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Patient Price Information List

Disclaimer: Manhattan Surgical 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, Manhattan Surgical Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/25. Manhattan Surgical Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Kansas City Orthopaedic Institute

Leawood

KS

Kansas Spine & Specialty Hospital

Wichita

KS

Salina Surgical Hospital

Salina

KS

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,650
$1,283

29% higher than market

MEDICINE (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

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

$163
$229

29% lower than market

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

$73
$104

29% lower than market

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

$88
$118

26% lower than market

PATHOLOGY & LABORATORY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Automated urinalysis test

$6
$6

Approximately equal to market

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

$22
$90

75% lower than market

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

$25
$97

74% lower than market

Lab analysis of any culture (except blood) to identify anaerobic bacteria [HCPCS 87075]

$44
$115

62% lower than market

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

$7
$32

78% lower than market

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

$12
$49

76% lower than market

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

$29
$85

66% lower than market

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

$9
$44

79% lower than market

RADIOLOGY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Fluoroscopic guidance for needle placement [HCPCS 77002]

$210
$430

51% lower than market

Urinary tract imaging [HCPCS 74420]

$982
$995

1% lower than market

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

$242
$223

9% higher than market

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

$242
$277

13% lower than market

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

$242
$235

3% higher than market

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

$242
$396

39% lower than market

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

$242
$401

40% lower than market

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

$242
$235

3% higher than market

Spinal x-ray (single view, physician must specify level) [HCPCS 72020]

$238
$363

34% lower than market

ORTHOPEDIC SURGERY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Total Knee or Hip Replacement

$55,335
$49,703

11% higher than market

Total Knee or Hip Revision

$68,797
$72,916

6% lower than market

SURGERY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Biceps tendon repair of biceps tendon tear [HCPCS 23430]

$22,982
$39,124

41% lower than market

Large joint or joint capsule fluid removal and/or injection with needle [HCPCS 20610]

$1,438
$1,079

33% higher than market

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

$3,585
$1,745

105% higher than market

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

$3,912
$2,061

90% higher than market

Complex cataract removal with lens insertion [HCPCS 66982]

$8,849
$4,535

95% higher than market

Toe joint defect correction [HCPCS 28285]

$44,995
$16,427

174% higher than market

Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]

$21,990
$17,564

25% higher than market

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

$2,969
$1,743

70% higher than market

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

$2,999
$1,209

148% higher than market

Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]

$8,671
$9,519

9% lower than market

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabe

$20,549
$11,627

77% higher than market

Big toe fusion at the joint with the foot [HCPCS 28750]

$28,557
$34,664

18% lower than market

Tendon covering incision [HCPCS 26055]

$6,923
$7,590

9% lower than market

Incision or partial removal of foot bone (other than big toe) to straighten toe

$19,680
$19,680

Approximately equal to market

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

$8,426
$1,227

587% higher than market

Tunneled central venous catheter insertion for infusion with implanted port beneath the skin (5 years of age or older) [HCPCS 36561]

$10,568
$5,374

97% higher than market

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

$25
$19

30% higher than market

Sacral nerve neurostimulator electrodes implantation [HCPCS 64561]

$29,033
$18,767

55% higher than market

Spinal neurostimulator pulse generator or receiver insertion [HCPCS 63685]

$132,220
$76,880

72% higher than market

Shoulder examination and removal of abnormal shoulder joint tissue with endoscope (limitied) [HCPCS 29822]

$31,541
$23,527

34% higher than market

Knee joint alignment with anesthesia [HCPCS 27570]

$4,745
$7,499

37% lower than market

Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]

$74,579
$59,792

25% higher than market

Ulnar nerve at elbow release and/or relocation [HCPCS 64718]

$6,621
$12,055

45% lower than market

Median nerve of hand release and/or relocation (Carpal Tunnel Release) [HCPCS 64721]

$6,654
$8,165

18% lower than market

Bone joints removal of bones between wrist and fingers [HCPCS 25447]

$13,165
$12,929

2% higher than market

Knee cartilage removal with endoscope (both knees) [HCPCS 29880]

$10,588
$12,887

18% 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]

$8,267
$4,073

103% higher than market

Bone implant removal (deep) [HCPCS 20680]

$8,863
$13,659

35% lower than market

Removal of gallbladder using an endoscope

$19,813
$19,813

Approximately equal to market

Tendon lesion removal from finger or hand [HCPCS 26160]

$5,458
$8,098

33% lower than market

Knee cartilage removal with endoscope (one knee) [HCPCS 29881]

$10,644
$11,607

8% lower than market

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

$3,893
$1,852

110% higher than market

Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]

$17,762
$11,882

49% higher than market

Rotator cuff (torn tendons of shoulder) repair (acute or new) [HCPCS 23410]

$25,749
$24,767

4% higher than market

Shoulder examination and shoulder rotator cuff repair with endoscope [HCPCS 29827]

$24,182
$28,468

15% lower than market

Knee joint repair at lower or upper part of joint (inside and outside compartments) [HCPCS 27447]

$51,897
$47,541

9% higher than market

Thigh bone replacement and hip joint prosthesis [HCPCS 27130]

$52,768
$59,124

11% lower than market

Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]

$40,527
$31,593

28% higher than market

Kidney stones crushing by shock wave [HCPCS 50590]

$10,048
$5,701

76% higher than market

Broken lower forearm bone or growth plate separation treatment with hardware insertion (3 or more fragments, open treatment) [HCPCS 25609]

$23,582
$23,217

2% higher than market

HCPCS - G CODES (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

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

$346
$363

5% lower than market

HCPCS - V CODES (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Post chmbr intraocular lens [HCPCS V2632]

$343
$443

23% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Manhattan Surgical Hospital 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 Manhattan Surgical 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 Manhattan Surgical 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 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 Manhattan Surgical 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 Billing Department at 785-776-5100.

If you need more information about the price of a future service, please contact our Customer Service at 785-776-5100. 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.