Patient Price Information List

Disclaimer: Jack Hughston Memorial Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, Jack Hughston Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 6/30/18. Jack Hughston Memorial Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Baptist Medical Center East

Montgomery

AL

Baptist Medical Center South

Montgomery

AL

East Alabama Medical Center

Opelika

AL

Flowers Hospital

Dothan

AL

John D Archbold Memorial Hospital

Thomasville

GA

Phoebe Putney Memorial Hospital

Albany

GA

Piedmont Columbus Regional

Columbus

GA

Piedmont Columbus Regional Midtown Campus

Columbus

GA

Saint Francis Hospital

Columbus

GA

South Georgia Medical Center

Valdosta

GA

Southeast Alabama Medical Center

Dothan

AL

UAB Hospital

Birmingham

AL

WellStar West Georgia Medical Center

Lagrange

GA

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$783
$1,024

24% lower than market

Intensive Care Unit

$1,545
$2,012

23% 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

$153
$218

30% 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

Blood glucose (sugar) level

$10
$55

83% lower than market

Blood test, basic group of blood chemicals

$219
$173

27% higher than market

Blood test, clotting time

$70
$73

4% lower than market

Blood test, comprehensive group of blood chemicals

$304
$224

36% higher than market

Complete blood cell count - automated differential WBC count

$101
$109

7% lower than market

Creatine kinase Level (cardiac enzyme) - Total

$78
$97

19% lower than market

Creatine kinase level (cardiac enzyme) - Muscle/Brain

$136
$148

8% lower than market

Troponin (protein) analysis

$165
$138

19% higher than market

Urinalysis, Automated Test

$42
$68

38% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital Observation per Hour

$50
$83

40% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Anchoring of biceps tendon

$3,433
$4,487

23% lower than market

Application of Short Arm Splint

$384
$468

18% lower than market

Application of Short Leg Splint (Calf to Foot)

$384
$618

38% lower than market

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2

$2,574
$7,719

67% lower than market

Arthrodesis, anterior interbody, including disc space preparation, discectomy, osteophytectomy and decompression of spinal cord and/or nerve roots; cervical below C2, each additional interspace

$2,574
$3,536

27% lower than market

Arthroscopically aided treatment of tibial fracture, proximal (plateau); unicondylar, includes internal fixation, when performed (includes arthroscopy)

$2,146
$4,328

50% lower than market

Aspiration and/or injection: large joint/bursa

$697
$999

30% lower than market

Carpal Tunnel Release

$3,433
$4,463

23% lower than market

Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation

$990
$1,387

29% lower than market

Closed treatment of dislocated hip prosthesis

$990
$1,426

31% lower than market

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

$1,442
$2,830

49% lower than market

Colonscopy

$1,442
$2,483

42% lower than market

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$2,163
$2,293

6% lower than market

Epidural Injection Lumbar

$2,375
$1,989

19% higher than market

Epidural Injection Thoracic

$1,569
$2,360

34% lower than market

Fusion of ankle joint, open procedure

$6,007
$7,566

21% lower than market

Fusion of foot joint, subtalar

$5,149
$9,826

48% lower than market

Injection of dye for X-ray imaging of shoulder joint

$90
$402

78% lower than market

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

$1,903
$2,733

30% lower than market

Injection(s), anesthetic agent and/or steroid, transforaminal epidural, with imaging guidance (fluoroscopy or CT); lumbar or sacral, single level

$1,903
$1,933

2% lower than market

Insertion of interbody biomechanical device(s) (eg, synthetic cage, mesh) with integral anterior instrumentation for device anchoring (eg, screws, flanges), when performed, to intervertebral disc space in conjunction with int

$1,287
$4,717

73% lower than market

Knee Scope

$3,433
$6,511

47% lower than market

Laminectomy

$6,007
$10,336

42% lower than market

Lumbar Joint Injection

$1,903
$2,194

13% lower than market

Lumbar Kyphoplasty

$3,433
$8,468

59% lower than market

Myelography via lumbar injection

$1,792
$2,091

14% lower than market

Open treatment of broken of lower forearm or growth plate separation with insertion of hardware 3 or

$4,291
$7,476

43% lower than market

Open treatment of ligament tear at ankle joint

$2,575
$5,244

51% lower than market

Partial removal of bone with release of spinal cord or spinal nerves of 1 interspace in lower spine

$9,439
$10,075

6% lower than market

Partial removal of collar bone at shoulder using an endoscope

$1,716
$4,642

63% lower than market

Pelvis or hip joint procedure

$4,291
$6,047

29% lower than market

Removal of both knee cartilages using an endoscope

$3,433
$5,851

41% lower than market

Removal of deep bone implant

$3,433
$5,819

41% lower than market

Removal of shoulder joint tissue using an endoscope

$4,291
$4,529

5% lower than market

Removal or shaving of hip joint socket cartilage using an endoscope

$4,291
$4,636

7% lower than market

Repair of knee joint; condyle and plateau, medial or lateral

$6,007
$11,060

46% lower than market

Rotator Cuff Repair

$3,433
$6,424

47% lower than market

Shoulder scope with debridement

$1,716
$4,724

64% lower than market

Thoracic Kyphoplasty

$1,717
$8,581

80% lower than market

Trigger Finger Release

$3,433
$3,830

10% lower than market

Ulnar Nerve Release

$1,717
$5,030

66% lower 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

3D radiographic procedure with computerized image postprocessing

$268
$1,160

77% lower than market

CT Abdomen & Pelvis with Contrast

$1,742
$4,271

59% lower than market

CT Abdomen & Pelvis without Contrast

$1,313
$3,650

64% lower than market

CT Head Brain without Contrast

$1,119
$2,008

44% lower than market

Chest X-Ray; 2 Views

$179
$355

50% lower than market

Chest X-Ray; Single View

$172
$284

39% lower than market

Imaging guidance for procedure, up to 1 hour

$470
$551

15% lower than market

MRI Arm Joint without Contrast

$1,014
$2,939

65% lower than market

MRI Brain with and without Conrast

$1,646
$4,154

60% lower than market

MRI Leg Joint without Contrast

$1,014
$2,862

65% lower than market

MRI Spine Cervical without Contrast

$1,014
$2,952

66% lower than market

MRI Spine Lumbar without Contrast

$1,014
$3,109

67% lower than market

Radiological supervision and interpretation X-ray of shoulder joint

$1,018
$1,149

11% lower than market

Ultrasound Behind Abdominal Cavity - Complete

$404
$859

53% lower than market

Ultrasound Veins of Both Arms or Legs

$767
$1,300

41% lower than market

Ultrasound Veins of One Arm or Leg

$424
$783

46% lower than market

X-Ray Ankle, 3 Views

$172
$381

55% lower than market

X-Ray Foot, 3 Views

$188
$388

51% lower than market

X-Ray Hand, 3 Views

$223
$374

40% lower than market

X-Ray Hip and Pelvis, 1 View

$172
$282

39% lower than market

X-Ray Hip and Pelvis, 2 Views

$172
$334

48% lower than market

X-Ray Knee, 1-2 Views

$172
$322

47% lower than market

X-Ray Knee, 4 or More Views

$172
$450

62% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$196
$421

53% lower than market

X-Ray Shoulder, 2 Views

$181
$358

49% lower than market

X-Ray Wrist, 2 Views

$172
$304

43% lower than market

X-Ray Wrist, 3 Views

$172
$349

51% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$13,327
$18,947

30% lower than market

Blood Infection with major complications

$39,157
$45,356

14% lower than market

Stomach Disorder without complications

$13,340
$19,521

32% lower than market

INPATIENT NEUROSURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Back and neck procedure except spinal fusion with complications

$25,466
$47,356

46% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Bilateral or multiple major joint procs of lower extremity without major complications

$58,474
$84,254

31% lower than market

Cervical spinal fusion with complications

$38,314
$62,971

39% lower than market

Cervical spinal fusion without complications

$33,705
$55,019

39% lower than market

Combined anterior/posterior spinal fusion without complications

$74,929
$115,166

35% lower than market

Hip & femur procedures except major joint with complications

$38,717
$47,683

19% lower than market

Hip & femur procedures except major joint without complications

$34,617
$39,649

13% lower than market

Revision of hip or knee replacement with complications

$61,689
$74,305

17% lower than market

Spinal fusion other than the neck without major complications

$63,143
$88,343

29% lower than market

Total Knee or Hip Replacement

$37,999
$48,982

22% lower than market

Total Knee or Hip Revision

$52,915
$61,744

14% lower than market

Total Shoulder Replacement

$42,792
$60,342

29% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Jack Hughston Memorial Hospital for your healthcare needs. As part of our commitment to delivering EXCELLENT service, 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 Jack Hughston Memorial Hospital, let us know if your personal information or insurance information has changed since your last visit.

• Please understand and follow the requirements of your health plan.

Be sure to know your benefits, obtain proper authorization for services and submit referral claim forms if necessary. Many insurance plans require patients to pay a co-payment or deductible amount. You are responsible for paying co-payments required by your insurance provider and Jack Hughston Memorial Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.

• Please respond promptly to any requests from your insurance provider.

You may receive multiple bills for your hospital visit, including your family doctor, specialists, physicians to read x-rays, give anesthesia, or do blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Jack Hughston Memorial Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.

Questions about Price and Billing Information

Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.

To ask questions or get more information about a bill for services you've received, please contact our Customer Call Center at 706-324-6661.

If you need more information about the price of a future service, please contact our Price Hotline at 706-324-6661 . 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 https://www.hughston.com/jhmh-home/. Jack Hughston Memorial Hospital offers secure online payment.

Jack Hughston Memorial Hospital also offers pre-registration and appointment requests through a secure online form at https://www.hughston.com/jhmh-home/. 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.

Jack Hughston Memorial Hospital's Charity Care Policy

Jack Hughston Memorial Hospital provides high quality care to everyone, regardless of their ability to pay.

Jack Hughston Memorial Hospital's charity care policy includes:

• Substantial charity care guidelines that provide free care for individuals and families who earn less than 200 percent of the federal poverty level.

• 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, Jack Hughston Memorial Hospital offers interest free loans for up to one year to assist patients.

For more information, please contact our Customer Call Center at 706-324-6661.