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Patient Price Information List

Disclaimer: Hampton Regional 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, Hampton Regional Medical Center has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2022. Hampton Regional Medical Center's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Abbeville Area Medical Center

Abbeville

SC

Allendale County Hospital

Fairfax

SC

Beaufort Memorial Hospital

Beaufort

SC

Coastal Carolina Hospital

Hardeeville

SC

Colleton Medical Center

Walterboro

SC

Edgefield County Hospital

Edgefield

SC

MUSC Health University Hospital

Charleston

SC

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$799
$1,553

49% lower than market

Swing Bed

$572
$572

Approximately equal to market

Intensive Care Unit

$1,735
$3,792

54% 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]

$5,138
$5,368

4% lower than market

Abdominal ultrasound (complete) [HCPCS 76700]

$990
$1,510

34% 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]

$4,593
$14,717

69% lower than market

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

$4,437
$7,995

44% lower than market

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

$4,663
$7,837

40% lower than market

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

$4,073
$6,926

41% lower than market

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

$4,299
$7,520

43% lower than market

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

$6,283
$6,751

7% lower than market

Gallbladder removal with an endoscope [HCPCS 47562]

$10,741
$34,727

69% lower than market

Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]

$10,264
$38,447

73% lower than market

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

$2,113
$2,022

5% higher than market

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

$4,514
$4,615

2% lower than market

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

$3,129
$3,832

18% lower than market

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

$3,091
$3,874

20% lower than market

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

$764
$805

5% lower than market

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

$84
$125

33% lower than market

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

$43
$72

40% lower than market

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

$136
$168

19% lower than market

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

$70
$106

34% lower than market

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

$175
$235

26% lower than market

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

$87
$110

21% lower than market

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

$90
$121

26% 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]

$141
$131

8% higher than market

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

$179
$188

5% lower than market

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

$112
$249

55% lower than market

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

$186
$190

2% 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]

$147
$193

24% lower than market

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

$190
$205

7% lower than market

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

$252
$270

7% lower than market

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

$299
$410

27% lower than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$424
$424

Approximately equal to market

Mammography of one breast for diagnosis [HCPCS 77065]

$324
$340

5% lower than market

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

$105
$93

13% higher than market

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

$1,004
$617

63% higher than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

Critical care delivery to critically ill or injured patient (each additional 30 minutes) [HCPCS 99292]

$495
$790

37% lower than market

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

$1,955
$3,326

41% lower than market

Emergency department visit for minor problem [HCPCS 99281]

$237
$371

36% lower than market

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

$881
$1,462

40% lower than market

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

$327
$498

34% lower than market

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

$573
$924

38% lower than market

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

$1,308
$2,080

37% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Lab analysis by immunoassay (ELISA) to identify infectious organism antigen (multiple-step method, each organism) [HCPCS 87449]

$78
$218

65% lower than market

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

$111
$157

29% lower than market

Lab analysis of any culture (except blood) to identify aerobic isolates (each isolate) [HCPCS 87077]

$108
$152

29% lower than market

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

$141
$240

41% lower than market

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

$71
$277

74% lower than market

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

$250
$271

8% lower than market

Lab analysis of urine culture to identify bacteria [HCPCS 87088]

$66
$162

59% lower than market

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

$108
$93

16% higher than market

Lab analysis of urine specimen by dipstick to detect the hormone found in women in early pregnancy [HCPCS 81025]

$136
$170

20% lower than market

Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by disk method (per plate) [HCPCS 87184]

$70
$148

53% lower than market

Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by identifying enzymes (per enzyme) [HCPCS 87185]

$47
$51

7% lower than market

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

$84
$138

39% lower than market

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

$38
$68

44% lower than market

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

$210
$223

6% lower than market

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

$103
$189

46% lower than market

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

$78
$96

19% lower than market

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

$60
$57

6% higher than market

Lab analysis to measure the ammonia level [HCPCS 82140]

$122
$178

32% lower than market

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

$188
$176

7% higher than market

Lab analysis to measure the amount of blood gases with oxygen saturation [HCPCS 82805]

$235
$448

47% lower than market

Lab analysis to measure the amount of blood in stool specimen by peroxidase activity [HCPCS 82272]

$41
$152

73% lower than market

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

$133
$148

10% lower than market

Lab analysis to measure the amount of immune system protein (complement) antigens (each component) [HCPCS 86160]

$176
$110

59% higher than market

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

$96
$171

44% lower than market

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

$151
$216

30% lower than market

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

$164
$245

33% lower than market

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

$113
$191

41% lower than market

Lab analysis to measure the beta-2 microglobulin (protein) level [HCPCS 82232]

$108
$96

13% higher than market

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

$32
$71

55% lower than market

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

$151
$203

26% lower than market

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

$120
$138

13% lower than market

Lab analysis to measure the creatinine level in blood specimen to test for kidney function or muscle injury [HCPCS 82565]

$54
$83

35% lower than market

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

$69
$95

27% lower than market

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

$132
$180

27% lower than market

Lab analysis to measure the direct bilirubin level [HCPCS 82248]

$61
$94

35% lower than market

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

$153
$186

18% lower than market

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

$109
$160

32% lower than market

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

$95
$158

40% lower than market

Lab analysis to measure the homocysteine (amino acid) level in urine or blood specimen [HCPCS 83090]

$233
$165

41% higher than market

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

$66
$102

35% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$69
$97

29% lower than market

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

$100
$131

24% lower than market

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

$80
$161

50% lower than market

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

$102
$161

36% lower than market

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

$53
$97

45% lower than market

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

$65
$107

39% lower than market

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

$239
$237

1% higher than market

Lab analysis to measure the organic acid level in urine specimen [HCPCS 83921]

$160
$342

53% lower than market

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

$200
$348

43% lower than market

Lab analysis to measure the phosphate level [HCPCS 84100]

$37
$69

46% lower than market

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

$59
$112

47% lower than market

Lab analysis to measure the total protein level in blood specimen [HCPCS 84155]

$68
$86

20% lower than market

Lab analysis to measure the transferrin (iron binding protein) level in serum specimen [HCPCS 84466]

$82
$139

41% lower than market

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

$45
$103

56% lower than market

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

$147
$212

31% lower than market

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

$203
$303

33% lower than market

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

$45
$98

54% lower than market

Lab analysis to screen for pathogenic organisms [HCPCS 87081]

$137
$268

49% lower than market

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

$143
$175

18% lower than market

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

$133
$218

39% 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]

$55
$77

29% lower than market

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

$106
$253

58% lower than market

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

$88
$291

70% lower than market

Pathology lab analysis of tissue with microscope (moderately low complexity) [HCPCS 88304]

$88
$194

55% lower than market

Platelet pheres leukoreduced [HCPCS P9035]

$1,354
$1,609

16% lower than market

Psa screening [HCPCS G0103]

$127
$171

26% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Chemotherapy administration into vein by infusion of each additional sequential infusion (up to 1 hour, different drug) [HCPCS 96417]

$248
$234

6% higher than market

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

$151
$210

28% lower than market

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

$39
$245

84% lower than market

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

$352
$553

36% 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]

$145
$342

58% lower than market

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

$59
$95

38% lower than market

Medication application by electic current through skin (each 15 minutes) [HCPCS 97033]

$121
$121

Approximately equal to market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$1
$4

68% lower than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

Non-covered item or service [HCPCS A9270]

$4
$18

78% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Bevacizumab injection [HCPCS J9035]

$10
$42

76% lower than market

Cefazolin sodium injection [HCPCS J0690]

$7
$5

37% higher than market

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

$125
$257

51% lower than market

Fentanyl citrate injection [HCPCS J3010]

$29
$50

42% lower than market

Furosemide injection [HCPCS J1940]

$29
$14

101% higher than market

Haloperidol injection [HCPCS J1630]

$29
$121

76% lower than market

Hydralazine hcl injection [HCPCS J0360]

$29
$66

56% lower than market

Hydromorphone injection [HCPCS J1170]

$29
$40

28% lower than market

Inj magnesium sulfate [HCPCS J3475]

$44
$264

83% lower than market

Methylprednisolone injection [HCPCS J2930]

$37
$53

31% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$29
$30

3% lower than market

Morphine sulfate injection [HCPCS J2270]

$29
$39

25% lower than market

Octreotide inj, non-depot [HCPCS J2354]

$3
$5

31% lower than market

Ondansetron hcl injection [HCPCS J2405]

$29
$14

112% higher than market

Penicillin g benzathine inj [HCPCS J0561]

$2
$3

30% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$31
$20

56% higher than market

Promethazine hcl injection [HCPCS J2550]

$29
$40

27% lower than market

Tc99m sestamibi [HCPCS A9500]

$184
$652

72% lower than market

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

$124
$186

34% lower than market

Thiamine hcl 100 mg [HCPCS J3411]

$29
$23

27% higher than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

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

$95
$153

38% lower than market

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

$92
$136

32% lower than market

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

$150
$309

51% lower than market

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

$175
$353

50% lower than market

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

$77
$127

39% lower than market

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

$125
$293

57% lower than market

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

$150
$338

56% lower than market

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

$175
$354

51% lower than market

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

$92
$138

33% lower than market

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

$114
$167

32% lower than market

Speech sound production evaluation [HCPCS 92522]

$175
$251

30% lower than market

Swallowing function evaluation [HCPCS 92610]

$195
$470

58% lower than market

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

$88
$136

35% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$422
$899

53% lower than market

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

$960
$1,760

45% lower than market

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

$260
$307

15% lower than market

Total and timed exhaled air capacity measurement and graphic recording [HCPCS 94010]

$253
$345

27% 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]

$233
$329

29% lower than market

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

$70
$117

40% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Abscess incision and drainage (simple procedure or single abscess) [HCPCS 10060]

$1,023
$2,217

54% lower than market

Blood or fluid collection incision and drainage [HCPCS 10140]

$12,000
$7,443

61% higher than market

Breast biopsy with ultrasound guidance (first lesion) [HCPCS 19083]

$2,017
$4,698

57% lower than market

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

$2,493
$8,112

69% lower than market

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

$506
$5,081

90% lower than market

Colon (large bowel) examination and injections beneath lining of colon with flexible endoscope [HCPCS 45381]

$7,122
$12,122

41% lower than market

Colon (large bowel) examination and tissue abnormalities, tumors, or polyps removal by hot biopsy forceps with flexible endoscope [HCPCS 45384]

$4,038
$8,729

54% lower than market

Colon (lower large bowel) examination with endoscope for diagnosis [HCPCS 45330]

$5,444
$10,249

47% lower than market

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

$3,956
$7,308

46% lower than market

Colorectal scrn; hi risk ind [HCPCS G0105]

$2,923
$7,284

60% lower than market

Dislocated shoulder treatment with manipulation and anesthesia (closed treatment) [HCPCS 23655]

$4,246
$9,795

57% lower than market

Esophagus widening (unguided) [HCPCS 43450]

$18,939
$11,361

67% higher than market

Esophagus, stomach, and/or upper small bowel examination and guide wire insertion for widening with endoscope [HCPCS 43248]

$4,214
$13,289

68% lower than market

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

$4,268
$11,911

64% lower than market

Fluid removal from between lung and chest cavity (open procedure) [HCPCS 32551]

$8,368
$7,530

11% higher than market

Foreign body removal from ear canal [HCPCS 69200]

$743
$1,291

42% lower than market

Incision into deepest layer of skin for foreign body removal (simple procedure) [HCPCS 10120]

$1,230
$2,207

44% lower than market

Indwelling bladder catheter insertion (simple) [HCPCS 51702]

$6,610
$3,185

108% higher than market

Median nerve of hand release and/or relocation [HCPCS 64721]

$7,201
$8,741

18% lower than market

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

$25
$25

1% higher than market

Removal of non-cancerous skin lesion of trunk, arms, or legs (2.1 to 3.0 cm) [HCPCS 11403]

$7,720
$1,803

328% higher than market

Simple repair of wound of face, ears, eyelids, nose, lips and/or mouth (2.5 cm or less) [HCPCS 12011]

$1,579
$6,494

76% lower than market

Simple repair of wound of face, ears, eyelids, nose, lips and/or mouth (2.6 to 5.0 cm) [HCPCS 12013]

$3,105
$6,520

52% lower than market

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.5 cm or less) [HCPCS 12001]

$998
$4,664

79% 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]

$2,079
$3,553

41% lower than market

Temporary bladder catheter insertion [HCPCS 51701]

$2,315
$3,820

39% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

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

$4,056
$4,646

13% lower than market

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

$6,078
$5,936

2% higher than market

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

$5,800
$4,606

26% higher than market

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

$2,095
$2,271

8% lower than market

Abdominal ultrasound (limited) [HCPCS 76705]

$719
$1,108

35% lower than market

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

$315
$456

31% lower than market

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

$265
$273

3% lower than market

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

$428
$544

21% lower than market

Abdominal, pelvic, and/or scrotal arterial inflow and venous outflow ultrasound (complete study) [HCPCS 93975]

$1,002
$1,578

36% lower than market

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

$1,299
$1,767

26% lower than market

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

$376
$395

5% lower than market

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

$357
$423

16% lower than market

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

$1,112
$1,590

30% lower than market

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

$809
$1,075

25% lower than market

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

$602
$736

18% lower than market

Arteries of both arms and legs ultrasound (complete) [HCPCS 93923]

$657
$1,063

38% lower than market

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

$432
$652

34% lower than market

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

$836
$1,263

34% lower than market

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

$507
$540

6% lower than market

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

$551
$634

13% lower than market

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

$2,060
$2,391

14% lower than market

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

$373
$409

9% lower than market

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

$2,783
$4,175

33% lower than market

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

$1,970
$4,057

51% lower than market

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

$2,476
$3,551

30% lower than market

Digital tomography of both breasts (screening exam) [HCPCS 77063]

$56
$150

63% lower than market

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

$268
$371

28% lower than market

Esophagus x-ray with barium swallow (single contrast material swallowed) [HCPCS 74220]

$550
$673

18% lower than market

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

$1,499
$2,574

42% lower than market

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

$311
$323

4% lower than market

Fluoroscopic guidance for needle placement [HCPCS 77002]

$323
$917

65% lower than market

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

$432
$694

38% lower than market

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

$220
$328

33% lower than market

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

$370
$456

19% lower than market

Hand x-ray (2 views) [HCPCS 73120]

$285
$245

16% higher than market

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

$389
$388

Approximately equal to market

Head and neck ultrasound [HCPCS 76536]

$754
$768

2% lower than market

Heart ultrasound (follow-up or limited) [HCPCS 93308]

$705
$930

24% lower than market

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

$980
$2,554

62% lower than market

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

$416
$479

13% lower than market

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

$380
$414

8% lower than market

Imaging for swallowing function evaluation with contrast [HCPCS 74230]

$350
$695

50% lower than market

Imaging of abdomen by MRI without contrast, followed by contrast [HCPCS 74183]

$3,630
$3,909

7% lower than market

Imaging of arm by MRI without contrast [HCPCS 73218]

$2,652
$3,280

19% lower than market

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

$3,302
$3,410

3% lower than market

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

$1,931
$2,419

20% lower than market

Imaging of brain by MRI without contrast [HCPCS 70551]

$2,709
$3,230

16% lower than market

Imaging of head blood vessels by MRA without contrast [HCPCS 70544]

$2,371
$3,222

26% lower than market

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

$4,200
$5,858

28% lower than market

Imaging of leg by MRI without contrast [HCPCS 73718]

$2,973
$3,311

10% lower than market

Imaging of leg by MRI without contrast, followed by contrast [HCPCS 73720]

$3,500
$4,139

15% lower than market

Imaging of pelvis by MRI without contrast [HCPCS 72195]

$2,624
$3,525

26% lower than market

Imaging of pelvis by MRI without contrast, followed by contrast [HCPCS 72197]

$4,253
$5,789

27% lower than market

Imaging of spinal canal by MRI without contrast, followed by contrast [HCPCS 72156]

$4,555
$5,924

23% lower than market

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

$2,834
$3,724

24% lower than market

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

$345
$647

47% lower than market

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

$817
$900

9% lower than market

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

$2,106
$2,933

28% lower than market

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

$257
$320

20% lower than market

Nuclear medicine stomach emptying evaluation [HCPCS 78264]

$1,337
$2,510

47% lower than market

Parathyroid imaging [HCPCS 78070]

$2,657
$2,301

15% higher than market

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

$767
$906

15% lower than market

Rib cage x-ray of ribs on both sides of body including chest (minimum of 4 views) [HCPCS 71111]

$477
$855

44% lower than market

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

$415
$466

11% lower than market

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

$2,219
$2,331

5% lower than market

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

$2,172
$2,546

15% lower than market

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

$420
$557

25% lower than market

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

$420
$485

13% lower than market

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

$254
$289

12% lower than market

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

$93
$133

30% lower than market

Ultrasound guidance for needle placement including imaging supervision of procedure and interpretation of results [HCPCS 76942]

$798
$1,092

27% lower than market

Upper digestive tract x-ray with barium swallow and multiple serial films (single contrast material) [HCPCS 74250]

$600
$803

25% lower than market

Urinary tract imaging with contrast into vein [HCPCS 74400]

$733
$3,486

79% lower than market

Wrist x-ray (2 views) [HCPCS 73100]

$257
$283

9% lower than market

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

$397
$406

2% lower than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Heart Failure with major complications

$21,191
$28,568

26% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Blood Infection with major complications

$34,618
$47,000

26% lower than market

Nutritional & misc metabolic disorders with major complications

$23,162
$30,655

24% lower than market

INPATIENT NEUROLOGY

Description

Our Charge
Market Charge

Variance

Stroke with complications

$31,019
$26,139

19% higher than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney failure with complications

$12,354
$21,402

42% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Hampton Regional Medical Center for your healthcare needs. We want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Hampton Regional 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 Hampton Regional 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 from your hospital visit, including your family doctor, specialists, physicians that read x-rays, providers that give anesthesia, or physicians that interpret 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 Hampton Regional 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 Billing Department at 800-575-1435.

If you need more information about the price of a future service, please contact our Customer Service at 800-575-1435. A physician’s order or CPT code is strongly encouraged when you call to assist us in providing you with the most accurate estimate. You can obtain the CPT code from the ordering physician.