

10% 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

Body fluid cell count with cell identification

$272
$103

165% higher than market

Carcinoembryonic antigen (CEA) protein level

$145
$130

11% higher 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

Creatine kinase Level (cardiac enzyme) - Total

$133
$79

67% higher than market

Creatine kinase level (cardiac enzyme) - Muscle/Brain

$128
$120

6% higher than market

Creatinine clearance measurement to test for kidney function

$90
$104

14% lower than market

Crystal identification from tissue or body fluid

$102
$76

34% higher than market

Cyanocobalamin (vitamin B-12) level

$130
$120

8% higher than market

Detection Test for Chlamydia; Amplified Probe Technique

$82
$115

29% lower than market

Detection Test for Hepatitis C Virus; Includes Reverse Transcription

$173
$503

66% lower than market

Detection Test for Neisseria Gonorrhoeae

$90
$113

20% lower than market

Detection test for Staphylococcus aureus (bacteria)

$82
$166

51% lower than market

Detection test for clostridium difficile toxins (stool pathogen)

$63
$98

36% lower than market

Detection test for giardia; immunoassay technique

$47
$115

59% lower than market

Detection test for multiple organisms; amplified probe technique

$315
$615

49% lower than market

Estradiol (hormone) level

$225
$178

26% higher than market

Estrogen analysis; total

$175
$122

44% higher than market

Ferritin (blood protein) level

$74
$113

34% lower than market

Folic acid; serum

$110
$105

5% higher than market

Gonadotropin (reproductive hormone) analysis

$75
$67

12% higher than market

Hemoglobin A1C level

$84
$88

5% lower than market

Hemoglobin Measurement

$25
$33

25% lower than market

Hepatitis C Antibody Measurement

$120
$123

3% lower than market

IgE (immune system protein) level

$130
$124

5% higher than market

Immunologic analysis for detection of tumor antigen (CA 125)

$137
$155

12% lower than market

Immunologic analysis technique on body fluid; Immunofixation electrophoresis

$130
$215

40% lower than market

Insulin Measurement; Total

$73
$92

21% lower than market

Iron Binding Capacity

$86
$71

21% higher than market

Iron level

$42
$62

33% lower than market

Kidney Function Blood Test Panel

$114
$99

16% higher than market

Lactate dehydrogenase (enzyme) level

$47
$56

15% lower than market

Lactic acid level

$65
$109

40% lower than market

Lipase (fat enzyme) level

$94
$79

19% higher than market

Liver enzyme (SGOT), level

$30
$44

32% lower than market

Liver enzyme (SGPT), level

$20
$44

55% lower 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

Measurement C-reactive protein

$102
$74

37% higher than market

Microscopic Examination of White Blood Cells with Manual Count

$41
$55

26% lower than market

Microsomal Antibodies Measurement

$125
$115

9% higher than market

Myoglobin (muscle protein) level

$114
$129

12% lower than market

Organic acid level

$542
$151

259% higher 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

Prealbumin (protein) level

$113
$97

17% higher than market

Prolactin (milk producing hormone) level

$65
$118

45% lower than market

Protein Measurement, Serum

$124
$101

23% higher than market

Protein measurement, body fluid

$162
$97

67% higher than market

Red Blood Cell Concentration Measurement

$30
$31

5% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$625
$635

2% lower than market

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

$63
$55

13% higher than market

Screening Test for Autoimmune Disorder

$291
$90

225% higher than market

Screening Test for Red Blood Cell Antibodies

$101
$92

10% higher than market

Screening test for antibody to noninfectious agent

$182
$136

33% higher than market

Screening test for mononucleosis (mono)

$91
$63

44% higher than market

Sex hormone binding globulin (protein) level

$110
$110

Approximately equal to market

Special Stain for Microorganism; Gram or Glemsa Stain

$54
$59

9% lower than market

Stool Culture

$91
$119

23% lower than market

Stool analysis for blood

$48
$83

43% lower than market

Stool lactoferrin (immune system protein) analysis

$80
$125

36% lower than market

Streptoccus

$79
$104

24% lower than market

Tacrolimus Level

$205
$186

10% higher than market

Testosterone (hormone) level

$120
$154

22% lower than market

Testosterone Level; Free

$254
$148

72% higher than market

Thyroid Hormone, T3 Measurement, Free

$77
$101

24% lower than market

Thyroid hormone, T3 measurement - Total

$108
$111

2% lower than market

Thyroid stimulating immune globulins (thyroid related protein) level

$255
$330

23% lower than market

Thyroxine (thyroid chemical) measurement - Free Thyroxine

$78
$88

12% lower than market

Thyroxine (thyroid chemical) measurement - Total

$58
$76

24% lower than market

Total Protein Level, Urine

$66
$50

31% higher 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
$32

94% higher than market

Urine microalbumin (protein) level

$34
$78

57% lower than market

Urine sodium level

$45
$54

17% lower than market

Valproic acid level

$134
$110

22% higher than market

Vancomycin (antibiotic) level

$122
$125

2% lower than market

Vitamin D-3 Level

$125
$173

28% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

ANESTHESIA EXTREME AGE PATIENT UNDER 1 YR/<

$212
$136

56% higher than market

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

$86
$90

5% lower than market

External shock to heart to regulate heart beat

$695
$1,419

51% lower than market

Hydration Infusion into a Vein

$91
$199

54% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$400
$380

5% higher than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$208
$205

1% higher than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$80
$152

48% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$351
$421

17% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$56
$119

53% lower than market

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

$50
$458

89% lower than market

Physical Therapy, electric stimulation therapy

$47
$60

22% lower than market

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

$143
$232

39% lower than market

Sleep Monitoring with CPAP

$3,251
$4,044

20% lower than market

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

$2,957
$3,641

19% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$125
$209

40% lower than market

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

$81
$79

2% higher than market

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

$156
$223

30% 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 30 minutes

$225
$232

3% lower than market

Hospital observation care typically 50 minutes

$306
$287

7% higher than market

Hospital observation care typically 70 minutes per day

$374
$371

1% higher than market

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

$360
$287

25% higher than market

Hospital observation or inpatient care moderate severity, 50 minutes per day

$450
$377

19% higher than market

Subsequent observation care, typically 25 minutes per day

$153
$131

16% higher than market

Subsequent observation care, typically 35 minutes per day

$208
$158

31% higher than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Anesthesia for examination of uterus using an endoscope

$212
$124

71% higher than market

Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; not otherwise specified

$212
$135

57% higher than market

Anesthesia for lower intestinal endoscopic procedures, endoscope introduced distal to duodenum; screening colonoscopy

$212
$136

55% higher than market

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

$1,481
$137

978% higher than market

Anesthesia for procedure in upper abdomen including use of an endoscope

$212
$136

56% higher than market

Cervical Joint Injection

$1,156
$1,642

30% lower than market

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

$62
$89

31% lower than market

Injection of anesthetic agent, brachial (arm) nerve bundle

$429
$1,422

70% lower than market

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

$184
$232

21% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$74
$90

19% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$188
$201

7% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$188
$164

14% higher 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

$23
$139

84% lower than market

Nebulizer Treatment

$114
$141

19% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

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

$605
$620

2% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of Short Arm Splint

$236
$285

17% lower than market

Biopsy of Large Bowel, Using an Endoscope

$1,548
$2,020

23% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$1,211
$1,959

38% lower than market

Carpal Tunnel Release

$7,520
$3,693

104% higher than market

Colonscopy

$1,548
$2,190

29% lower than market

Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope

$2,693
$1,478

82% higher than market

Epidural Injection Lumbar

$633
$1,609

61% lower than market

Epidural Injection Thoracic

$622
$1,637

62% lower than market

Gallbladder Removal Using an Endoscope

$3,375
$7,058

52% lower than market

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

$1,323
$1,664

21% lower than market

Insertion of Indwelling Bladder Catheter

$182
$321

43% lower than market

Insertion of Needle into Vein to Collect Blood

$25
$24

4% higher than market

Removal of deep bone implant

$4,620
$5,753

20% lower than market

Removal of fluid from chest cavity

$290
$903

68% lower than market

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

$7,893
$7,725

2% higher than market

Repair of groin hernia patient age 5 years or older

$1,912
$5,591

66% lower than market

Shaving of shoulder bone using an endoscope

$30,115
$4,209

616% higher than market

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

$259
$468

45% lower than market

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

$276
$475

42% lower than market

Transfusion of Blood or Blood Products

$870
$794

10% higher than market

Ultrasound measurement of bladder capacity after voiding

$188
$223

16% 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

Breast Ultrasound - Limited

$481
$364

32% higher than market

CT Abdomen & Pelvis with Contrast

$2,870
$2,611

10% higher than market

CT Abdomen & Pelvis with and without Contrast

$3,100
$3,173

2% lower than market

CT Abdomen & Pelvis without Contrast

$1,250
$2,046

39% lower than market

CT Abdomen with Contrast

$1,537
$1,745

12% lower 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 Neck with Contrast

$1,385
$1,622

15% lower than market

CT Neck without Contrast

$1,349
$1,267

6% higher than market

CT Pelvis with Contrast

$1,432
$1,573

9% lower than market

CT Spine Cervical without Contrast

$1,421
$1,466

3% lower than market

CT Spine Lumbar without Contrast

$1,492
$1,453

3% higher than market

CT scan bone mineral density study 1 or more sites

$205
$157

31% higher than market

Chest X-Ray; 2 Views

$295
$277

7% higher than market

Chest X-Ray; Single View

$243
$221

10% higher than market

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

$908
$770

18% higher than market

Diagnostic mammography, bilateral

$453
$396

14% higher than market

Diagnostic mammography, unilateral

$384
$311

24% higher than market

Fluoroscopic guidance for insertion of needle

$236
$412

43% lower than market

Fluoroscopic guidance for spine or spinal canal injection

$421
$497

15% lower than market

Imaging guidance for procedure, up to 1 hour

$361
$535

33% lower than market

Imaging of Abdomen; 2 Views

$296
$314

6% lower than market

Imaging of Abdomen; Single View

$254
$218

16% higher than market

Imaging of Liver and Bile Duct System with Use of Drugs

$1,643
$1,605

2% higher than market

MRI Abdomen without Contrast

$1,716
$2,254

24% lower than market

MRI Arm Joint without Contrast

$2,292
$1,964

17% higher 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 Leg without Contrast

$1,904
$1,996

5% lower than market

MRI Spine Cervical with and without Contrast

$2,530
$3,482

27% 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

$2,988
$3,630

18% lower than market

Radiologic examination, chest; 3 views

$312
$490

36% lower than market

Screening Mammography, Bilateral, with CAD

$378
$315

20% higher than market

Screening digital breast tomosynthesis, bilateral

$38
$80

52% lower than market

Ultrasound Abdomen - Complete

$688
$674

2% higher than market

Ultrasound Abdomen - Limited

$597
$478

25% higher than market

Ultrasound Behind Abdominal Cavity - Complete

$670
$589

14% higher than market

Ultrasound Blood Flow Outside the Brain

$1,008
$867

16% higher than market

Ultrasound Head Neck

$685
$511

34% higher than market

Ultrasound Heart

$1,367
$1,671

18% lower than market

Ultrasound Joint Soft Tissue - Complete

$307
$434

29% lower than market

Ultrasound Pelvis NonOB

$566
$564

Approximately equal to market

Ultrasound Pelvis through Vagina

$375
$565

34% lower than market

Ultrasound Scrotum

$491
$520

6% lower than market

Ultrasound Veins of One Arm or Leg

$724
$601

20% higher than market

X-Ray Ankle, 3 Views

$268
$306

13% lower than market

X-Ray Elbow, 2 Views

$274
$224

22% higher than market

X-Ray Elbow, 3 Views

$296
$315

6% 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, 2 Views

$258
$275

6% lower than market

X-Ray Foot, 3 Views

$333
$294

13% higher than market

X-Ray Forearm, 2 Views

$304
$266

14% higher than market

X-Ray Hip and Pelvis, 2 Views

$302
$346

13% lower than market

X-Ray Knee, 3 Views

$328
$331

1% lower than market

X-Ray Lower Leg, 2 Views

$327
$284

15% higher 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

$297
$291

2% higher than market

X-Ray Pelvis, 3 Views

$355
$361

2% 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 Toes, 2 Views

$244
$222

10% higher than market

X-Ray Upper Arm, 2 Views

$319
$300

6% higher than market

X-Ray Wrist, 3 Views

$333
$315

6% higher than market

X-Ray of Middle Spine; 3 Views

$406
$380

7% higher than market

X-ray Ribs One Side, Minimum 3 Views

$400
$359

11% higher than market

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

$428
$548

22% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat without complications

$4,856
$12,302

61% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$12,634
$20,134

37% lower than market

Heart Failure with complications

$7,285
$18,383

60% lower than market

Heart failure & shock without complications

$10,816
$13,727

21% lower than market

Peripheral vascular disorders with complications

$13,103
$22,554

42% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Laparoscopic cholecystectomy with major complications

$27,715
$45,418

39% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$23,532
$19,813

19% higher than market

Blood Infection with major complications

$18,482
$35,915

49% lower than market

Digestive System Bleeding with complications

$11,086
$23,641

53% lower than market

Disorders of pancreas except malignancy with complications

$14,864
$19,611

24% lower than market

G.I. obstruction with major complications

$17,307
$31,584

45% lower than market

G.I. obstruction without complications

$4,720
$12,170

61% lower than market

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

$19,414
$16,640

17% higher than market

Nutritional & misc metabolic disorders with major complications

$14,975
$26,875

44% lower than market

Nutritional or Metabolic Disorders without major complications

$7,832
$13,453

42% lower than market

INPATIENT NEUROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Intracranial hemorrhage or cerebral infarction without complications

$5,617
$15,016

63% lower than market

Stroke with complications

$10,432
$19,121

45% lower than market

Stroke with major complications

$5,778
$31,580

82% lower than market

INPATIENT ONCOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Digestive malignancy with complications

$14,588
$24,693

41% lower than market

Digestive malignancy with major complications

$15,212
$36,611

58% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Amputation for musculoskeletal system & connective tissue with complications

$30,773
$61,561

50% lower than market

Hip & femur procedures except major joint with complications

$54,345
$47,175

15% higher than market

Hip & femur procedures except major joint without complications

$26,050
$38,595

32% lower than market

Total Ankle Replacement

$48,218
$72,267

33% lower than market

Total Knee or Hip Replacement

$49,803
$50,009

Approximately equal to market

Total Shoulder Replacement

$52,412
$64,920

19% lower than market

INPATIENT ORTHOPEDICS CHARGES

Description

Our Charge
Market Charge

Variance

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

$3,827
$14,948

74% lower than market

Tendonitis, myositis & bursitis without major complications

$2,410
$17,786

86% lower than market

INPATIENT PSYCHIATRY CHARGES

Description

Our Charge
Market Charge

Variance

Acute adjustment reaction & psychosocial dysfunction

$7,710
$18,724

59% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$10,364
$22,520

54% lower than market

Chronic Lung Disease without complications

$7,320
$14,813

51% lower than market

Pneumonia with complications

$15,017
$18,404

18% lower than market

Pneumonia with major complications

$7,643
$20,374

62% lower than market

Pneumonia without complications

$10,525
$12,457

16% lower than market

Pulmonary embolism with major complications

$2,483
$22,929

89% lower than market

Pulmonary embolism without major complications

$6,601
$16,083

59% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection with major complications

$11,327
$19,967

43% lower than market

Kidney & urinary Infection without complications

$7,598
$13,722

45% lower than market

Kidney failure with complications

$11,650
$15,776

26% 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.