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 3/31/2020. 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

$1,154
$1,905

39% lower than market

Semi-Private Room

$725
$1,765

59% lower than market

Intensive Care Unit

$2,860
$3,293

13% lower than market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with Level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Description

Our Charge
Market Charge

Variance

Emergency Department Visit - Level 1

$312
$422

26% lower than market

Emergency Department Visit - Level 2

$440
$622

29% lower than market

Emergency Department Visit - Level 3

$765
$955

20% lower than market

Emergency Department Visit - Level 4

$1,108
$1,408

21% lower than market

Emergency Department Visit - Level 5

$1,643
$2,182

25% lower than market

Emergency Critical Care, First 30 Minutes

$1,953
$4,089

52% 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
$222

50% lower than market

Electric Stimulation for Therapy

$83
$186

55% lower than market

Gait Training - 15 Minutes

$78
$135

42% lower than market

PT Evaluation - Moderate Complexity

$239
$523

54% lower than market

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

$90
$198

55% lower than market

Physical Therapy 1 or More Regions (15 min)

$100
$211

53% lower than market

Physical Therapy Exercise, 15 Minutes

$86
$183

53% lower than market

Physical Therapy, complex evaluation

$239
$643

63% lower than market

Physical Therapy, re-evaluation

$162
$200

19% lower than market

Physical Therapy, standard evaluation - 20 minutes

$239
$410

42% lower than market

OUTPATIENT CLINIC CHARGES

Description

Our Charge
Market Charge

Variance

Hospital Outpatient Clinic Visit for Assessment and Management of a Patient

$288
$478

40% 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 Evaluation - Moderate Complexity

$232
$641

64% lower than market

Occupational Therapy, complex evaluation

$232
$480

52% lower than market

Occupational Therapy, standard evaluation - 30 minutes

$232
$383

39% lower than market

Paraffin Wax Bath

$52
$229

77% lower than market

Self Care - Home Management Training - 15 Minutes

$92
$212

57% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$91
$182

50% 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
$680

55% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Speech Therapy

$186
$288

35% lower than market

Swallow Evaluation

$446
$661

33% lower than market

Swallow Treatment

$252
$371

32% 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

Alpha-Fetoprotein (AFP) Level, Serum

$109
$205

47% lower than market

Ammonia level

$109
$163

33% lower than market

Amylase (enzyme) level

$115
$116

1% lower than market

Analysis of Substance Using Immunoassay Technique

$155
$337

54% lower than market

Bacterial Blood Culture

$154
$210

26% lower than market

Bacterial Culture for Aerobic Isolates

$70
$168

58% lower than market

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

$150
$221

32% lower than market

Blood Typing, Rh (D)

$54
$118

54% lower than market

Blood Unit Compatibility Test; Immediate Spin Technique

$147
$377

61% lower than market

Blood test, basic group of blood chemicals

$148
$190

22% lower than market

Blood test, clotting time

$60
$82

27% lower than market

Blood test, comprehensive group of blood chemicals

$262
$336

22% lower than market

Blood test, lipids (cholesterol and triglycerides)

$201
$254

21% lower than market

Blood test, thyroid stimulating hormone (TSH)

$161
$146

10% higher than market

Carcinoembryonic antigen (CEA) protein level

$176
$222

21% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$215
$366

41% lower than market

Complete blood cell count - automated differential WBC count

$105
$114

8% lower than market

Complete blood cell count - automated test with out Differential

$80
$92

13% lower than market

Cyanocobalamin (vitamin B-12) level

$98
$157

37% lower than market

Detection test for clostridium difficile

$181
$269

33% lower than market

Detection test for cytomegalovirus, quantification

$333
$640

48% lower than market

Drug Test(s) by Chemistry Analyzer

$219
$348

37% lower than market

Ferritin (blood protein) level

$152
$156

2% lower than market

Fungal culture (mold or yeast)

$146
$156

7% lower than market

Gammaglobulin Measurement

$81
$131

38% lower than market

Gonadotropin (reproductive hormone) analysis

$102
$173

41% lower than market

Hemoglobin A1C level

$86
$118

27% lower than market

Hemoglobin Measurement

$38
$51

26% lower than market

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, by radioimmunoassay (eg, RIA)

$291
$606

52% lower than market

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified

$148
$256

42% lower than market

Immunofixation electrophoresis; serum

$127
$261

51% lower than market

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

$121
$154

21% lower than market

Immunologic analysis for detection of tumor antigen (CA 125)

$161
$220

27% lower than market

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

$270
$618

56% lower than market

Iron level

$86
$103

16% lower than market

Kidney Function Blood Test Panel

$138
$222

38% lower than market

LDL cholesterol level

$75
$124

40% lower than market

Lactic acid level

$86
$186

54% lower than market

Lipase (fat enzyme) level

$131
$141

7% lower than market

Liver function blood test panel

$161
$143

13% higher than market

Magnesium Level

$90
$95

5% lower than market

Measurement C-reactive protein

$107
$127

16% lower than market

Measurement high sensitivity C-reactive protein

$104
$144

28% lower than market

Measurement of Antibody for Assessment of Autoimmune Disorder

$116
$156

26% lower than market

Measurement of antibody (IgE) to allergic substance

$64
$79

19% lower than market

Microscopic Examination of White Blood Cells with Manual Count

$63
$145

57% lower than market

Microscopic examination for white blood cells

$25
$37

32% lower than market

Natriuretic peptide (heart and blood vessel protein) level

$205
$255

20% lower than market

Nephelometry, test method using light

$145
$144

1% higher than market

PSA (prostate specific antigen) measurement

$104
$188

45% lower than market

PSA Measurement; Free

$104
$195

47% lower than market

Parathormone

$140
$443

68% lower than market

Coagulation assessment blood test

$77
$103

25% lower than market

Pathology examination of tissue using a microscope

$129
$244

47% lower than market

Pathology examination of tissue using a microscope, intermediate complexity

$170
$456

63% lower than market

Protein Measurement, Serum

$86
$220

61% lower than market

Quantitation of therapeutic drug

$123
$197

37% lower than market

Red Blood Cell Concentration Measurement

$36
$55

35% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$545
$1,038

47% lower than market

Rheumatoid factor level

$92
$119

23% lower than market

Screening Test for Autoimmune Disorder

$113
$201

44% lower than market

Screening Test for Red Blood Cell Antibodies

$119
$179

34% lower than market

Screening test for Pathogenic Organisms

$85
$107

20% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$59
$86

31% lower than market

Special stained specimen slides to examine tissue

$303
$358

15% lower than market

Special stained specimen slides to examine tissue including interpretation and report

$129
$195

34% lower than market

Special stained specimen slides to identify organisms including interpretation and report

$149
$290

49% lower than market

Strep Test

$142
$155

8% lower than market

Streptoccus

$152
$160

5% lower than market

Tacrolimus Level

$227
$302

25% lower than market

Testosterone (hormone) level

$161
$286

44% lower than market

Thyroid Hormone, T3 Measurement, Free

$150
$155

3% lower than market

Thyroxine (thyroid chemical) measurement - Free Thyroxine

$115
$247

53% lower than market

Thyroxine (thyroid chemical) measurement - Total

$104
$127

18% lower than market

Tissue or Cell Analysis by Immunologic Technique

$197
$974

80% lower than market

Urea nitrogen level to assess kidney function

$75
$97

22% lower than market

Urinalysis with Examination, using Microscope

$74
$83

11% lower than market

Urinalysis, Automated Test

$39
$48

18% lower than market

Urine microalbumin (protein) level

$69
$133

48% lower than market

Vitamin D-3 Level

$113
$227

50% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Debridement, open wound; first 20 cm2 or less

$258
$547

53% lower than market

Fluoroscopic and video recorded motion evaluation of swallowing function

$598
$847

29% lower than market

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

$161
$439

63% lower than market

Hydration Infusion into a Vein

$78
$139

44% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$308
$439

30% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$113
$141

20% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$93
$153

39% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$381
$474

20% lower than market

Infusion of chemotherapy into a vein

$161
$356

55% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$127
$288

56% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$58
$203

71% lower than market

Irrigation of implanted venous access drug delivery device

$83
$167

50% lower than market

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

$161
$771

79% lower than market

Physical Therapy, electric stimulation therapy

$83
$176

53% lower than market

Sleep Monitoring with CPAP

$3,300
$4,377

25% lower than market

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

$2,949
$4,127

29% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$225
$283

20% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital Observation per Hour

$120
$173

31% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Injection, fosphenytoin, 50 mg phenytoin equivalent

$30
$51

42% lower than market

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

$5
$8

37% lower than market

Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity

$4
$5

13% lower than market

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

$157
$235

33% 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, during rest and cardiovascular stress test usin

$2,329
$2,257

3% higher than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

5% dextrose/water (500 ml = 1 unit)

$29
$88

67% lower than market

Administration of 1 Vaccine

$97
$229

58% lower than market

Chemotherapy Infustion - Up to 1 Hour

$564
$1,061

47% lower than market

Infusion, normal saline solution , 1000 cc

$40
$66

39% lower than market

Infusion, normal saline solution, 250 cc

$29
$88

67% lower than market

Infusion, normal saline solution, sterile (500 ml = 1 unit)

$29
$45

35% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$138
$179

23% lower than market

Injection, Cefazolin Sodium, 500 mg

$15
$40

64% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$19
$27

29% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$21
$35

41% lower than market

Injection, Furosemide, up to 20 mg

$19
$22

15% lower than market

Injection, Hydralazine hcl, Up to 20 mg

$49
$152

68% lower than market

Injection, Hydromorphone, Up to 4 mg

$21
$33

37% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$10
$32

69% lower than market

Injection, Levofloxacin, 250 mg

$23
$69

66% lower than market

Injection, Lorazepam, 2 mg

$21
$28

26% lower than market

Injection, Magnesium Sulfate, per 500 mg

$15
$37

60% lower than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$39
$54

28% lower than market

Injection, Midazolam Hydrochloride, per 1 mg

$11
$26

60% lower than market

Injection, Morphine Sulfate, up to 10 mg

$21
$29

28% lower than market

Injection, Ondansetron Hydrochloride, per 1 mg

$5
$17

73% lower than market

Injection, Piperacillin Sodium/Tazobactam (1.125 grams)

$14
$51

71% lower than market

Injection, Promethazine HCL, up to 50 mg

$19
$28

32% lower than market

Injection, Vancomycin HCL, 500 mg

$45
$44

2% higher than market

Injection, acyclovir, 5 mg

$1
$1

40% lower than market

Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)

$7
$10

34% lower than market

Injection, alteplase recombinant, 1 mg

$230
$333

31% lower than market

Injection, aminophyllin, up to 250 mg

$26
$82

69% lower than market

Injection, ampicillin sodium/sulbactam sodium, per 1.5 gm

$29
$51

43% lower than market

Injection, atropine sulfate, 0.01 mg

$1
$2

63% lower than market

Injection, bendamustine hcl (bendeka), 1 mg

$44
$143

70% lower than market

Injection, bevacizumab, 10 mg

$159
$430

63% lower than market

Injection, cefoxitin sodium, 1 gm

$44
$66

34% lower than market

Injection, decitabine, 1 mg

$72
$250

71% lower than market

Injection, denosumab, 1 mg

$39
$99

60% lower than market

Injection, docetaxel, 1 mg

$11
$40

72% lower than market

Injection, epoetin alfa, (for non-esrd use), 1000 units

$60
$111

46% lower than market

Injection, ertapenem sodium, 500 mg

$205
$396

48% lower than market

Injection, etoposide, 10 mg

$3
$16

79% lower than market

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

$2
$5

52% lower than market

Injection, fosaprepitant, 1 mg

$5
$10

47% lower than market

Injection, garamycin, gentamicin, up to 80 mg

$29
$54

46% lower than market

Injection, gemcitabine hydrochloride, 200 mg

$50
$111

55% lower than market

Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg

$104
$175

40% lower than market

Injection, ipilimumab, 1 mg

$291
$628

54% lower than market

Injection, irinotecan, 20 mg

$22
$114

80% lower than market

Injection, iron sucrose, 1 mg

$1
$2

24% lower than market

Injection, lidocaine hcl for intravenous infusion, 10 mg

$2
$11

79% lower than market

Injection, meperidine hydrochloride, per 100 mg

$24
$38

38% lower than market

Injection, methylprednisolone sodium succinate, up to 40 mg

$24
$46

48% lower than market

Injection, naloxone hydrochloride, per 1 mg

$89
$95

6% lower than market

Injection, nivolumab, 1 mg

$54
$128

58% lower than market

Injection, octreotide, depot form for intramuscular injection, 1 mg

$426
$840

49% lower than market

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

$10
$37

75% lower than market

Injection, orphenadrine citrate, up to 60 mg

$59
$93

36% lower than market

Injection, oxaliplatin, 0.5 mg

$2
$6

76% lower than market

Injection, paclitaxel, 1 mg

$2
$7

80% lower than market

Injection, pembrolizumab, 1 mg

$96
$271

65% lower than market

Injection, pemetrexed, 10 mg

$159
$307

48% lower than market

Injection, perflutren lipid microspheres, per ml

$130
$151

14% lower than market

Injection, phenylephrine hcl, up to 1 ml

$19
$46

59% lower than market

Injection, phytonadione (vitamin k), per 1 mg

$84
$83

2% higher than market

Injection, propofol, 10 mg

$1
$4

70% lower than market

Injection, regadenoson, 0.1 mg

$182
$260

30% lower than market

Injection, romiplostim, 10 micrograms

$175
$305

42% lower than market

Injection, succinylcholine chloride, up to 20 mg

$35
$80

56% lower than market

Injection, tenecteplase, 1 mg

$211
$338

38% lower than market

Injection, trastuzumab, 10 mg

$290
$535

46% lower than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$9
$46

80% lower than market

Ringers lactate infusion, up to 1000 cc

$40
$153

74% lower than market

Tetanus Vaccine

$156
$227

31% 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
$129

6% higher than market

Nebulizer Treatment

$300
$298

1% higher than market

Pulse Oximetry

$38
$70

46% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries

$290
$649

55% lower than market

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

$427
$635

33% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Biopsy of Large Bowel, Using an Endoscope

$1,658
$7,347

77% lower than market

Biopsy of prostate gland

$1,349
$6,343

79% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$829
$7,074

88% lower than market

Carpal Tunnel Release

$2,698
$10,073

73% lower than market

Collection of blood specimen from a completely implantable venous access device

$306
$311

1% lower than market

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

$1,658
$3,905

58% lower than market

Colonscopy

$1,658
$3,798

56% lower than market

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$2,078
$4,069

49% lower than market

Control Nose Bleed - Simple Case

$201
$827

76% lower than market

Declotting infusion of implanted central venous access device or catheter

$350
$528

34% lower than market

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

$1,658
$8,010

79% lower than market

Removal of cataract with insertion of lens

$2,698
$5,754

53% lower than market

Extracapsular cataract removal with insertion of intraocular lens prosthesis; complex

$3,386
$8,622

61% lower than market

Gallbladder Removal Using an Endoscope

$2,698
$18,770

86% lower than market

Insertion of Breathing Tube Using an Endoscope

$487
$1,186

59% lower than market

Insertion of Central Venous Catheter

$4,074
$9,432

57% lower than market

Insertion of Indwelling Bladder Catheter

$300
$482

38% lower than market

Insertion of Needle into Vein to Collect Blood

$28
$38

27% lower than market

Insertion of non-tunneled centrally inserted central venous catheter; age 5 years or older

$2,052
$2,371

13% lower than market

Removal of one knee cartilage using an endoscope

$3,386
$11,843

71% lower than market

Colonoscopy with removal of polyp(s)

$1,658
$9,565

83% lower than market

Removal of both knee cartilages using an endoscope

$3,386
$10,368

67% lower than market

Repair of Wound (2.6 to 7.5 centimeters)

$360
$458

21% lower than market

Repair of groin hernia patient age 5 years or older

$4,074
$17,176

76% lower than market

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

$335
$458

27% lower than market

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

$321
$458

30% lower than market

Transfusion of Blood or Blood Products

$1,212
$1,171

4% higher than market

OUTPATIENT VISION CHARGES

Description

Our Charge
Market Charge

Variance

Posterior chamber intraocular lens

$1,278
$1,258

2% 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

Breast Ultrasound - Limited

$654
$707

8% lower than market

CT Abdomen & Pelvis with Contrast

$5,435
$10,128

46% lower than market

CT Abdomen & Pelvis with and without Contrast

$5,559
$9,114

39% lower than market

CT Abdomen & Pelvis without Contrast

$4,300
$9,093

53% lower than market

CT Abdomen with Contrast

$2,797
$5,007

44% lower than market

CT Angiogram Chest with and without Contrast

$2,911
$4,244

31% lower than market

CT Angiogram Head with and without Contrast

$2,945
$3,725

21% lower than market

CT Angiogram Neck with and without Contrast

$2,945
$3,721

21% lower than market

CT Arm without Contrast

$2,055
$2,008

2% higher than market

CT Chest with Contrast

$2,500
$3,744

33% lower than market

CT Chest without Contrast

$2,127
$3,053

30% lower than market

CT Face without Contrast

$1,863
$2,661

30% lower than market

CT Head Brain with and without Contrast

$2,999
$3,788

21% lower than market

CT Head Brain without Contrast

$2,231
$3,614

38% lower than market

CT Leg without Contrast

$2,250
$2,819

20% lower than market

CT Neck with Contrast

$2,526
$4,217

40% lower than market

CT Pelvis with Contrast

$2,708
$3,787

28% lower than market

CT Pelvis without Contrast

$2,300
$4,199

45% lower than market

CT Spine Cervical without Contrast

$2,620
$4,627

43% lower than market

CT Spine Lumbar without Contrast

$2,550
$4,281

40% lower than market

CT scan of heart blood vessels and grafts with contrast dye

$3,192
$7,283

56% lower than market

Calculation of radiation therapy dose

$376
$841

55% lower than market

Chest X-Ray; 2 Views

$367
$644

43% lower than market

Chest X-Ray; Single View

$308
$600

49% lower than market

Design and construction of device for radiation therapy

$969
$3,047

68% lower than market

Diagnostic mammography, bilateral

$479
$520

8% lower than market

Diagnostic mammography, unilateral

$410
$331

24% higher than market

Imaging for Evaluation of Swalling Function

$664
$997

33% lower than market

Imaging of Abdomen and Chest

$516
$850

39% lower than market

Imaging of Abdomen; 2 Views

$368
$393

6% lower than market

Imaging of Abdomen; Single View

$263
$506

48% lower than market

Intensity modulated radiation treatment delivery (IMRT), includes guidance and tracking

$1,567
$4,689

67% lower than market

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries

$441
$868

49% lower than market

MRI Abdomen with and without Contrast

$3,575
$5,549

36% lower than market

MRI Arm Joint without Contrast

$2,870
$3,161

9% lower than market

MRI Brain with and without Conrast

$3,879
$8,276

53% lower than market

MRI Brain without Contrast

$2,667
$4,775

44% lower than market

MRI Leg Joint without Contrast

$3,278
$3,601

9% lower than market

MRI Orbit, Face, Neck with and without Contrast

$3,000
$6,838

56% lower than market

MRI Spine Cervical without Contrast

$3,125
$3,720

16% lower than market

MRI Spine Lumbar with and without Contrast

$4,254
$6,629

36% lower than market

MRI Spine Lumbar without Contrast

$3,125
$4,467

30% lower than market

MRI Spine Thoracic without Contrast

$3,125
$5,273

41% lower than market

Management of modulation radiotherapy planning

$3,560
$11,246

68% lower than market

Management of radiation therapy, 3D

$3,560
$11,424

69% lower than market

Management of radiation therapy, simulation, complex

$969
$4,506

78% lower than market

Myocardial Perfusion, Tomographic

$3,669
$5,483

33% lower than market

Nuclear medicine study with CT imaging skull base to mid-thigh

$3,966
$5,163

23% lower than market

Physical Therapy, ultrasound therapy - 15 minutes

$86
$225

62% lower than market

Radiation treatment devices, design and construction, complex

$969
$2,191

56% lower than market

Radiological supervision and interpretation of CT guidance for needle insertion

$1,986
$3,835

48% lower than market

Screening Mammography, Bilateral, with CAD

$368
$423

13% lower than market

Special radiation therapy planning

$376
$797

53% 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

$1,445
$2,846

49% lower than market

Ultrasound Abdomen - Complete

$965
$1,334

28% lower than market

Ultrasound Abdomen - Limited

$770
$1,353

43% lower than market

Ultrasound Behind Abdominal Cavity - Complete

$705
$1,429

51% lower than market

Ultrasound Blood Flow Outside the Brain

$1,170
$1,167

Approximately equal to market

Ultrasound Guidance for Insertion of Needle

$977
$1,563

38% lower than market

Ultrasound Head Neck

$666
$980

32% lower than market

Ultrasound Heart

$1,445
$2,458

41% lower than market

Ultrasound Joint Soft Tissue - Limited

$390
$887

56% lower than market

Ultrasound Pelvis NonOB

$863
$1,306

34% lower than market

Ultrasound Pelvis through Vagina

$738
$1,208

39% lower than market

Ultrasound Scrotum

$695
$1,451

52% lower than market

Ultrasound Veins of Both Arms or Legs

$1,293
$2,387

46% lower than market

Ultrasound Veins of One Arm or Leg

$650
$1,310

50% lower than market

Ultrasound of Arteries of Both Legs

$815
$1,731

53% lower than market

Ultrasound of pelvis

$573
$1,089

47% lower than market

Whole Body Bone Scan

$1,885
$2,288

18% lower than market

X-Ray Ankle, 3 Views

$401
$707

43% lower than market

X-Ray Both Hips and Pelvis, 2 Views

$439
$626

30% lower than market

X-Ray Elbow, 2 Views

$335
$582

42% lower than market

X-Ray Esophagus

$501
$1,836

73% lower than market

X-Ray Femus, 2 Views

$404
$388

4% higher than market

X-Ray Fingers, 2 Views

$293
$440

33% lower than market

X-Ray Foot, 3 Views

$432
$659

34% lower than market

X-Ray Hand, 3 Views

$435
$632

31% lower than market

X-Ray Hip and Pelvis, 2 Views

$404
$422

4% lower than market

X-Ray Knee, 1-2 Views

$365
$613

40% lower than market

X-Ray Knee, 3 Views

$603
$822

27% lower than market

X-Ray Lower Leg, 2 Views

$384
$708

46% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$405
$821

51% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$668
$1,176

43% lower than market

X-Ray Neck Spine, 2-3 Views

$415
$705

41% lower than market

X-Ray Pelvis, 1-2 Views

$334
$854

61% lower than market

X-Ray Ribs One Side, 2 Views

$433
$745

42% lower than market

X-Ray Shoulder, 2 Views

$444
$706

37% lower than market

X-Ray Upper Arm, 2 Views

$335
$621

46% lower than market

X-Ray Wrist, 2 Views

$342
$606

44% lower than market

X-Ray Wrist, 3 Views

$489
$690

29% lower than market

X-Ray of Middle Spine; 3 Views

$574
$794

28% lower than market

X-ray Ribs One Side, Minimum 3 Views

$431
$418

3% higher than market

X-ray of eye

$304
$275

11% higher than market

X-ray of sacroiliac joints, less than 3 views

$325
$1,069

70% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Heart Failure with major complications

$20,751
$40,247

48% lower than market

INPATIENT GYNECOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Uterus or Ovary Surgery Not Related to Cancer without complications

$22,420
$57,443

61% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Blood Infection with major complications

$20,141
$61,512

67% lower than market

Blood infection without major complications

$18,633
$31,882

42% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Total Knee or Hip Replacement

$51,393
$93,469

45% lower than market

INPATIENT PSYCHIATRY CHARGES

Description

Our Charge
Market Charge

Variance

Mental Illness

$18,121
$19,825

9% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Pneumonia with major complications

$18,722
$49,738

62% 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.