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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.
Manhattan Surgical Hospital Patient Information Price List
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 6/30/23. Manhattan Surgical Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:
Kansas City Orthopaedic Institute
Leawood
KS
Kansas Spine & Specialty Hospital
Wichita
KS
Salina Surgical Hospital
Salina
KS
Manhattan Surgical Hospital Patient Information Price List
INPATIENT ROOM AND BOARD DAILY CHARGES
INPATIENT ROOM AND BOARD DAILY CHARGES
Description
Variance
Private Room
Private Room
32% higher than market
Manhattan Surgical Hospital Patient Information Price List
CMS SHOPPABLE SERVICE
CMS SHOPPABLE SERVICE
Description
Variance
Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]
Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]
26% 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]
Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]
86% higher than market
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
A flexible colonoscopy is performed with single or multiple biopsies. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Any suspect site(s) to be biopsied is identified and biopsy forceps are placed through the biopsy channel in the endoscope. The forceps are opened, the tissue is spiked, and the forceps are closed. The biopsied tissue is then removed through the endoscope. One or more tissue samples may be obtained and are sent for separately reportable laboratory analysis.
22% higher than market
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
A flexible colonoscopy is performed with removal of tumors, polyps, or other lesions by hot biopsy forceps or snare technique. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The tumor, polyp, or other lesion is identified. Hot biopsy method uses insulated monopolar forceps to remove and electrocoagulate (cauterize) tissue simultaneously. Hot biopsy forceps are used primarily for removal of small polyps and treatment of vascular ectasias. A wire snare loop is placed around the lesion. The loop is heated to shave off and cauterize the lesion. Lesions may be removed en bloc with one placement of the snare or in a piecemeal fashion which requires multiple applications of the snare. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, bleeding sites, lesions, strictures, or other abnormalities.
23% higher than market
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
A flexible colonoscopy is performed with or without collection of specimens by brushing or washing. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn as mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology (cell) samples may be obtained using a brush introduced through the endoscope. Alternatively, sterile water may be introduced to wash the mucosal lining and the fluid aspirated to obtain cell samples. Cytology samples are sent for separately reportable laboratory analysis.
63% higher than market
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.
12% higher than market
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
A diagnostic upper gastrointestinal (UGI) endoscopic examination is performed of the esophagus, stomach, duodenum and/or jejunum with or without collection of specimens by brushing or washing. This procedure may also be referred to as an esophagogastroduodenoscopy (EGD). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum of the stomach are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum. Mucosal surfaces of the duodenum and/or jejunum are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology samples may be obtained by cell brushing or washing.
1% higher than market
Gallbladder removal with an endoscope [HCPCS 47562]
Gallbladder removal with an endoscope [HCPCS 47562]
The gallbladder is removed by laparoscopic technique. A small portal incision is made at the navel and a trocar is inserted. The scope and video camera are then inserted at this site. The abdomen is inflated with carbon dioxide. Two to three additional abdominal portal incisions are made and trocars are inserted for placing surgical instruments. The gallbladder is identified. If the gallbladder is distended, a needle may be used to drain bile from the gallbladder. Grasper clamps are applied. The Hartmann's pouch is identified and retracted, exposing the triangle of Calot. The cystic artery and cystic duct are identified. The cystic duct is dissected free and transected. The cystic artery is dissected free, ligated, and doubly divided. Electrocautery is used to dissect the gallbladder off the liver bed. The gallbladder is placed in an extraction sac and removed from the abdomen through one of the small incisions.
53% higher than market
Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]
Groin hernia repair for patient 5 years of age or older (herniated tissue that is not trapped) [HCPCS 49505]
An initial inguinal hernia repair is performed on a patient who is five years or older. An inguinal hernia is a condition where structures protrude through a weakness in the abdominal wall in the groin area. Incarcerated hernia tissue cannot be pushed back into its normal position. Strangulated hernias are those in which circulation is compromised. An incision is made over the internal ring. The skin, fat, and subcutaneous fascia are incised down to the aponeurosis of the external oblique muscle. The external ring is identified and the external oblique aponeurosis is slit. The internal ring is opened and the inguinal canal is exposed. In males, the spermatic cord and its covering are mobilized and the covering is removed. The hernia sac is dissected free into the retroperitoneum, opened, and inspected for the presence of bowel or bladder wall. Any bowel or bladder content is reduced (pushed back into the abdominal cavity) and the hernia sac is transected and inverted into the abdominal cavity. A mesh plug may be placed to reinforce the repair. In women, the sac is inspected for the ovary. If the ovary is present, it is returned to the abdomen. The sac is then resected together with the round ligament. The internal ring is closed and the posterior wall of the inguinal canal is repaired.
20% lower than market
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
16% lower than market
Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]
Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]
A urinalysis is performed by dip stick or tablet reagent for bilirubin, glucose, hemoglobin, ketones, leukocytes, nitrite, pH, protein, specific gravity, and/or urobilinogen. Urinalysis can quickly screen for conditions that do not immediately produce symptoms such as diabetes mellitus, kidney disease, or urinary tract infection. A dip stick allows qualitative and semi-quantitative analysis using a paper or plastic stick with color strips for each agent being tested. The stick is dipped in the urine specimen and the color strips are then compared to a color chart to determine the presence or absence and/or a rough estimate of the concentration of each agent tested. Reagent tablets use an absorbent mat with a few drops of urine placed on the mat followed by a reagent tablet. A drop of distilled, deionized water is then placed on the tablet and the color change is observed. Bilirubin is a byproduct of the breakdown of red blood cells by the liver. Normally bilirubin is excreted through the bowel, but in patients with liver disease, bilirubin is filtered by the kidneys and excreted in the urine. Glucose is a sugar that is normally filtered by the glomerulus and excreted only in small quantities in the urine. Excess sugar in the urine (glycosuria) is indicative of diabetes mellitus. The peroxidase activity of erythrocytes is used to detect hemoglobin in the urine which may be indicative of hematuria, myoglobinuria, or hemoglobinuria. Ketones in the urine are the result of diabetic ketoacidosis or calorie deprivation (starvation). A leukocyte esterase test identifies the presence of white blood cells in the urine. The presence of nitrites in the urine is indicative of bacteria. The pH identifies the acid-base levels in the urine. The presence of excessive amounts of protein (proteinuria) may be indicative of nephrotic syndrome. Specific gravity measures urine density and is indicative of the kidneys' ability to concentrate and dilute urine. Following dip stick or reagent testing, the urine sample may be examined under a microscope. The urine sample is placed in a test tube and centrifuged. The sediment is resuspended. A drop of the resuspended sediment is then placed on a glass slide, cover-slipped, and examined under a microscope for crystals, casts, squamous cells, blood (white, red) cells, and bacteria.
46% lower than market
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.
82% lower than market
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]
Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]
An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.
76% 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]
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]
An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.
59% 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]
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]
A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.
74% lower than market
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.
79% lower than market
Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]
Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]
Therapeutic exercise is the application of careful, graduated force to the body to increase strength, endurance, range of motion, and flexibility. Increased muscle strength is achieved by the deliberate overloading of a targeted muscle or muscle group and improved endurance is achieved by raising the intensity of the strengthening exercise to the targeted area(s) over a prolonged period of time. To maintain range of motion (ROM) and flexibility requires the careful movement and stretching of contractile and non-contractile tissue that may tighten with injury or neurological disease, causing weakness and/or spasticity. Therapeutic exercise can increase blood flow to the targeted area, reduce pain and inflammation, reduce the risk of blood clots from venous stasis, decrease muscle atrophy and improve coordination and motor control. Therapeutic exercise may be prescribed following acute illness or injury and for chronic conditions that affect physical activity or function.
46% lower than market
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
34% lower than market
Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]
Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]
11% lower than market
Total Knee or Hip Replacement
Total Knee or Hip Replacement
13% higher than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT CLINIC
OUTPATIENT CLINIC
Description
Variance
Hospital outpatient clinic visit for assessment and management of a patient [HCPCS G0463]
Hospital outpatient clinic visit for assessment and management of a patient [HCPCS G0463]
Hospital outpatient clinic visit for assessment and management of a patient
40% lower than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY
OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY
Description
Variance
Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]
Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]
In a one-on-one physical therapy session, the provider instructs and assists the patient in therapeutic activities designed to address specific functional limitations. The therapeutic activities are specifically developed and modified for the patient. Dynamic/movement activities, also called kinetic activities, that are designed to improve functional performance such as lifting, bending, pushing, pulling, jumping and reaching are included in this service. For example, the patient may be given therapeutic activities to perform to improve the ability to sit, stand, and get out of bed after an injury without straining or risking reinjury. This code is reported for each 15 minutes of one-on-one therapeutic activity provided.
54% lower than market
Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]
Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]
Gait training is a therapeutic procedure that observes and educates an individual in the manner of walking including the rhythm, cadence, step, stride, and speed. The objective of gait training is to strengthen muscles and joints, improve balance and posture, and develop muscle memory. As the lower extremities are retrained for repetitive motion, the body also benefits from the exercise with increased endurance, improved heart/lung function, and reduced or improved osteoporosis. Gait training is an appropriate therapeutic procedure following brain and/or spinal cord injury, stroke, fracture of the pelvis and/or lower extremity, joint injury or replacement of the knee, hip, or ankle, amputation, and for certain musculoskeletal and/or neurological diseases. A treadmill fitted with a safety harness is initially used to ensure safe walking. As the patient gains strength and balance, step training and stair climbing is added to the treatment modality.
49% lower than market
Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]
Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]
A physical therapy evaluation or re-evaluation is performed. The physical therapist takes a history of the current complaint including onset of symptoms, comorbidities, changes since the onset, treatment received for the symptoms or condition, medications prescribed for it, and any other medications the patient is taking. A physical examination of body systems is done to assess physical structure and function, any activities or movements that exacerbate the symptoms, limit activity, or restrict participation in movement, as well as anything that helps to relieve the symptoms. The evaluation may involve provocative maneuvers or positions that increase symptoms; tests for joint flexibility and muscle strength; assessments of general mobility, posture, and core strength; evaluation of muscle tone; and tests for restrictions of movement caused by myofascial disorders. Following the history and physical, the therapist determines the patient's clinical presentation characteristics, provides a detailed explanation of the condition, identifies physical therapy treatment options, and explains how often and how long physical therapy modalities should be applied. The physical therapist will then develop a plan of care with clinical decision making based on patient assessment and/or measurable functional outcome. The plan of care may include both physical therapy in the clinic and exercises or changes in the home environment. Upon re-evaluation, the established care plan is reviewed and an interim history is taken requiring the use of standardized tests and measures. The patient's response to treatment is evaluated and the plan of care is revised based on the patient's measurable response.
28% lower than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT PULMONARY THERAPY
OUTPATIENT PULMONARY THERAPY
Description
Variance
Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]
Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]
An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.
37% lower than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT SURGICAL SERVICES
OUTPATIENT SURGICAL SERVICES
Description
Variance
Biceps tendon repair of biceps tendon tear [HCPCS 23430]
Biceps tendon repair of biceps tendon tear [HCPCS 23430]
38% lower than market
Big toe fusion at the joint with the foot [HCPCS 28750]
Big toe fusion at the joint with the foot [HCPCS 28750]
38% lower than market
Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]
Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]
17% lower than market
Bone implant removal (deep) [HCPCS 20680]
Bone implant removal (deep) [HCPCS 20680]
56% lower than market
Bone joints removal of bones between wrist and fingers [HCPCS 25447]
Bone joints removal of bones between wrist and fingers [HCPCS 25447]
14% lower than market
Colon (large bowel) examination and injections beneath lining of colon with flexible endoscope [HCPCS 45381]
Colon (large bowel) examination and injections beneath lining of colon with flexible endoscope [HCPCS 45381]
4% higher than market
Kidney stones crushing by shock wave [HCPCS 50590]
Kidney stones crushing by shock wave [HCPCS 50590]
1% lower than market
Knee cartilage removal with endoscope (both knees) [HCPCS 29880]
Knee cartilage removal with endoscope (both knees) [HCPCS 29880]
24% lower than market
Knee joint alignment with anesthesia [HCPCS 27570]
Knee joint alignment with anesthesia [HCPCS 27570]
39% lower than market
Large joint or joint capsule fluid removal and/or injection with needle [HCPCS 20610]
Large joint or joint capsule fluid removal and/or injection with needle [HCPCS 20610]
Arthrocentesis, aspiration, and/or injection of a joint or bursa is performed. Arthrocentesis and aspiration is performed to remove fluid from a joint or bursa in order to diagnose the cause of joint effusion and/or to reduce pain caused by the excess fluid. Injection of a joint or bursa may be performed in conjunction with the arthrocentesis procedure and is typically performed using an anti-inflammatory medication such as a steroid to reduce inflammation of the joint or bursa. The skin over the joint is cleansed. A local anesthetic is injected as needed. A needle with a syringe attached is inserted into the affected joint or bursa. Fluid is removed and sent for separately reportable laboratory analysis. This may be followed by a separate injection of medication into the joint or bursa.
16% lower than market
Lower or sacral spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64636]
Lower or sacral spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64636]
38% higher than market
Lower or sacral spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64635]
Lower or sacral spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64635]
40% lower than market
Lower or sacral spine facet joint injections with imaging guidance (first level) [HCPCS 64493]
Lower or sacral spine facet joint injections with imaging guidance (first level) [HCPCS 64493]
6% lower than market
Median nerve of hand release and/or relocation [HCPCS 64721]
Median nerve of hand release and/or relocation [HCPCS 64721]
38% lower than market
Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]
Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]
5% higher than market
Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]
Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]
9% higher than market
Rotator cuff (torn tendons of shoulder) repair (acute or new) [HCPCS 23410]
Rotator cuff (torn tendons of shoulder) repair (acute or new) [HCPCS 23410]
23% lower than market
Tendon covering incision [HCPCS 26055]
Tendon covering incision [HCPCS 26055]
5% lower than market
Thigh bone replacement and hip joint prosthesis [HCPCS 27130]
Thigh bone replacement and hip joint prosthesis [HCPCS 27130]
3% lower than market
Upper or middle spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64634]
Upper or middle spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64634]
32% higher than market
Upper or middle spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64633]
Upper or middle spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64633]
39% higher than market
Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]
Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]
38% lower than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT VISION SERVICES
OUTPATIENT VISION SERVICES
Description
Variance
Post chmbr intraocular lens [HCPCS V2632]
Post chmbr intraocular lens [HCPCS V2632]
27% lower than market
Manhattan Surgical Hospital Patient Information Price List
OUTPATIENT X-RAY AND RADIOLOGICAL
OUTPATIENT X-RAY AND RADIOLOGICAL
Description
Variance
Chest x-ray (single view) [HCPCS 71045]
Chest x-ray (single view) [HCPCS 71045]
A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.
30% lower than market
Fluoroscopic guidance for needle placement [HCPCS 77002]
Fluoroscopic guidance for needle placement [HCPCS 77002]
49% lower than market
Fluoroscopy imaging guidance for procedure (up to 1 hour) [HCPCS 76000]
Fluoroscopy imaging guidance for procedure (up to 1 hour) [HCPCS 76000]
1% higher than market
Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]
Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]
A radiologic examination of the hip is done on either the left or the right side, which may also include the pelvis. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for conditions such as fractures, dislocations, deformities, degenerative bone conditions, osteomyelitis, arthritis, foreign body, infection, or tumor. Hip standard views that are taken most frequently include the front to back anteroposterior view taken with the patient lying supine and the legs straight, rotated slightly inward; the lateral ‘frog-leg’ view, taken with the hips flexed and abducted and the knees flexed with the soles of the feet placed together; a cross table view with the unaffected hip and knee flexed at a 90 degree angle out of the way and the beam aimed perpendicular to the long axis of the femur on the affected side. Another type of lateral view is taken with the hip flexed 45 degrees and abducted 45 degrees and the beam aimed perpendicular to the table.
1% lower than market
Knee x-ray (1 or 2 views) [HCPCS 73560]
Knee x-ray (1 or 2 views) [HCPCS 73560]
A radiologic examination of the knee images the femur, tibia, fibula, patella, and soft tissue. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. The radiographs may be taken to look for the cause of pain, limping, or swelling, or conditions such as fractures, dislocations, deformities, degenerative disease, osteomyelitis, arthritis, foreign body, and cysts or tumors. Knee x-rays may also be used to determine whether there is satisfactory alignment of lower extremity bones following fracture treatment. Standard views of the knee include front to back anteroposterior (AP), lateral (side), and back to front posteroanterior (PA) with variations in the flexion of the joint, and weight bearing and non-weight bearing postures.
58% lower than market
Pelvis x-ray (1 or 2 views) [HCPCS 72170]
Pelvis x-ray (1 or 2 views) [HCPCS 72170]
A diagnostic x-ray examination of the pelvis is done. X-ray uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures. Bones appear white while soft tissue and fluids appear shades of grey. Pelvic x-rays are taken when the patient complains of pain and/or injury in the area of the pelvis or hip joints to assess for fractures and detect arthritis or bone disease. The patient is placed on a table and different views of the pelvis are taken by having the patient position the legs and feet differently, such as turning the feet inward to point at each other, or bending the knees outward with the soles of the feet together in a 'frog-leg' position.
25% lower than market
Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]
Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]
A radiologic examination of the shoulder is done. The shoulder is the junction of the humeral head and the glenoid of the scapula. Standard views include the anteroposterior (AP) view and the lateral 'Y' view, named because of the Y shape formed by the scapula when looking at it from the side. An axial view can also be obtained for further assessment when the patient is able to hold the arm in abduction. X-ray imaging uses indirect ionizing radiation to take pictures inside the body. X-rays work on non-uniform material, such as human tissue, because of the different density and composition of the object, which allows some of the x-rays to be absorbed and some to pass through and be captured behind the object on a detector. This produces a 2D image of the structures.
30% lower than market
Spinal x-ray (single view, physician must specify level) [HCPCS 72020]
Spinal x-ray (single view, physician must specify level) [HCPCS 72020]
30% lower than market
Urinary tract imaging [HCPCS 74420]
Urinary tract imaging [HCPCS 74420]
14% lower than market
Manhattan Surgical Hospital Patient Information Price List
BILLING PROCESS AND INFORMATION
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.
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