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 3/31/18. 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

$725
$1,706

57% lower than market

Semi-Private Room

$725
$1,065

32% lower than market

Intensive Care Unit

$2,860
$3,266

12% lower than market

INPATIENT LABOR AND DELIVERY CHARGES

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

Description

Our Charge
Market Charge

Variance

Cesarean Section with complications

$17,418
$31,036

44% 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 Critical Care, First 30 Minutes

$1,953
$3,762

48% lower than market

Emergency Department Visit - Level 1

$312
$381

18% lower than market

Emergency Department Visit - Level 2

$440
$589

25% lower than market

Emergency Department Visit - Level 3

$765
$857

11% lower than market

Emergency Department Visit - Level 4

$1,108
$1,236

10% lower than market

Emergency Department Visit - Level 5

$1,643
$1,928

15% 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

Application of Electrical Stimulation - 15 Minutes

$111
$134

17% lower than market

Gait Training - 15 Minutes

$78
$130

40% lower than market

Physical Therapy, complex evaluation

$239
$392

39% lower than market

Physical Therapy, standard evaluation

$239
$383

38% lower than market

PT Evaluation - Moderate Complexity

$239
$419

43% lower than market

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

$90
$187

52% lower than market

Physical Therapy 1 or More Regions (15 min)

$99
$172

42% lower than market

Physical Therapy Exercise, 15 Minutes

$86
$170

49% lower than market

Physical Therapy, re-evaluation

$162
$188

14% 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, complex evaluation

$232
$368

37% lower than market

Occupational Therapy, standard evaluation

$232
$398

42% lower than market

Occupational Therapy Evaluation - Moderate Complexity

$232
$476

51% lower than market

Paraffin Wax Bath

$52
$52

Approximately equal to market

Occupational Therapy, re-evaluation

$153
$159

4% lower than market

Self Care - Home Management Training - 15 Minutes

$92
$156

41% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$91
$135

33% 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

Routine EKG - Minimum 12 Leads

$306
$494

38% lower than market

Stress Test

$796
$1,174

32% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Swallow Evaluation

$446
$465

4% lower than market

Swallow Treatment

$252
$311

19% 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

$259
$356

27% lower than market

Adrenocorticotropic hormone (ACTH) level

$167
$245

32% lower than market

Aldolase (enzyme) level

$69
$70

1% lower than market

Aldosterone hormone level

$196
$201

3% lower than market

Alpha-Fetoprotein (AFP) Level, Serum

$109
$157

31% lower than market

Ammonia Level

$109
$122

11% lower than market

Amylase

$115
$117

2% lower than market

Analysis for Gastrointestinal Bacteria

$99
$110

10% lower than market

Analysis for antibody to Coccidioides (bacteria)

$115
$150

24% lower than market

Analysis for antibody to Cryptococcus (yeast)

$98
$98

Approximately equal to market

Analysis for antibody to aspergillus (fungus)

$66
$79

17% lower than market

Analysis for antibody to histoplasma (fungus)

$125
$125

Approximately equal to market

Analysis for detection of tumor marker

$191
$244

22% lower than market

Analysis of Substance Using Immunoassay Technique

$155
$158

2% lower than market

Angiotensin l - converting enzyme (ACE) level

$104
$96

9% higher than market

Antibody Screen

$302
$369

18% lower than market

Arsenic level

$70
$88

21% lower than market

Bacterial Blood Culture

$154
$189

18% lower than market

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

$150
$226

34% lower than market

Bacterial Culture, Any Source Blood

$153
$172

11% lower than market

Bacterial Culture for Aerobic Isolates

$70
$160

56% lower than market

Bacterial urine culture; isolation and identification of each isolate

$155
$215

28% lower than market

Basic Metabolic Panel

$148
$176

16% lower than market

Bilirubin Level; Direct

$75
$67

12% higher than market

Blood Osmolality Measurement

$81
$81

Approximately equal to market

Blood Typing, ABO

$56
$86

35% lower than market

Blood Typing, Rh (D)

$54
$87

38% lower than market

Blood Unit Compatibility Test; Immediate Spin Technique

$147
$144

2% higher than market

Blood gases measurement

$356
$356

Approximately equal to market

Blood glucose (sugar) measurement using reagent strip

$32
$32

Approximately equal to market

Blood typing for red blood cell antigens

$71
$161

56% lower than market

Blood viscosity measurement

$133
$142

6% lower than market

Body fluid cell count with cell identification

$120
$203

41% lower than market

Body fluid pH level

$49
$72

32% lower than market

Calcium Level

$50
$76

34% lower than market

Carbamazepine Level

$162
$176

8% lower than market

Carboxyhemoglobin

$158
$185

15% lower than market

Carcinoembryonic Antigen (CEA) Protein Level

$176
$196

10% lower than market

Cell examination of specimen; concentration technique

$156
$205

24% lower than market

Chemical analysis of stone

$81
$81

Approximately equal to market

Chromium level to test for poisoning or deficiency

$113
$114

1% lower than market

Clotting factor VIII (VW factor) antigen

$151
$196

23% lower than market

Russell viper venom time (includes venom); diluted

$65
$94

31% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$215
$294

27% lower than market

Coagulation assessment blood test

$45
$65

31% lower than market

Complete Blood Count

$80
$110

27% lower than market

Complete Blood Count/Differential

$105
$113

7% lower than market

Comprehensive Metabolic Panel

$262
$294

11% lower than market

Concentration of specimen for infectious agents

$55
$71

22% lower than market

Copper level

$158
$140

13% higher than market

Cortisol Measurement

$115
$135

15% lower than market

Creatine Kinase Level

$86
$92

6% lower than market

Creatinine Level to Test for Kidney Function

$81
$78

4% higher than market

Crystal identification from tissue or body fluid

$50
$107

53% lower than market

Culture for acid-fast bacilli

$165
$273

39% lower than market

Cyanocobalamin (Vitamin B-12)

$98
$119

18% lower than market

Cyclosporine level

$166
$159

5% higher than market

Dehydroepiandrosterone (DHEA) hormone level

$109
$169

35% lower than market

Dehydroepiandrosterone (DHEA-S) hormone level

$118
$115

3% higher than market

Detection Test for Chlamydia; Amplified Probe Technique

$130
$165

21% lower than market

Detection Test for Neisseria Gonorrhoeae

$130
$172

25% lower than market

Detection test for Chlamydia pneumoniae

$205
$205

Approximately equal to market

Detection test for HIV-1 virus, quantification

$339
$463

27% lower than market

Detection test for Mycoplasma pneumoniae (bacteria)

$120
$120

Approximately equal to market

Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)

$163
$163

Approximately equal to market

Detection test for clostridium difficile

$181
$222

18% lower than market

Detection test for cryptosporidium (parasite); immunoassay technique

$89
$131

32% lower than market

Detection test for cytomegalovirus, quantification

$333
$512

35% lower than market

Detection test for giardia; immunoassay technique

$100
$121

17% lower than market

Detection test for multiple types influenza virus

$181
$181

Approximately equal to market

Detection test for multiple types of influenza virus

$181
$181

Approximately equal to market

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (eg, adenovirus, influenza virus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, rhinovirus), includes multiplex reve

$1,419
$1,419

Approximately equal to market

Detection test for organism; amplified probe technique

$345
$345

Approximately equal to market

Digoxin Level

$106
$93

14% higher than market

Drug Test(s) by Chemistry Analyzer

$219
$304

28% lower than market

Estradiol (hormone) level

$196
$220

11% lower than market

Estrone (hormone) level

$125
$125

Approximately equal to market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral); enzyme detection

$89
$89

Approximately equal to market

Evaluation of fine needle aspirate with interpretation and report

$235
$290

19% lower than market

Ferritin

$152
$142

7% higher than market

Fibrinogen (factor 1) activity measurement

$81
$109

26% lower than market

Flow cytometry, cell surface, cytoplasmic, or nuclear marker, technical component only; first marker

$174
$234

26% lower than market

Folic Acid Level

$70
$102

32% lower than market

Fungal culture (mold or yeast)

$146
$180

19% lower than market

Gammaglobulin Measurement

$81
$98

18% lower than market

Gastrin (GI tract hormone) level

$115
$123

7% lower than market

Glucose Level on Body Fluid

$40
$38

7% higher than market

Gonadotropin Analysis

$102
$129

21% lower than market

Gonadotropin, follicle stimulating (reproductive hormone) level

$163
$174

7% lower than market

Gonadotropin, luteinizing (reproductive hormone) level

$152
$170

11% lower than market

Heavy metal level

$132
$148

11% lower than market

Hemoglobin A1c

$86
$98

12% lower than market

Hepatitis B Surface Antibody Measurement

$124
$142

13% lower than market

Hepatitis B core antibody (IgM) measurement

$75
$97

23% lower than market

Hepatitis C Antibody Measurement

$104
$116

11% lower than market

Homocysteine (amino acid) level

$138
$152

9% lower than market

Culture, typing; immunologic method, other than immunofluorescence (eg, agglutination grouping), per antiserum

$48
$48

Approximately equal to market

IgE (immune system protein) level

$113
$128

12% lower than market

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

$161
$202

20% lower than market

HLA typing; A, B, or C (eg, A10, B7, B27), single antigen

$112
$139

19% lower than market

Immunologic Analysis for Detection of Tumor Antigen; Immunoassay - Quantitative CA 15-3

$121
$122

1% lower than market

Immunofixation electrophoresis; serum

$127
$169

25% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); 12-25 targets

$1,419
$1,620

12% lower than market

Infusion, albumin (human), 25%, 50 ml

$158
$338

53% lower than market

Insulin Measurement; Total

$86
$122

30% lower than market

Iron Level

$86
$86

Approximately equal to market

Kidney Function Blood Test Panel

$138
$181

24% lower than market

LDL cholesterol level

$75
$87

13% lower than market

Lactate Dehydrogenase

$98
$115

15% lower than market

Lactic Acid

$86
$151

43% lower than market

Lead level

$72
$80

10% lower than market

Lipase

$131
$133

1% lower than market

Lipid Panel

$201
$225

11% lower than market

Lithium Level

$81
$114

29% lower than market

Liver Enzyme (SGPT) Level

$70
$75

6% lower than market

Liver Panel

$161
$175

8% lower than market

Magnesium Level

$90
$79

14% higher than market

Manual blood cell count

$85
$85

Approximately equal to market

Mass spectrometry and tandem mass spectrometry (eg, MS, MS/ MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

$200
$200

Approximately equal to market

Measurement C-reactive protein

$107
$115

7% lower than market

Measurement high sensitivity C-reactive protein

$104
$100

4% higher than market

Measurement of Antibody for Assessment of Autoimmune Disorder

$111
$132

16% lower than market

Measurement of Complement (Immune System Proteins)

$93
$137

32% lower than market

Deoxyribonucleic acid (DNA) antibody; native or double stranded

$84
$124

32% lower than market

Measurement of antibody (IgE) to allergic substance

$64
$86

25% lower than market

Measurement of antibody to noninfectious agent

$169
$310

45% lower than market

Measurement of complement (immune system proteins)

$155
$223

30% lower than market

Mercury level

$77
$115

33% lower than market

Microscopic Examination of White Blood Cells with Manual Count

$63
$121

48% lower than market

Microscopic examination for white blood cells

$25
$25

Approximately equal to market

Microscopic genetic analysis of tumor; each single antibody stain procedure

$195
$419

53% lower than market

Microsomal Antibodies Measurement

$183
$240

24% lower than market

Natriuretic Peptide

$205
$219

6% lower than market

Nephelometry, test method using light

$145
$205

29% lower than market

Other closed skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration

$198
$198

Approximately equal to market

Oxcarbazepine level

$131
$131

Approximately equal to market

PSA Measurement; Total

$104
$132

21% lower than market

PSA Measurement; Free

$104
$141

26% lower than market

Parathormone

$135
$235

43% lower than market

Partial Thromblostatin Time, Activated

$77
$81

5% lower than market

Pathology examination of tissue during surgery

$260
$278

7% lower than market

Pathology examination of tissue using a microscope

$129
$160

19% lower than market

Phenobarbital Level

$93
$109

15% lower than market

Phenytoin Level

$150
$176

15% lower than market

Phosphate Level

$79
$83

5% lower than market

Plasminogen antigenic (factor inhibitor) measurement

$223
$223

Approximately equal to market

Platelet count, automated test

$65
$100

35% lower than market

Platelets, pheresis, leukocytes reduced, each unit

$1,154
$1,481

22% lower than market

Pregnenolone (reproductive hormone) level

$165
$165

Approximately equal to market

Preparation of tissue for examination by removing any calcium present

$82
$97

16% lower than market

Progesterone (reproductive hormone) level

$127
$154

18% lower than market

Protein Measurement, Serum

$86
$106

19% lower than market

Prothrombin Time

$60
$68

12% lower than market

Qualitative or semiquantitative detection test for helicobacter pylori in stool, multiple-step metho

$149
$228

35% lower than market

Quantitation of therapeutic drug

$120
$147

18% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$545
$728

25% lower than market

Red blood cells, leukocytes reduced, irradiated, each unit

$648
$1,429

55% lower than market

Renin (kidney enzyme) level

$66
$106

37% lower than market

Rheumatoid factor level

$92
$107

14% lower than market

Screening Test for Autoimmune Disorder

$113
$151

25% lower than market

Screening Test for Red Blood Cell Antibodies

$119
$143

17% lower than market

Cytopathology, smears, any other source; screening and interpretation

$169
$169

Approximately equal to market

Screening test for Pathogenic Organisms

$99
$124

20% lower than market

Screening test for antibody to noninfectious agent

$109
$124

12% lower than market

Screening test for compatible blood unit

$80
$80

Approximately equal to market

Sirolimus level

$81
$81

1% higher than market

Smear for infectious agents

$50
$59

15% lower than market

Special stain for microorganism; fluorescent and/or acide fast stain

$85
$110

23% lower than market

Special stained specimen slides to examine tissue including interpretation and report

$129
$141

8% lower than market

Special stained specimen slides to identify organisms including interpretation and report

$149
$181

18% lower than market

Stool analysis for blood

$62
$77

20% lower than market

Stool lactoferrin (immune system protein) analysis

$120
$120

Approximately equal to market

Strep Test

$142
$142

Approximately equal to market

Streptoccus

$152
$156

2% lower than market

Surgical Pathology, High Complexity

$1,170
$1,146

2% higher than market

Surgical Pathology, Intermediate Complexity

$170
$302

44% lower than market

T cells; absolute CD4 and CD8 count, including ratio

$231
$256

10% lower than market

Tacrolimus Level

$227
$332

32% lower than market

Testosterone Level; Free

$161
$185

13% lower than market

Testosterone Level; Total

$161
$210

23% lower than market

Thrombin time, fibrinogen screening test

$43
$43

Approximately equal to market

Thromboplastin inhibition (circulating anticoagulant) measurement

$116
$116

Approximately equal to market

Thyroglobulin (thyroid protein) antibody measurement

$76
$101

25% lower than market

Thyroid Hormone, T3 Measurement, Total

$112
$117

4% lower than market

Thyroid Hormone, T3 Measurement, Free

$150
$140

7% higher than market

Thyroxine

$115
$139

17% lower than market

Thyroxine Measurement

$104
$114

9% lower than market

Tissue or Cell Analysis by Immunologic Technique

$197
$320

38% lower than market

Total Protein Level, Blood

$68
$60

12% higher than market

Total Protein Level, Urine

$86
$142

39% lower than market

Translocation analysis (BCR/ABL1) major breakpoint

$493
$434

14% higher than market

Triglycerides Level

$81
$103

22% lower than market

Tuberculosis Test

$302
$429

30% lower than market

Uric Acid Level, Blood

$75
$71

5% higher than market

Urinalysis with Examination, using Microscope

$74
$95

22% lower than market

Urinalysis with Microscopy

$31
$31

Approximately equal to market

Urinalysis, Automated Test

$39
$37

5% higher than market

Urine Microalbumin Level

$69
$90

23% lower than market

Urine Sodium Level

$70
$61

15% higher than market

Urine Volume Measurement

$24
$24

Approximately equal to market

Urine calcium level

$87
$93

7% lower than market

Vancomycin Level

$109
$115

5% lower than market

Virus isolation; including identification by non-immunologic method

$214
$301

29% lower than market

Vitamin E level

$135
$154

12% lower than market

White blood cell alkaline phosphatase (enzyme) measurement with cell count

$139
$139

Approximately equal to market

Zinc level

$81
$74

9% higher than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Application of mechanical traction to 1 or more areas

$103
$128

20% lower than market

Determination of lung volumes using gas dilution or washout

$776
$781

1% lower than market

External shock to heart to regulate heart beat

$1,203
$2,649

55% lower than market

Fluoroscopic and video recorded motion evaluation of swallowing function

$598
$749

20% lower than market

Hemodialysis procedure with one physician evaluation

$1,520
$2,122

28% lower than market

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

$161
$297

46% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$308
$539

43% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$113
$246

54% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$93
$221

58% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$381
$576

34% lower than market

Infusion of chemotherapy into a vein

$161
$355

55% lower than market

Infusion of chemotherapy into a vein using push technique

$319
$382

16% lower than market

Infusion of drug into vein to dissolve coronary blood clot

$698
$698

Approximately equal to market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$127
$243

48% lower than market

Irrigation of implanted venous access drug delivery device

$83
$108

23% lower than market

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

$161
$360

55% lower than market

Psychiatric diagnostic evaluation

$343
$343

Approximately equal to market

Pulmonary service or operation

$83
$83

Approximately equal to market

Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound

$258
$318

19% lower than market

Sleep Monitoring with CPAP

$3,300
$3,790

13% lower than market

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

$2,949
$3,463

15% lower than market

Therapeutic hot and cold baths to 1 or more areas, each 15 minutes

$38
$38

Approximately equal to market

Therapeutic massage to 1 or more areas, each 15 minutes

$69
$69

Approximately equal to market

Therapeutic removal of whole blood to correct blood level imbalance

$225
$232

3% lower than market

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

$114
$153

26% lower than market

Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older

$229
$202

14% higher than market

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

$78
$195

60% lower than market

Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes

$104
$104

Approximately equal to market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Chemotherapy administration, intravenous infusion technique; initiation of infusion in the office/clinic setting using office/clinic pump/supplies, with continuation of the infusion in the community setting (e.g., home, domic

$838
$838

Approximately equal to market

Colonoscopy on High Cancer Risk Patient

$1,658
$1,634

1% higher than market

Connective tissue, human (includes fascia lata)

$4,488
$5,960

25% lower than market

Crushing, fragmenting, and removal of bladder stones, complicated or larger than 2.5 centimeters

$5,477
$13,508

59% lower than market

Destruction of lower or sacral spinal facet joint nerves with imaging guidance

$332
$332

Approximately equal to market

Destruction of peripheral nerve or branch

$8,068
$8,068

Approximately equal to market

Destruction of upper or middle spinal facet joint nerves using imaging guidance

$1,113
$1,113

Approximately equal to market

Electric Stimulation for Therapy

$83
$171

51% lower than market

Hospital Observation per Hour

$120
$134

10% lower than market

Hospital Outpatient Clinic Visit for Assessment and Management of a Patient

$288
$286

1% higher than market

Influenza virus vaccine, split virus, when administered to individuals 3 years of age and older, for intramuscular use (fluvirin)

$64
$64

Approximately equal to market

Injection of anesthetic agent, greater occipital nerve

$1,381
$1,381

Approximately equal to market

Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography

$2,613
$2,539

3% higher than market

Injection, perflutren lipid microspheres, per ml

$130
$131

1% lower than market

Injection(s) of joint with fluoroscopy or CT; lumbar or sacral; single level

$3,600
$3,664

2% lower than market

Injection(s) of joint with fluoroscopy or CT; lumbar or sacral; second level

$4,930
$4,930

Approximately equal to market

Injection(s) of joint with fluoroscopy or CT; lumbar or sacral; third and additional levels

$4,930
$4,930

Approximately equal to market

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

$2,466
$2,641

7% lower than market

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

$3,083
$3,083

Approximately equal to market

Injection(s) of joint with fluoroscopy or CT, cervical or thoracic; third or additional levels

$3,854
$3,854

Approximately equal to market

Insertion of anterior segment aqueous drainage device, with creation of intraocular reservoir, internal approach, into the supraciliary space

$1,693
$1,693

Approximately equal to market

Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries

$291
$290

Approximately equal to market

Lead, neurostimulator test kit (implantable)

$2,200
$2,200

Approximately equal to market

Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml

$5
$5

6% lower than market

Ocular implant, aqueous drainage assist device

$3,750
$3,750

Approximately equal to market

Port, indwelling (implantable)

$2,877
$3,899

26% lower than market

Excision or transposition of pterygium; with graft

$2,698
$4,832

44% lower than market

Repair of defect of sclera with graft

$2,037
$2,037

Approximately equal to market

Laparoscopy, surgical, repair, recurrent incisional hernia (includes mesh insertion, when performed); reducible

$6,826
$6,826

Approximately equal to market

Repair recurrent inguinal hernia, any age; reducible

$6,138
$6,138

Approximately equal to market

Repair of trapped hernia at navel patient age 5 years or older

$2,698
$2,698

Approximately equal to market

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

$216
$283

24% lower than market

Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries

$157
$196

20% lower than market

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

$427
$496

14% 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

$1,385
$1,385

Approximately equal to market

Transthoracic echocardiography, with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, during rest and cardiovascular stress test usin

$2,329
$2,329

Approximately equal to market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$97
$107

10% lower than market

Chemotherapy Infustion - Up to 1 Hour

$564
$694

19% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$277
$241

15% higher than market

Injection of New Drug into Vein for Therapy or Diagnosis

$137
$190

28% lower than market

Administration of Influenza Virus Vaccine

$75
$70

7% higher than market

5% dextrose/normal saline (500 ml = 1 unit)

$66
$122

46% lower than market

Atezolizumab - 1200 mg

$35
$35

Approximately equal to market

Cyclophosphamide, 100 mg

$514
$448

15% higher than market

Infusion, normal saline solution , 1000 cc

$119
$134

11% lower than market

Infusion, normal saline solution, 250 cc

$101
$91

11% higher than market

Injection, Azithromycin, 500 mg

$60
$55

9% higher than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$4
$8

48% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$21
$21

4% higher than market

Injection, Fentanyl Citrate, 0.1 mg

$16
$32

49% lower than market

Injection, Furosemide, up to 20 mg

$6
$15

60% lower than market

Injection, Hydralazine hcl, Up to 20 mg

$94
$152

38% lower than market

Injection, Hydromorphone, Up to 4 mg

$12
$30

59% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$20
$24

20% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$15
$34

56% lower than market

Injection, Morphine Sulfate, up to 10 mg

$15
$31

53% lower than market

Injection, Piperacillin Sodium/Tazobactam (1.125 grams)

$30
$46

35% lower than market

Injection, Promethazine HCL, up to 50 mg

$11
$14

24% lower than market

Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm

$56
$52

7% higher than market

Injection, bendamustine hcl (treanda), 1 mg

$232
$232

Approximately equal to market

Injection, butorphanol tartrate, 1 mg

$27
$27

Approximately equal to market

Injection, calcium gluconate, per 10 ml

$24
$36

34% lower than market

Injection, carboplatin, 50 mg

$63
$60

5% higher than market

Injection, cefoxitin sodium, 1 gm

$83
$72

15% higher than market

Injection, cetuximab, 10 mg

$336
$336

Approximately equal to market

Injection, darbepoetin alfa, 1 microgram (non-esrd use)

$30
$30

Approximately equal to market

Injection, decitabine, 1 mg

$140
$194

28% lower than market

Injection, denosumab, 1 mg

$77
$103

25% lower than market

Injection, docetaxel, 1 mg

$39
$38

3% higher than market

Injection, dopamine hcl, 40 mg

$12
$27

54% lower than market

Injection, ertapenem sodium, 500 mg

$311
$301

3% higher than market

Injection, ferric carboxymaltose, 1mg

$10
$10

Approximately equal to market

Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram

$4
$4

7% lower than market

Injection, fulvestrant, 25 mg

$365
$479

24% lower than market

Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units)

$586
$586

Approximately equal to market

Injection, hydrocortisone sodium succinate, up to 100 mg

$59
$53

12% higher than market

Injection, ibandronate sodium, 1 mg

$650
$752

14% lower than market

Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg

$275
$275

Approximately equal to market

Injection, infliximab, excludes biosimilar, 10 mg

$478
$478

Approximately equal to market

Injection, leucovorin calcium, per 50 mg

$42
$54

23% lower than market

Injection, lidocaine hcl for intravenous infusion, 10 mg

$7
$8

16% lower than market

Injection, methylprednisolone acetate, 80 mg

$131
$128

2% higher than market

Injection, methylprednisolone sodium succinate, up to 40 mg

$43
$44

1% lower than market

Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg

$18
$18

Approximately equal to market

Injection, omalizumab, 5 mg

$133
$133

Approximately equal to market

Injection, orphenadrine citrate, up to 60 mg

$124
$108

15% higher than market

Injection, palonosetron hcl, 25 mcg

$353
$334

6% higher than market

Injection, pembrolizumab, 1 mg

$179
$258

31% lower than market

Injection, penicillin g potassium, up to 600,000 units

$6
$6

Approximately equal to market

Injection, phenobarbital sodium, up to 120 mg

$8
$8

Approximately equal to market

Injection, propofol, 10 mg

$3
$3

1% higher than market

Injection, propranolol hcl, up to 1 mg

$53
$53

Approximately equal to market

Injection, sumatriptan succinate, 6 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

$596
$596

Approximately equal to market

Injection, tenecteplase, 1 mg

$4,195
$4,195

Approximately equal to market

Injection, thiamine hcl, 100 mg

$21
$33

37% lower than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$18
$28

36% lower than market

Injection, triptorelin pamoate, 3.75 mg

$3,490
$3,490

Approximately equal to market

Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg

$55
$64

14% lower than market

Injection, zoledronic acid, 1 mg

$468
$676

31% lower than market

Ringers lactate infusion, up to 1000 cc

$128
$132

3% lower than market

OUTPATIENT RESPIRATORY THERAPY CHARGES

The following charges reflect the most common services offered by our Respiratory Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Arterial Puncture

$136
$144

5% lower than market

CO Diffusion Capacity

$256
$373

31% lower than market

Pulse Oximetry

$38
$79

52% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$1,658
$2,592

36% lower than market

Repair of groin hernia patient age 5 years or older

$3,386
$8,384

60% lower than market

Amputation of finger or thumb; with direct closure

$2,698
$2,698

Approximately equal to market

Application of Short Leg Splint (Calf to Foot)

$313
$681

54% lower than market

Application of long leg splint (thigh to ankle or toes)

$313
$368

15% lower than market

Aqueous shunt to extraocular equatorial plate reservoir, external approach; without graft

$2,698
$2,698

Approximately equal to market

Aspiration and/or injection: intermediate joint/bursa

$577
$1,009

43% lower than market

Aspiration and/or injection: small joint/bursa

$577
$577

Approximately equal to market

Biopsy of large bowel using an endoscope

$1,658
$4,061

59% lower than market

Biopsy of prostate gland

$2,698
$6,775

60% lower than market

Biopsy of sclera

$2,698
$2,698

Approximately equal to market

Biopsy of the bladder using an endoscope

$2,698
$5,468

51% lower than market

Biopsy or removal of lymph nodes of under the arm, open procedure

$4,074
$8,502

52% lower than market

Collection of blood specimen from a completely implantable venous access device

$306
$323

5% lower than market

Colonscopy

$829
$1,269

35% lower than market

Complicated repair of the scrotum

$1,365
$1,365

Approximately equal to market

Contrast injections for X-ray imaging procedure to evaluate central venous access device

$575
$575

Approximately equal to market

Correction, hallux valgus (bunionectomy), with sesamoidectomy, when performed; with resection of proximal phalanx base, when performed, any method

$2,037
$2,037

Approximately equal to market

Correction of toe joint deformity

$1,817
$2,296

21% lower than market

Declotting infusion of implanted central venous access device or catheter

$350
$382

8% lower than market

Diagnostic examination of large bowel using an endoscope which is inserted through abdominal opening

$829
$829

Approximately equal to market

Drainage of fluid from abdominal cavity using imaging guidance

$1,533
$1,737

12% lower than market

Fine needle aspiration using imaging guidance

$559
$744

25% lower than market

Fluid collection drainage by catheter using imaging guidance, accessed through the skin; soft tissue

$2,037
$2,037

Approximately equal to market

Fusion of ankle joint, open procedure

$6,138
$6,138

Approximately equal to market

Arthrodesis, great toe; metatarsophalangeal joint

$1,817
$3,026

40% lower than market

Incision of the bladder canal (urethra) using an endoscope

$2,037
$2,037

Approximately equal to market

Incision to repair tendon covering at wrist; deQuervains disease

$2,698
$2,698

Approximately equal to market

Injection procedure for X-ray imaging of the bladder or during voiding

$768
$984

22% lower than market

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

$1,521
$1,760

14% lower than market

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

$1,521
$1,788

15% lower than market

Injections of large bowel using an endoscope

$693
$693

Approximately equal to market

Injections of tendon attachment to bone

$643
$643

Approximately equal to market

Injections of trigger points in 1 or 2 muscles

$789
$755

5% higher than market

Injections of trigger points in 3 or more muscles

$643
$643

Approximately equal to market

Insertion of Central Venous Catheter

$2,698
$6,246

57% lower than market

Insertion of Central Venous Catheter for Infusion

$1,238
$2,813

56% lower than market

Insertion of Needle into Vein to Collect Blood

$28
$35

20% lower than market

, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;

$3,386
$7,154

53% lower than market

Insertion of needle into vein, patient 3 years or older

$822
$822

Approximately equal to market

Insertion of stent in urinary duct (ureter) using an endoscope

$2,698
$6,700

60% lower than market

Joint procedure using an endoscope

$2,037
$2,037

Approximately equal to market

Laser vaporization of prostate including control of bleeding using an endoscope

$5,477
$5,477

Approximately equal to market

Open treatment of distal fibular fracture

$4,762
$7,618

37% lower than market

Open treatment of bimalleolar ankle fracture

$6,138
$9,221

33% lower than market

Open treatment of trimalleolar ankle fracture

$6,138
$9,875

38% lower than market

Open treatment of calcaneal fracture, includes internal fixation, when performed;

$7,514
$7,514

Approximately equal to market

Open treatment of broken of lower forearm or growth plate separation with insertion of hardware of 2

$558
$558

Approximately equal to market

Partial removal of tissue at sole of foot

$1,587
$1,587

Approximately equal to market

Placement of mesh to repair incisional or abdominal hernia, open procedure

$2,037
$3,676

45% lower than market

Release and/or relocation of median nerve of hand

$2,698
$5,012

46% lower than market

Release and/or relocation of ulnar nerve at elbow

$1,693
$1,693

Approximately equal to market

Release of nerve between tissue and bone of foot

$1,349
$1,349

Approximately equal to market

Removal of (up to 1 centimeter) growth of sclera

$1,693
$1,693

Approximately equal to market

Removal of 1 or more breast growth, open procedure

$3,386
$5,051

33% lower than market

Removal of Polyps in Large Bowel, Using an Endoscope

$829
$1,556

47% lower than market

Removal of bladder neck through bladder canal (urethra)

$2,037
$2,037

Approximately equal to market

Removal of bone defect of shin and/or ankle using an endoscope

$3,386
$3,386

Approximately equal to market

Removal of both knee cartilages using an endoscope

$3,386
$5,290

36% lower than market

Removal of bunion at fifth toe joint

$2,698
$2,698

Approximately equal to market

Extracapsular cataract removal with insertion of intraocular lens prosthesis

$2,698
$4,377

38% lower than market

Removal of fluid from chest cavity with imaging guidance

$2,182
$2,807

22% lower than market

Removal of foreign body in external eye, conjunctiva

$250
$314

20% lower than market

Removal of growth (2.1 to 3.0 centimeters) of face, ears, eyelids, nose, lips, or mouth

$2,698
$5,110

47% lower than market

Removal of growth (3.1 to 4.0 centimeters) of the scalp, neck, hands, feet, or genitals

$1,349
$1,349

Approximately equal to market

Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs

$1,349
$1,349

Approximately equal to market

Removal of heel bone spur

$2,698
$2,698

Approximately equal to market

Removal of loose or foreign body of ankle using an endoscope

$1,191
$1,191

Approximately equal to market

Removal of malignant growth (1.1 to 2.0 centimeters) of the trunk, arms, or legs

$2,037
$2,037

Approximately equal to market

Removal of malignant growth (3.1 to 4 centimeters) of the trunk, arms, or legs

$2,698
$5,155

48% lower than market

Removal of one knee cartilage using an endoscope

$7,514
$8,082

7% lower than market

Removal of peripheral venous catheter for infusion

$2,698
$5,549

51% lower than market

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

$1,658
$1,658

Approximately equal to market

Removal of polyps or growths of large bowel using an endoscope which is inserted through abdominal o

$1,658
$1,658

Approximately equal to market

Removal of pressure sore at sacrum with skin graft

$4,074
$4,074

Approximately equal to market

Removal of shoulder joint tissue using an endoscope

$4,074
$4,074

Approximately equal to market

Removal of skin and/or muscle

$899
$899

Approximately equal to market

Repair of Wound (2.6 to 7.5 centimeters)

$360
$683

47% lower than market

Conjunctivoplasty; with conjunctival graft or extensive rearrangement

$2,037
$2,037

Approximately equal to market

Repair, primary, disrupted ligament, ankle; collateral

$1,191
$1,191

Approximately equal to market

Repair, tendon, flexor, foot; primary or secondary, without free graft, each tendon

$2,037
$2,974

32% lower than market

Repair, flexor tendon, leg; primary, without graft, each tendon

$1,191
$1,191

Approximately equal to market

Repair of nonunion, scaphoid carpal (navicular) bone, with or without radial styloidectomy (includes obtaining graft and necessary fixation)

$8,202
$8,202

Approximately equal to market

Repair of prolapsing hemorrhoids

$3,386
$3,386

Approximately equal to market

Repair of shoulder socket cartilage using an endoscope

$5,450
$5,450

Approximately equal to market

Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/

$482
$452

7% higher than market

Repair of wound (2.5 centimeters or less) of the scalp, underarms, trunk, arms, and/or legs

$2,037
$2,037

Approximately equal to market

Repair of wound (2.6 to 7.5 centimeters) of neck, hands, feet, and/or genitals

$1,349
$1,349

Approximately equal to market

Repair of wound (2.6 to 7.5 centimeters) of trunk

$815
$815

Approximately equal to market

Repair of wound of trunk

$815
$815

Approximately equal to market

Replacement, complete, of a tunneled centrally inserted central venous access device, with subcutaneous port, through same venous access

$4,074
$4,074

Approximately equal to market

Revision of aqueous shunt to extraocular equatorial plate reservoir; without graft

$1,039
$1,039

Approximately equal to market

Shaving of shoulder bone using an endoscope

$2,725
$4,272

36% lower than market

Sigmoidoscopy, flexible; with ablation of tumor(s), polyp(s), or other lesion(s) (includes pre- and post-dilation and guide wire passage, when performed)

$1,658
$1,658

Approximately equal to market

Sigmoidoscopy, flexible; with band ligation(s) (eg, hemorrhoids)

$1,658
$1,658

Approximately equal to market

Skin, mucus membrane and beneath the skin procedure

$2,037
$3,169

36% lower than market

Tissue transfer repair of wound (10.1 to 30.0 sq centimeters) of the scalp, arms, and/or legs

$1,365
$1,365

Approximately equal to market

Transfusion of Blood or Blood Products

$1,212
$1,062

14% higher than market

Tying or biopsy of temporal artery (side of skull)

$2,698
$2,698

Approximately equal to market

Ultrasound measurement of bladder capacity after voiding

$122
$131

7% lower than market

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

$335
$665

50% lower than market

Simple wound repair of face, including ears; 2.6 cm to 5.0 cm

$381
$547

30% lower than market

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

$321
$461

30% lower than market

OUTPATIENT TRANSPORTATION CHARGES

Description

Our Charge
Market Charge

Variance

Advanced life support, level 2 (als 2)

$878
$878

Approximately equal to market

Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)

$607
$607

Approximately equal to market

Ambulance service, basic life support, emergency transport (bls-emergency)

$512
$512

Approximately equal to market

Ambulance service, basic life support, non-emergency transport, (bls)

$355
$355

Approximately equal to market

Ground mileage, per statute mile

$13
$13

Approximately equal to market

OUTPATIENT VISION CHARGES

Description

Our Charge
Market Charge

Variance

Amniotic membrane for surgical reconstruction, per procedure

$6,158
$6,158

Approximately equal to market

Posterior chamber intraocular lens

$1,278
$1,188

8% higher 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

Cardiac testing - electrocardiogram, doppler

$891
$891

Approximately equal to market

Insertion of probe in esophagus for heart ultrasound examination including interpretation and report

$1,599
$1,984

19% lower than market

Ultrasound Blood Flow Outside the Brain

$1,170
$1,497

22% lower than market

Ultrasound Heart

$1,947
$2,083

7% lower than market

Ultrasound Veins of Both Arms or Legs

$1,293
$1,870

31% lower than market

Ultrasound Veins of One Arm or Leg

$650
$983

34% lower than market

Cardiac testing - stress test with electrocardiogram

$1,204
$1,204

Approximately equal to market

Ultrasound of Arteries of Both Legs

$815
$1,120

27% lower than market

Ultrasound of Arteries of One Leg

$715
$899

20% lower than market

Ultrasound study of arteries and arterial grafts of one arm or limited

$525
$499

5% higher than market

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries

$441
$567

22% lower than market

Physical Therapy, ultrasound therapy

$86
$179

52% lower than market

3 Phase Bone Scan