Patient Price Information List

Disclaimer: Gila Medical Center 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, Gila Medical Center has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/22. Gila Medical Center charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Memorial Medical Center

Las Cruces

NM

Mimbres Memorial Hospital

Deming

NM

Mountainview Regional Medical Center

Las Cruces

NM

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$994
$2,125

53% lower than market

Semi-Private Room

$1,800
$1,821

1% 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]

$6,290
$11,489

45% lower than market

Abdominal ultrasound (complete) [HCPCS 76700]

$1,054
$1,516

30% 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]

$9,889
$12,825

23% lower than market

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

$5,217
$11,311

54% lower than market

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

$5,953
$15,742

62% lower than market

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

$4,354
$8,530

49% lower than market

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

$5,536
$12,169

55% lower than market

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

$2,456
$4,148

41% lower than market

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

$4,489
$8,619

48% lower than market

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

$3,545
$3,702

4% lower than market

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

$3,595
$4,657

23% lower than market

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

$80
$94

15% lower than market

Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]

$42
$52

19% lower than market

Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]

$11
$24

55% lower than market

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

$65
$94

31% lower than market

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

$86
$118

27% lower than market

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

$87
$104

16% 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]

$114
$128

11% lower than market

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

$218
$289

24% 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]

$172
$215

20% lower than market

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

$121
$217

44% lower than market

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

$284
$381

25% lower than market

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

$399
$488

18% lower than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$518
$636

19% lower than market

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

$100
$158

37% lower than market

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

$746
$1,118

33% lower than market

Total Knee or Hip Replacement

$50,955
$126,721

60% lower than market

OUTPATIENT CLINIC

Description

Our Charge
Market Charge

Variance

Hospital outpatient clinic visit for assessment and management of a patient [HCPCS G0463]

$331
$524

37% 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]

$2,260
$4,610

51% lower than market

Emergency department visit for minor problem [HCPCS 99281]

$338
$461

27% lower than market

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

$1,283
$1,563

18% lower than market

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

$499
$690

28% lower than market

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

$829
$1,058

22% lower than market

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

$1,902
$2,418

21% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Cov-19 amp prb hgh thruput [HCPCS U0003]

$1,545
$240

544% higher than market

Drug screening read by chemistry analyzers [HCPCS 80307]

$253
$414

39% lower than market

Lab analysis by immunoassay (ELISA) to identify cryptosporidium (parasite) [HCPCS 87328]

$104
$111

6% lower than market

Lab analysis by immunoassay (ELISA) to identify giardia (intestinal parasite) [HCPCS 87329]

$108
$150

28% lower than market

Lab analysis by immunoassay (ELISA) to identify the severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [HCPCS 87426]

$124
$129

4% lower than market

Lab analysis by immunologic analysis technique on serum (immunofixation) [HCPCS 86334]

$148
$302

51% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify antigen of severe acute respiratory syndrome coronavirus 2 (Covid-19) [HCPCS 87635]

$50
$170

71% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify clostridium difficile by amplified probe technique [HCPCS 87493]

$205
$295

31% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify Staphylococcus aureus, methicillin resistant (MRSA bacteria) by amplified probe technique [HCPCS 87641]

$177
$179

1% lower than market

Lab analysis by nucleic acid (DNA or RNA) to measure the amount of cytomegalovirus [HCPCS 87497]

$171
$701

76% lower than market

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

$162
$247

34% lower than market

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

$179
$239

25% lower than market

Lab analysis of special gram or Giemsa stain to idenitfy microorganisms [HCPCS 87205]

$68
$99

31% lower than market

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

$162
$163

Approximately equal to market

Lab analysis of therapeutic drug not elsewhere specified [HCPCS 80299]

$178
$196

9% lower than market

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

$129
$123

5% higher than market

Lab analysis to identify antibodies for autoimmune disorder assessment (any method) [HCPCS 86235]

$132
$177

26% lower than market

Lab analysis to identify antibodies to Coccidioides (bacteria) [HCPCS 86635]

$133
$230

42% lower than market

Lab analysis to identify antibodies to native or double stranded DNA [HCPCS 86225]

$98
$156

37% lower than market

Lab analysis to identify antibody to noninfectious agents [HCPCS 86256]

$65
$126

48% lower than market

Lab analysis to identify gonadotropin (reproductive hormone) in serum or urine specimen [HCPCS 84703]

$119
$193

38% lower than market

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

$113
$144

22% lower than market

Lab analysis to identify tumor antigens by immunoassay (quantitative, CA 15-3) [HCPCS 86300]

$141
$168

16% lower than market

Lab analysis to identify white blood cells (manual) with microscope [HCPCS 85007]

$74
$106

30% lower than market

Lab analysis to identify white blood cells with microscope [HCPCS 85008]

$28
$42

33% lower than market

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

$44
$60

27% lower than market

Lab analysis to measure cerebrospinal fluid cell count with a differential cell study [HCPCS 89051]

$130
$169

23% lower than market

Lab analysis to measure coagulation function measurement of D-dimer (quantitative) [HCPCS 85379]

$234
$439

47% lower than market

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

$133
$288

54% lower than market

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (automated) [HCPCS 85652]

$91
$101

10% lower than market

Lab analysis to measure rheumatoid factor level [HCPCS 86431]

$100
$134

25% lower than market

Lab analysis to measure the ammonia level [HCPCS 82140]

$127
$186

32% lower than market

Lab analysis to measure the amount of C-reactive protein in serum by high sensitivity assay to identify infection or inflammation [HCPCS 86141]

$121
$163

26% lower than market

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

$116
$144

20% lower than market

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

$163
$173

6% lower than market

Lab analysis to measure the amount of gammaglobulin (immune system protein) [HCPCS 82784]

$32
$138

77% lower than market

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

$100
$259

61% lower than market

Lab analysis to measure the amount of sirolimus in blood specimen [HCPCS 80195]

$95
$118

19% lower than market

Lab analysis to measure the amount of substance by other immunoassay technique [HCPCS 83520]

$172
$285

40% lower than market

Lab analysis to measure the amount of tacrolimus in blood specimen [HCPCS 80197]

$246
$351

30% lower than market

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

$194
$229

15% lower than market

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

$125
$133

6% lower than market

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

$192
$243

21% lower than market

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

$89
$86

4% higher than market

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

$114
$179

36% lower than market

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

$165
$173

5% lower than market

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

$82
$162

50% lower than market

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

$34
$134

75% lower than market

Lab analysis to measure the IgE (immune system protein) level [HCPCS 82785]

$131
$196

33% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$94
$117

20% lower than market

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

$100
$216

54% lower than market

Lab analysis to measure the level of blood proteins (nephelometry) using light [HCPCS 83883]

$79
$120

34% lower than market

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

$142
$158

10% lower than market

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

$98
$108

10% lower than market

Lab analysis to measure the microalbumin (protein) level in urine specimen [HCPCS 82043]

$80
$154

48% lower than market

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

$238
$284

16% lower than market

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

$162
$515

69% lower than market

Lab analysis to measure the thyroid stimulating immune globulins (thyroid related protein) level in serum specimen [HCPCS 84445]

$201
$345

42% lower than market

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

$100
$212

53% lower than market

Lab analysis to measure the vitamin D-3 level in serum or plasma specimen [HCPCS 82306]

$131
$263

50% lower than market

Lab analysis to measure urea nitrogen level in serum or plasma specimen to assess kidney function (quantitative) [HCPCS 84520]

$81
$112

28% lower than market

Lab analysis to screen for autoimmune disorders [HCPCS 86038]

$129
$230

44% lower than market

Lab blood analysis to confirm blood unit compatibility by antiglobulin technique [HCPCS 86922]

$121
$586

79% lower than market

Lab blood analysis to confirm blood unit compatibility by immediate spin technique [HCPCS 86920]

$171
$477

64% 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]

$63
$133

53% lower than market

Lab blood analysis to screen for antibodies to red blood cell antigens (each serum technique) [HCPCS 86850]

$138
$203

32% lower than market

Pathology lab analysis by flow cytometry technique for DNA or cell analysis technical component (each additional marker) [HCPCS 88185]

$4
$13

70% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue (each additional procedure) [HCPCS 88341]

$329
$391

16% lower than market

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

$228
$1,068

79% lower than market

Pathology lab analysis of special stained specimen slides to identify organisms with interpretation and report [HCPCS 88312]

$173
$263

34% lower than market

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

$197
$506

61% lower than market

Pathology lab analysis of tissue with microscope [HCPCS 88302]

$150
$307

51% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$590
$666

11% lower than market

Rbc leukoreduced irradiated [HCPCS P9040]

$295
$787

62% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Chemotherapy administration beneath the skin or into muscle (hormonal, anti-cancer) [HCPCS 96402]

$187
$495

62% lower than market

Chemotherapy administration into vein by infusion (each additional hour) [HCPCS 96415]

$187
$791

76% lower than market

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

$148
$320

54% lower than market

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

$180
$176

3% higher than market

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

$54
$181

70% lower than market

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

$442
$555

20% 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]

$131
$197

33% lower than market

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

$67
$226

70% lower than market

Gastroesophageal reflux test with pH electrode insertion including recording, analysis and interpretation [HCPCS 91035]

$1,389
$1,631

15% lower than market

Hydration administration into vein by infusion (31 minutes to 1 hour) [HCPCS 96360]

$357
$493

28% lower than market

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

$90
$153

41% lower than market

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

$105
$256

59% lower than market

Implanted venous access drug delivery device irrigation [HCPCS 96523]

$97
$182

47% lower than market

Moderate conscious sedation services by physician also performing a procedure, first 15 minutes (patient 5 years of age or older) [HCPCS 99152]

$159
$743

79% lower than market

Swallowing function evaluation by fluoroscopy with video recording [HCPCS 92611]

$687
$991

31% lower than market

Tissue removal from wounds per session (first 20 sq cm or less) [HCPCS 97597]

$299
$597

50% lower than market

Unlisted procedure for lung service or operation [HCPCS 94799]

$324
$707

54% lower than market

Whole blood removal by needle to correct blood level imbalance [HCPCS 99195]

$261
$454

42% lower than market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$4
$7

41% lower than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

Fosphenytoin inj pe [HCPCS Q2009]

$2
$2

27% lower than market

Visualization adjunct [HCPCS Q9968]

$1
$3

79% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Adenosine inj 1mg [HCPCS J0153]

$1
$1

15% lower than market

Amiodarone hcl [HCPCS J0282]

$1
$11

89% lower than market

Ampicillin sulbactam 1.5 gm [HCPCS J0295]

$30
$37

17% lower than market

Azithromycin [HCPCS J0456]

$30
$158

81% lower than market

Calcium gluconate injection [HCPCS J0610]

$39
$80

51% lower than market

Cefazolin sodium injection [HCPCS J0690]

$8
$18

58% lower than market

Cefoxitin sodium injection [HCPCS J0694]

$20
$53

62% lower than market

Chemotherapy administration into vein by infusion (up to 1 hour, single drug) [HCPCS 96413]

$654
$1,189

45% lower than market

Cisplatin 10 mg injection [HCPCS J9060]

$2
$8

80% lower than market

Denosumab injection [HCPCS J0897]

$1
$2

65% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$20
$30

33% lower than market

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

$160
$201

20% lower than market

Epoetin alfa, non-esrd [HCPCS J0885]

$3
$3

13% higher than market

Ertapenem injection [HCPCS J1335]

$101
$217

53% lower than market

F18 fdg [HCPCS A9552]

$336
$725

54% lower than market

Fentanyl citrate injection [HCPCS J3010]

$22
$39

44% lower than market

Fluorouracil injection [HCPCS J9190]

$9
$192

95% lower than market

Garamycin gentamicin inj [HCPCS J1580]

$4
$25

83% lower than market

Haloperidol injection [HCPCS J1630]

$25
$112

78% lower than market

Hydralazine hcl injection [HCPCS J0360]

$56
$167

66% lower than market

Hydromorphone injection [HCPCS J1170]

$22
$37

40% lower than market

In gemcitabine hcl nos 200mg [HCPCS J9201]

$9
$21

58% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$2
$8

79% lower than market

Inj heparin sodium per 1000u [HCPCS J1644]

$10
$46

79% lower than market

Inj magnesium sulfate [HCPCS J3475]

$8
$30

74% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$6
$15

63% lower than market

Inj morphine pf epid ithc [HCPCS J2274]

$32
$75

58% lower than market

Inj naloxone hydrochloride [HCPCS J2310]

$2
$97

98% lower than market

Inj pembrolizumab [HCPCS J9271]

$1
$1

63% lower than market

Inj, atezolizumab,10 mg [HCPCS J9022]

$1
$3

54% lower than market

Inj., rituximab, 10 mg [HCPCS J9312]

$11
$6

73% higher than market

Irinotecan injection [HCPCS J9206]

$2
$6

71% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$5
$18

71% lower than market

Leucovorin calcium injection [HCPCS J0640]

$3
$10

73% lower than market

Levofloxacin injection [HCPCS J1956]

$12
$52

76% lower than market

Lorazepam injection [HCPCS J2060]

$22
$31

29% lower than market

Meperidine hydrochl /100 mg [HCPCS J2175]

$25
$38

34% lower than market

Methylprednisolone injection [HCPCS J2920]

$25
$40

37% lower than market

Methylprednisolone injection [HCPCS J2930]

$41
$60

32% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$20
$26

24% lower than market

Morphine sulfate injection [HCPCS J2270]

$22
$45

51% lower than market

Omalizumab injection [HCPCS J2357]

$2
$4

40% lower than market

Ondansetron hcl injection [HCPCS J2405]

$1
$5

72% lower than market

Orphenadrine injection [HCPCS J2360]

$62
$102

39% lower than market

Phenylephrine hcl injection [HCPCS J2370]

$20
$54

63% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$4
$19

78% lower than market

Prochlorperazine injection [HCPCS J0780]

$73
$60

21% higher than market

Promethazine hcl injection [HCPCS J2550]

$30
$31

Approximately equal to market

Regadenoson injection [HCPCS J2785]

$37
$72

49% lower than market

Romiplostim injection [HCPCS J2796]

$6
$7

8% lower than market

Succinycholine chloride inj [HCPCS J0330]

$23
$85

73% lower than market

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

$177
$252

30% lower than market

Vancomycin hcl injection [HCPCS J3370]

$24
$29

19% lower than market

Vitamin b12 injection [HCPCS J3420]

$29
$42

31% lower than market

Ziprasidone mesylate [HCPCS J3486]

$43
$77

44% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$28
$148

81% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Elec stim other than wound [HCPCS G0283]

$91
$172

47% lower than market

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

$106
$198

47% lower than market

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

$269
$419

36% lower than market

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

$269
$681

61% lower than market

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

$90
$149

39% lower than market

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

$277
$450

38% lower than market

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

$277
$571

51% lower than market

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

$277
$686

60% lower than market

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

$105
$220

52% lower than market

Physical therapy re-evaluation (typically 20 minutes) [HCPCS 97164]

$188
$221

15% lower than market

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

$58
$199

71% lower than market

Speech sound production evaluation with evaluation of language comprehension and expression [HCPCS 92523]

$517
$969

47% lower than market

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

$216
$290

25% lower than market

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

$292
$406

28% lower than market

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

$107
$215

50% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$355
$705

50% 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]

$324
$388

16% lower than market

Oxygen saturation measurement in blood by ear or finger device (single determination) [HCPCS 94760]

$44
$78

44% lower than market

OUTPATIENT SUPPLIES

Description

Our Charge
Market Charge

Variance

Event recorder, cardiac [HCPCS C1764]

$6,489
$26,490

75% lower than market

Radiopharm dx agent noc [HCPCS A4641]

$277
$265

4% higher than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Blood or blood products transfusion [HCPCS 36430]

$3,758
$10,779

65% lower than market

Blood specimen collection from a completely implantable venous access device [HCPCS 36591]

$10,607
$17,167

38% lower than market

Collection of blood specimen from arterial puncture for diagnosis [HCPCS 36600]

$8,395
$18,589

55% lower than market

Indwelling bladder catheter insertion (simple) [HCPCS 51702]

$9,392
$7,536

25% higher than market

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

$33
$43

24% lower than market

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.6 to 7.5 cm) [HCPCS 12002]

$5,293
$5,956

11% lower than market

OUTPATIENT VISION SERVICES

Description

Our Charge
Market Charge

Variance

Post chmbr intraocular lens [HCPCS V2632]

$1,372
$1,299

6% higher 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]

$4,976
$10,357

52% lower than market

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

$6,433
$9,427

32% lower than market

Abdominal and pelvic vessels CTA scan with contrast [HCPCS 74174]

$5,878
$5,685

3% higher than market

Abdominal ultrasound (limited) [HCPCS 76705]

$892
$1,538

42% lower than market

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

$399
$438

9% lower than market

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

$305
$573

47% lower than market

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

$597
$1,076

45% lower than market

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

$435
$795

45% lower than market

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

$1,484
$2,178

32% lower than market

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

$753
$1,230

39% lower than market

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

$511
$951

46% lower than market

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

$1,266
$1,301

3% lower than market

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

$708
$778

9% lower than market

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

$2,893
$4,318

33% lower than market

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

$2,462
$3,525

30% lower than market

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

$402
$614

34% lower than market

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

$357
$681

48% lower than market

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

$3,369
$4,879

31% lower than market

CTA scan of head blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70496]

$3,244
$4,288

24% lower than market

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

$3,313
$4,282

23% lower than market

Design and construction of radiation therapy device [HCPCS 77338]

$1,122
$3,289

66% lower than market

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

$370
$660

44% lower than market

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

$2,016
$2,997

33% lower than market

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

$339
$653

48% lower than market

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

$468
$750

38% lower than market

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

$471
$718

34% lower than market

Head and neck ultrasound [HCPCS 76536]

$747
$1,108

33% lower than market

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

$3,453
$5,068

32% lower than market

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

$438
$467

6% lower than market

Hip x-ray of hip with pelvis (single view) [HCPCS 73501]

$301
$670

55% lower than market

Imaging for swallowing function evaluation with contrast [HCPCS 74230]

$769
$1,126

32% lower than market

Imaging of brain by MRI without contrast [HCPCS 70551]

$3,087
$5,025

39% lower than market

Imaging of eye, face, and/or neck by MRI without contrast, followed by contrast [HCPCS 70543]

$3,472
$5,776

40% lower than market

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

$3,986
$6,090

35% lower than market

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

$3,380
$3,816

11% lower than market

Intensity modulated radiation therapy delivery (complex) [HCPCS 77386]

$1,814
$5,061

64% lower than market

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

$452
$1,494

70% lower than market

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

$409
$696

41% lower than market

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

$653
$733

11% lower than market

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

$2,434
$3,960

39% lower than market

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

$445
$796

44% lower than market

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

$2,878
$4,136

30% lower than market

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

$2,662
$4,764

44% lower than market

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

$663
$1,211

45% lower than market

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

$937
$1,456

36% lower than market

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

$387
$964

60% lower than market

PET (positron emission tomography) imaging with CT imaging (skull base to mid-thigh) [HCPCS 78815]

$4,590
$5,980

23% lower than market

Radiation therapy dose calculation [HCPCS 77300]

$218
$908

76% lower than market

Radiation therapy treatment planning (modulated) with advanced computer programs to calculate and deliver radiation to cancer cells [HCPCS 77301]

$4,120
$12,140

66% lower than market

Radiation treatment delivery (complex) [HCPCS 77412]

$759
$1,907

60% lower than market

Radiation treatment devices, design and construction (complex) [HCPCS 77334]

$1,122
$2,365

53% lower than market

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

$467
$479

3% lower than market

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

$481
$804

40% lower than market

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

$2,951
$4,898

40% lower than market

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

$3,032
$5,317

43% lower than market

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

$469
$927

49% lower than market

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

$621
$895

31% lower than market

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography

$2,427
$3,137

23% lower than market

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

$100
$248

60% lower than market

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

$817
$1,628

50% lower than market

Upper digestive tract x-ray with barium swallow (double contrast material [HCPCS 74246]

$581
$629

8% lower than market

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

$529
$785

33% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Respiratory infections and inflammations with major complications

$46,855
$65,636

29% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Gila Medical Center for your healthcare needs. At Gila Medical Center, 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 Gila Medical Center, 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 Gila Medical Center 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 Gila Medical Center 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 (575) 538-4000.

If you need more information about the price of a future service, please contact our Price Hotline at (575) 538-4000. 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.grmc.org/. Gila Medical Center offers secure online payment.

Gila Medical Center also offers pre-registration and appointment requests through a secure online form at http://www.grmc.org/. 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.

Gila Medical Center's Charity Care Policy

Gila Medical Center provides high quality care to everyone, regardless of their ability to pay.

Gila Medical Center'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, Gila Medical Center offers interest free loans for up to one year to assist patients.

For more information, please contact our Customer Call Center at (575) 538-4000.