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Patient Price Information List

Disclaimer: Ed Fraser 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, Ed Fraser Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2021. Ed Fraser Memorial Hospital charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Ascension St. Vincent's Clay County Hospital

Middleburg

FL

Ascension St. Vincent's Riverside Hospital

Jacksonville

FL

Baptist Medical Center Jacksonville

Jacksonville

FL

Baptist Medical Center Nassau

Fernandina Beach

FL

Lake Butler Hospital

Lake Butler

FL

Lake City Medical Center

Lake City

FL

Mayo Clinic Hospital in Florida

Jacksonville

FL

Orange Park Medical Center

Orange Park

FL

Shands Lake Shore Regional Medical Center

Lake City

FL

Shands Starke Medical Center

Starke

FL

UF Health Jacksonville

Jacksonville

FL

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$817
$2,988

73% lower than market

Semi-Private Room

$660
$2,675

75% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]

$4,945
$5,713

13% lower than market

Abdominal ultrasound (complete) [HCPCS 76700]

$771
$2,205

65% lower than market

Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]

$2,944
$20,480

86% lower than market

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

$9,128
$12,200

25% lower than market

Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]

$8,697
$13,190

34% lower than market

Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]

$2,689
$11,438

76% lower than market

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

$7,080
$11,867

40% lower than market

Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]

$4,707
$13,998

66% lower than market

Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]

$1,886
$3,498

46% lower than market

Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]

$5,026
$5,020

Approximately equal to market

Imaging of leg joint by MRI without contrast [HCPCS 73721]

$3,180
$4,654

32% lower than market

Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]

$3,180
$3,915

19% lower than market

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

$1,222
$1,206

1% higher than market

Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]

$103
$231

55% lower than market

Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]

$263
$333

21% lower than market

Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]

$103
$111

8% lower than market

Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]

$110
$378

71% lower than market

Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]

$116
$214

46% lower than market

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]

$102
$184

45% lower than market

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]

$113
$123

8% lower than market

Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 800

$320
$324

1% lower than market

Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]

$96
$50

92% higher than market

Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]

$181
$340

47% lower than market

Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]

$263
$371

29% lower than market

Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]

$109
$245

55% lower than market

Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]

$267
$520

49% lower than market

Mammography of both breasts (screening exam) [HCPCS 77067]

$294
$522

44% lower than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$342
$547

37% lower than market

Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]

$2,473
$4,784

48% lower than market

Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]

$70
$164

57% lower than market

Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]

$2,719
$6,444

58% lower than market

Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]

$793
$1,456

46% lower than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

Critical care delivery to critically ill or injured patient (first 30-74 minutes) [HCPCS 99291]

$3,665
$5,166

29% lower than market

Emergency department visit for minor problem [HCPCS 99281]

$397
$543

27% lower than market

Emergency department visit for problem of high severity [HCPCS 99284]

$1,864
$2,472

25% lower than market

Emergency department visit for problem of low to moderate severity [HCPCS 99282]

$653
$1,019

36% lower than market

Emergency department visit for problem of moderate severity [HCPCS 99283]

$1,032
$1,582

35% lower than market

Emergency department visit for problem with significant threat to life [HCPCS 99285]

$2,643
$3,802

30% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Drug test def 1-7 classes [HCPCS G0480]

$163
$822

80% lower than market

Lab analysis by immunoassay (ELISA) to identify clostridium difficile toxins (stool pathogen) [HCPCS 87324]

$174
$147

19% higher than market

Lab analysis by immunoassay to identify Strep (streptococcus) [HCPCS 87880]

$67
$105

36% lower than market

Lab analysis of any culture (except urine, blood, or stool) to identify bacteria [HCPCS 87070]

$220
$394

44% lower than market

Lab analysis of blood culture to identify bacteria [HCPCS 87040]

$199
$341

42% lower than market

Lab analysis of stool culture to identify bacteria [HCPCS 87045]

$193
$407

53% lower than market

Lab analysis of urine culture to measure the amount of bacteria [HCPCS 87086]

$163
$306

47% lower than market

Lab analysis to identify antibody IgE to allergic substance (each crude allergen extract) [HCPCS 86003]

$22
$72

69% lower than market

Lab analysis to identify coagulation function (qualitative or semiquantitative) [HCPCS 85378]

$85
$108

21% lower than market

Lab analysis to identify Hepatitis C antibodies [HCPCS 86803]

$99
$170

42% lower than market

Lab analysis to identify ketone bodies in blood, serum, or plasma specimen [HCPCS 82009]

$99
$269

63% lower than market

Lab analysis to identify total thyroxine (thyroid chemical) function in serum specimen for screening [HCPCS 84436]

$65
$263

75% lower than market

Lab analysis to measure blood count (hemoglobin) [HCPCS 85018]

$46
$84

45% lower than market

Lab analysis to measure free thyroxine (thyroid chemical) in serum specimen [HCPCS 84439]

$142
$129

10% higher than market

Lab analysis to measure red blood cell concentration [HCPCS 85014]

$46
$75

39% lower than market

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (non-automated) [HCPCS 85651]

$77
$211

63% lower than market

Lab analysis to measure red blood count (automated test) [HCPCS 85045]

$46
$166

72% lower than market

Lab analysis to measure rheumatoid factor level [HCPCS 86431]

$64
$81

21% lower than market

Lab analysis to measure the ammonia level [HCPCS 82140]

$136
$228

40% lower than market

Lab analysis to measure the amount of blood gases [HCPCS 82803]

$247
$420

41% lower than market

Lab analysis to measure the amount of C-reactive protein in serum to identify infection or inflammation [HCPCS 86140]

$62
$149

58% lower than market

Lab analysis to measure the amount of free thyroid hormone, T3 in serum specimen [HCPCS 84481]

$66
$82

20% lower than market

Lab analysis to measure the amount of hepatitis A antibody, hepatitis B core antibody, hepatitis B surface antigen, and hepatitis C antibody in blood specimen to evaluate acute hepatitis [HCPCS 80074]

$387
$403

4% lower than market

Lab analysis to measure the amount of protein in serum specimen [HCPCS 84165]

$117
$115

2% higher than market

Lab analysis to measure the amount of total cortisol (hormone) [HCPCS 82533]

$122
$148

18% lower than market

Lab analysis to measure the amount of total digoxin in blood specimen [HCPCS 80162]

$102
$162

37% lower than market

Lab analysis to measure the amount of total estradiol (hormone) [HCPCS 82670]

$404
$142

184% higher than market

Lab analysis to measure the amount of total phenytoin in blood specimen [HCPCS 80185]

$163
$296

45% lower than market

Lab analysis to measure the amount of total thyroid hormone, T3 in serum specimen [HCPCS 84480]

$118
$163

27% lower than market

Lab analysis to measure the amount of total valproic acid in blood specimen [HCPCS 80164]

$97
$224

57% lower than market

Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]

$181
$207

12% lower than market

Lab analysis to measure the amylase (enzyme) level in serum specimen [HCPCS 82150]

$98
$225

56% lower than market

Lab analysis to measure the blood potassium level in blood specimen [HCPCS 84132]

$82
$107

24% lower than market

Lab analysis to measure the carboxyhemoglobin (protein) level [HCPCS 82375]

$112
$102

9% higher than market

Lab analysis to measure the carcinoembryonic antigen (cea) protein level [HCPCS 82378]

$123
$174

29% lower than market

Lab analysis to measure the creatine kinase (cardiac enzyme) level (MB fraction only) [HCPCS 82553]

$132
$140

6% lower than market

Lab analysis to measure the creatinine level to test for kidney function or muscle injury (other than blood specimen) [HCPCS 82570]

$207
$232

11% lower than market

Lab analysis to measure the cyanocobalamin (vitamin b-12) level [HCPCS 82607]

$123
$155

21% lower than market

Lab analysis to measure the ferritin (blood protein) level [HCPCS 82728]

$89
$180

50% lower than market

Lab analysis to measure the folic acid level in serum specimen [HCPCS 82746]

$145
$146

1% lower than market

Lab analysis to measure the glucose (sugar) level in blood [HCPCS 82947]

$96
$128

25% lower than market

Lab analysis to measure the glutamyltransferase (liver enzyme) level [HCPCS 82977]

$48
$171

72% lower than market

Lab analysis to measure the hemoglobin A1C level in blood specimen [HCPCS 83036]

$72
$150

52% lower than market

Lab analysis to measure the iron binding capacity [HCPCS 83550]

$86
$229

62% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$58
$119

51% lower than market

Lab analysis to measure the lactate dehydrogenase (enzyme) level [HCPCS 83615]

$91
$177

49% lower than market

Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]

$103
$163

37% lower than market

Lab analysis to measure the lipase (fat enzyme) level [HCPCS 83690]

$83
$267

69% lower than market

Lab analysis to measure the liver enzyme (sgot), level in serum or plasma specimen [HCPCS 84450]

$46
$160

71% lower than market

Lab analysis to measure the liver enzyme (sgpt), level in serum or plasma specimen [HCPCS 84460]

$46
$143

68% lower than market

Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]

$141
$139

1% higher than market

Lab analysis to measure the natriuretic peptide (heart and blood vessel protein) level in plasma specimen [HCPCS 83880]

$348
$295

18% higher than market

Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]

$278
$275

1% higher than market

Lab analysis to measure the phosphate level [HCPCS 84100]

$52
$128

59% lower than market

Lab analysis to measure the sodium level in blood specimen [HCPCS 84295]

$49
$103

52% lower than market

Lab analysis to measure the total calcium level in blood specimen [HCPCS 82310]

$91
$56

63% higher than market

Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]

$136
$206

34% lower than market

Lab analysis to measure the total protein level in urine specimen [HCPCS 84156]

$86
$126

32% lower than market

Lab analysis to measure the uric acid level in blood specimen [HCPCS 84550]

$52
$193

73% lower than market

Lab analysis to measure total testosterone (hormone) level in serum specimen [HCPCS 84403]

$180
$148

22% higher than market

Lab analysis to screen for syphilis [HCPCS 86592]

$66
$119

44% lower than market

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's blood group type (ABO) [HCPCS 86900]

$50
$76

34% lower than market

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's Rh (D) type (Rh positive or Rh negative) [HCPCS 86901]

$50
$79

37% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue (initial procedure) [HCPCS 88342]

$188
$313

40% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue with interpretation and report [HCPCS 88313]

$74
$227

67% lower than market

Pathology lab analysis of tissue with microscope (intermediate complexity) [HCPCS 88305]

$160
$542

70% lower than market

Psa screening [HCPCS G0103]

$105
$183

42% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Drug administration beneath the skin or into muscle by injection for therapy, diagnosis, or prevention [HCPCS 96372]

$80
$252

68% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (concurrent with another infusion) [HCPCS 96368]

$109
$602

82% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (each additional hour) [HCPCS 96366]

$55
$233

76% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96365]

$212
$877

76% lower than market

Drug administration into vein by infusion of additional sequential infusion of new drug for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96367]

$180
$389

54% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of same drug) [HCPCS 96376]

$80
$263

70% lower than market

External 48-hour EKG heart rhythm tracing, analysis, and interpretation with scanning analysis and report [HCPCS 93226]

$461
$1,203

62% lower than market

Hydration administration into vein by infusion (each additional hour) [HCPCS 96361]

$61
$184

67% lower than market

Immunization administration of vaccine into, between, or beneath the skin or into muscle (single vaccine) [HCPCS 90471]

$177
$202

13% lower than market

Lung volumes measurement by gas dilution or washout [HCPCS 94727]

$426
$1,420

70% lower than market

Orthotics use training (supports, braces, or splints) for arms, legs and/or trunk (initial encounter, each 15 minutes) [HCPCS 97760]

$67
$255

74% lower than market

Oxygen saturation measurement in blood by ear or finger device (multiple determinations) [HCPCS 94761]

$159
$362

56% lower than market

Sleep pattern monitoring of patient in sleep lab with continued pressured respiratory assistance by mask or breathing tube (6 years of age or older) [HCPCS 95811]

$3,090
$6,870

55% lower than market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$224
$46

383% higher than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

Home sleep test/type 3 porta [HCPCS G0399]

$272
$880

69% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Amiodarone hcl [HCPCS J0282]

$29
$4

665% higher than market

Calcium gluconate injection [HCPCS J0610]

$45
$51

12% lower than market

Cefazolin sodium injection [HCPCS J0690]

$40
$19

109% higher than market

Diphenhydramine hcl injectio [HCPCS J1200]

$32
$76

58% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of new drug) [HCPCS 96375]

$80
$391

80% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (initial drug) [HCPCS 96374]

$80
$490

84% lower than market

Ertapenem injection [HCPCS J1335]

$343
$182

89% higher than market

Fentanyl citrate injection [HCPCS J3010]

$38
$77

51% lower than market

Furosemide injection [HCPCS J1940]

$34
$32

7% higher than market

Gad-base mr contrast nos,1ml [HCPCS A9579]

$17
$11

52% higher than market

Inj heparin sodium per 1000u [HCPCS J1644]

$49
$34

45% higher than market

Inj midazolam hydrochloride [HCPCS J2250]

$37
$29

28% higher than market

Levofloxacin injection [HCPCS J1956]

$39
$89

56% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$34
$74

54% lower than market

Ondansetron hcl injection [HCPCS J2405]

$28
$12

135% higher than market

Regadenoson injection [HCPCS J2785]

$147
$199

26% lower than market

Tetanus, diphtheria toxoids and acellular pertussis (whooping cough) vaccine for injection into muscle (7 years of age or older) [HCPCS 90715]

$117
$173

32% lower than market

Vancomycin hcl injection [HCPCS J3370]

$54
$41

33% higher than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Electrical stimulation application to 1 or more areas (each 15 minutes) [HCPCS 97032]

$118
$234

50% lower than market

Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]

$98
$195

50% lower than market

Occupational therapy evaluation (typically 30 minutes) [HCPCS 97165]

$148
$481

69% lower than market

Occupational therapy evaluation (typically 45 minutes) [HCPCS 97166]

$160
$631

75% lower than market

Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]

$70
$203

65% lower than market

Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]

$148
$456

68% lower than market

Physical therapy evaluation (typically 30 minutes) [HCPCS 97162]

$160
$506

68% lower than market

Physical therapy evaluation (typically 45 minutes) [HCPCS 97163]

$173
$567

69% lower than market

Physical therapy procedure to re-educate brain-to-nerve-to-muscle function (each 15 minutes) [HCPCS 97112]

$70
$223

69% lower than market

Physical therapy techniques to 1 or more regions (each 15 minutes) [HCPCS 97140]

$118
$199

41% lower than market

Speech, language, voice, communication, and/or hearing processing disorder treatment [HCPCS 92507]

$106
$426

75% lower than market

Swallowing and/or oral feeding function treatment [HCPCS 92526]

$117
$401

71% lower than market

Swallowing function evaluation [HCPCS 92610]

$148
$722

80% lower than market

Training activities for home and self-care management (each 15 minutes) [HCPCS 97535]

$99
$223

56% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Aerosol generator, nebulizer, metered dose inhaler, or intermittent positive pressure breathing (IPPB) device demonstration and/or evaluation for patient use [HCPCS 94664]

$142
$211

33% lower than market

Amount and speed of breathed air measurement and graphic recording before and after medication administration [HCPCS 94060]

$510
$1,563

67% lower than market

External 48-hour EKG heart rhythm tracing, analysis, and interpretation with recording [HCPCS 93225]

$461
$654

30% lower than market

Heart and blood vessel stress test with EKG tracing and monitoring (exercise or drug-induced) [HCPCS 93017]

$1,174
$2,403

51% lower than market

Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]

$180
$540

67% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Airway inhalation treatment to relieve airway obstruction or for sputum collection (inhaled pressure or nonpressure treatment) [HCPCS 94640]

$487
$403

21% higher than market

Lung diffusing capacity measurement [HCPCS 94729]

$426
$898

53% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Breathing tube insertion into windpipe cartilage with endoscope (emergent) [HCPCS 31500]

$894
$16,704

95% lower than market

Colorectal cancer screening; colonoscopy on invididual not meeting high risk [HCPCS G0121]

$4,966
$9,840

50% lower than market

Colorectal scrn; hi risk ind [HCPCS G0105]

$4,839
$10,627

54% lower than market

Esophagus, stomach, and/or upper small bowel examination and removal of polyps or tumors by snare technique with endoscope [HCPCS 43251]

$5,881
$14,225

59% lower than market

Esophagus, stomach, and/or upper small bowel examination and stomach tube insertion with endoscope [HCPCS 43246]

$3,699
$14,764

75% lower than market

Esophagus, stomach, and/or upper small bowel examination and widening by balloon with endoscope (less than 30 mm) [HCPCS 43249]

$7,263
$16,675

56% lower than market

Fibrous tissue repair of foot with endoscope [HCPCS 29893]

$3,453
$34,338

90% lower than market

Foot incision of joint capsule of foot and toe [HCPCS 28270]

$17,258
$13,870

24% higher than market

Inj for sacroiliac jt anesth [HCPCS G0260]

$1,089
$2,665

59% lower than market

Lower or sacral spine facet joint injections with imaging guidance (first level) [HCPCS 64493]

$2,292
$4,311

47% lower than market

Lower or sacral spine facet joint injections with imaging guidance (second level) [HCPCS 64494]

$2,498
$4,277

42% lower than market

Needle insertion into vein for collection of blood sample [HCPCS 36415]

$15
$34

56% lower than market

Toe incision to straighten toe bone at the midfoot bone (each toe bone) [HCPCS 28308]

$11,670
$40,082

71% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

Abdominal and pelvic CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74176]

$4,391
$5,183

15% lower than market

Abdominal and pelvic CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74178]

$5,160
$7,073

27% lower than market

Abdominal aorta and both leg arteries CTA scan with contrast [HCPCS 75635]

$1,985
$6,349

69% lower than market

Abdominal blood vessels CTA scan with contrast [HCPCS 74175]

$2,538
$5,570

54% lower than market

Abdominal CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74160]

$2,473
$4,069

39% lower than market

Abdominal CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74150]

$2,172
$3,931

45% lower than market

Abdominal CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74170]

$2,473
$4,481

45% lower than market

Abdominal ultrasound (limited) [HCPCS 76705]

$752
$1,414

47% lower than market

Abdominal x-ray (2 views) [HCPCS 74019]

$508
$801

37% lower than market

Abdominal x-ray (single view) [HCPCS 74018]

$346
$445

22% lower than market

Abdominal x-ray, complete study including 2 or more views of abdomen and single view of chest [HCPCS 74022]

$729
$1,101

34% lower than market

Ankle x-ray (2 views) [HCPCS 73600]

$428
$669

36% lower than market

Ankle x-ray (minimum of 3 views) [HCPCS 73610]

$666
$701

5% lower than market

Arm CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73200]

$1,836
$3,350

45% lower than market

Arm x-ray of forearm (2 views) [HCPCS 73090]

$671
$685

2% lower than market

Arm x-ray of upper arm (minimum of 2 views) [HCPCS 73060]

$663
$658

1% higher than market

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (complete, both arms or legs) [HCPCS 93970]

$1,184
$1,652

28% lower than market

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (limited, one arm or leg) [HCPCS 93971]

$752
$1,312

43% lower than market

Arteries and arterial grafts ultrasound of one leg (limited study) [HCPCS 93926]

$414
$1,002

59% lower than market

Arteries of both arms and legs ultrasound (limited) [HCPCS 93922]

$699
$918

24% lower than market

Blood flow (outside of the brain) ultrasound on both sides of head and neck [HCPCS 93880]

$1,184
$1,667

29% lower than market

Bone density measurement of the axial skeleton (hips, pelvis, spine) [HCPCS 77080]

$591
$1,216

51% lower than market

Breast ultrasound (one breast, complete) [HCPCS 76641]

$434
$857

49% lower than market

Breast ultrasound (one breast, limited) [HCPCS 76642]

$645
$711

9% lower than market

Chest CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 71260]

$2,340
$4,049

42% lower than market

Chest CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 71250]

$2,064
$3,486

41% lower than market

Chest CT scan without contrast, followed by contrast to examine injury, foreign bodies, or tumors [HCPCS 71270]

$2,459
$4,685

48% lower than market

Chest ultrasound [HCPCS 76604]

$729
$1,136

36% lower than market

Chest x-ray (2 views) [HCPCS 71046]

$375
$597

37% lower than market

Chest x-ray (single view) [HCPCS 71045]

$346
$380

9% lower than market

Collar bone x-ray, complete study [HCPCS 73000]

$693
$691

Approximately equal to market

CTA scan of chest blood vessels with contrast to examine injury, foreign bodies, or tumors [HCPCS 71275]

$2,528
$4,276

41% lower than market

CTA scan of neck blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70498]

$2,523
$4,726

47% lower than market

Elbow x-ray (2 views) [HCPCS 73070]

$539
$640

16% lower than market

Elbow x-ray, complete study (minimum of 3 views) [HCPCS 73080]

$695
$747

7% lower than market

Facial CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70486]

$2,806
$3,753

25% lower than market

Finger(s) x-ray (minimum of 2 views) [HCPCS 73140]

$346
$571

39% lower than market

Fluoroscopy imaging guidance for procedure (up to 1 hour) [HCPCS 76000]

$523
$999

48% lower than market

Foot x-ray (2 views) [HCPCS 73620]

$547
$722

24% lower than market

Foot x-ray, complete study (minimum of 3 views) [HCPCS 73630]

$709
$714

1% lower than market

Hand x-ray (minimum of 2 views) [HCPCS 73130]

$565
$736

23% lower than market

Head and neck ultrasound [HCPCS 76536]

$752
$1,335

44% lower than market

Head or brain CT scan without contrast, followed by contrast to examine injury, foreign bodies, or tumors [HCPCS 70470]

$2,334
$4,549

49% lower than market

Heart blood vessels and grafts CTA scan with contrast [HCPCS 75574]

$1,985
$2,684

26% lower than market

Heart ultrasound including color-depicted blood flow rate, direction, and valve function [HCPCS 93306]

$2,013
$3,328

40% lower than market

Heart ultrasound performed during rest, exercise, and/or drug-induced stress with interpretation and report [HCPCS 93350]

$1,817
$3,945

54% lower than market

Hip x-ray of both hips with pelvis (2 views) [HCPCS 73521]

$575
$1,008

43% lower than market

Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]

$330
$665

50% lower than market

Imaging of arm joint by MRI without contrast [HCPCS 73221]

$3,180
$4,947

36% lower than market

Imaging of bone and/or joint (whole body) [HCPCS 78306]

$1,496
$4,595

67% lower than market

Imaging of brain by MRI without contrast [HCPCS 70551]

$3,180
$4,089

22% lower than market

Imaging of heart vessels with SPECT tomography and drugs or exercise (multiple studies) [HCPCS 78452]

$6,894
$8,371

18% lower than market

Imaging of leg by MRI without contrast [HCPCS 73718]

$3,180
$3,742

15% lower than market

Imaging of lower spinal canal by MRI without contrast, followed by contrast [HCPCS 72158]

$5,026
$4,948

2% higher than market

Imaging of lung ventilation and blood circulation in the lungs [HCPCS 78582]

$1,947
$2,002

3% lower than market

Imaging of middle spinal canal by MRI without contrast [HCPCS 72146]

$3,180
$3,913

19% lower than market

Imaging of scrotum by ultrasound [HCPCS 76870]

$752
$1,340

44% lower than market

Imaging of upper spinal canal by MRI without contrast [HCPCS 72141]

$3,180
$3,833

17% lower than market

Joint or other non-blood vessel structure of arm or leg ultrasound (partial) [HCPCS 76882]

$485
$672

28% lower than market

Knee x-ray (1 or 2 views) [HCPCS 73560]

$722
$626

15% higher than market

Knee x-ray (3 views) [HCPCS 73562]

$435
$683

36% lower than market

Knee x-ray (4 or more views) [HCPCS 73564]

$764
$767

Approximately equal to market

Knee x-ray of both knees, standing (front to back view) [HCPCS 73565]

$363
$449

19% lower than market

Leg CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73700]

$1,856
$3,347

45% lower than market

Leg ultrasound of arteries and arterial grafts of both legs (complete study) [HCPCS 93925]

$1,184
$1,225

3% lower than market

Liver and bile duct system imaging with the use of oral medication [HCPCS 78227]

$1,790
$3,571

50% lower than market

Lower leg blood vessels CTA scan with contrast [HCPCS 73706]

$2,528
$3,628

30% lower than market

Lower leg x-ray (2 views) [HCPCS 73590]

$700
$709

1% lower than market

Neck CT scan of the soft tissue of the neck with contrast to examine injury, foreign bodies, or tumors [HCPCS 70491]

$2,211
$3,874

43% lower than market

Neck CT scan of the soft tissue of the neck without contrast to examine injury, foreign bodies, or tumors [HCPCS 70490]

$1,766
$3,419

48% lower than market

Neck x-ray to examine soft tissue for any obstructions and/or foreign bodies within the throat or neck [HCPCS 70360]

$346
$564

39% lower than market

Nuclear medicine stomach emptying evaluation [HCPCS 78264]

$1,491
$3,315

55% lower than market

Paranasal sinuses x-ray usually including 4 to 5 standard views of the skull (complete study, miniumum of 3 views) [HCPCS 70220]

$546
$792

31% lower than market

Pelvis CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 72192]

$2,220
$3,796

42% lower than market

Pelvis ultrasound, not pregnancy related (limited) [HCPCS 76857]

$544
$1,001

46% lower than market

Pelvis ultrasound, not pregrnancy related (complete) [HCPCS 76856]

$752
$1,590

53% lower than market

Pelvis x-ray (1 or 2 views) [HCPCS 72170]

$346
$583

41% lower than market

Rib cage x-ray of ribs on one side of body including chest (minimum of 3 views) [HCPCS 71101]

$448
$806

44% lower than market

Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]

$740
$697

6% higher than market

Skull CT scan to examine the bones of the eye and ear without contrast to examine injury, foreign bodies, or tumors [HCPCS 70480]

$1,886
$4,173

55% lower than market

Spinal CT scan of lower spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72131]

$1,902
$3,463

45% lower than market

Spinal CT scan of middle spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72128]

$1,820
$3,487

48% lower than market

Spinal CT scan of upper spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72125]

$1,800
$3,538

49% lower than market

Spinal x-ray of junction of middle and lower spine (2 views) [HCPCS 72080]

$415
$644

36% lower than market

Spinal x-ray of lower and sacral spine (2 or 3 views) [HCPCS 72100]

$729
$801

9% lower than market

Spinal x-ray of middle spine (2 views) [HCPCS 72070]

$428
$577

26% lower than market

Spinal x-ray of middle spine (3 views) [HCPCS 72072]

$433
$670

35% lower than market

Spinal x-ray of upper spine (2 or 3 views) [HCPCS 72040]

$346
$764

55% lower than market

Spinal x-ray of upper spine (4 or 5 views) [HCPCS 72050]

$577
$1,208

52% lower than market

Spinal x-ray of upper spine including bending views, complete study (6 or more views) [HCPCS 72052]

$770
$1,134

32% lower than market

Toe(s) x-ray (minimum of 2 views) [HCPCS 73660]

$346
$576

40% lower than market

Transplanted kidney ultrasound [HCPCS 76776]

$752
$707

6% higher than market

Ultrasound application to 1 or more areas (each 15 minutes) [HCPCS 97035]

$109
$182

40% lower than market

Ultrasound of area behind abdominal cavity (complete) [HCPCS 76770]

$752
$1,079

30% lower than market

Wrist x-ray, complete study (minimum of 3 views) [HCPCS 73110]

$617
$691

11% lower than market

X-ray of sacrum and tailbone (minimum of 2 views) [HCPCS 72220]

$382
$761

50% lower than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Heart Failure with complications

$22,035
$38,856

43% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Nutritional or Metabolic Disorders without major complications

$20,579
$28,598

28% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$28,644
$47,569

40% lower than market

Chronic Lung Disease without complications

$35,872
$33,435

7% higher than market

Pneumonia with complications

$30,371
$45,745

34% lower than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$16,958
$30,417

44% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Ed Fraser Memorial Hospital for your healthcare needs. At Ed Fraser Memorial Hospital, we are committed to making the billing process as patient-friendly as possible. Here are some ways you can help the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Ed Fraser 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 Ed Fraser 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 Ed Fraser 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 904-259-3151 ext. 2217.

If you need more information about the price of a future service, please contact our Price Hotline at 904-259-3151 ext. 2217. A CPT code is strongly encouraged when you call. You can obtain the CPT code from the ordering physician.

Online Registration & Scheduling

For the convenience of our patients, a number of online services are available at https://edfraserhospital.com/. Ed Fraser Memorial Hospital offers secure online registration & scheduling.

Ed Fraser Memorial Hospital also offers pre-registration and appointment requests through a secure online form at https://edfraserhospital.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.

Ed Fraser Memorial Hospital's Charity Care Policy

Ed Fraser Memorial Hospital provides high quality care to everyone, regardless of their ability to pay.

Ed Fraser 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.

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

For more information, please contact our Customer Call Center at 904-259-3151 ext. 2217.