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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 6/30/23. 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
$1,246

32% higher than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Anesthetic agent and/or steroid injection into lower or sacral spine nerve root with imaging guidance (single level) [HCPCS 64483]

$2,759
$3,735

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]

$6,792
$3,656

86% higher than market

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

$3,543
$2,896

22% higher than market

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

$3,597
$2,935

23% higher than market

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

$2,799
$1,712

63% higher than market

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

$3,293
$2,928

12% higher than market

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

$2,592
$2,557

1% higher than market

Gallbladder removal with an endoscope [HCPCS 47562]

$11,972
$7,836

53% higher than market

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

$9,193
$11,438

20% lower than market

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

$9,761
$11,581

16% lower than market

Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]

$10
$18

46% lower than market

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

$12
$65

82% lower than market

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

$14
$58

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]

$18
$43

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]

$23
$90

74% lower than market

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

$23
$112

79% lower than market

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

$59
$110

46% lower than market

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

$18,778
$28,367

34% lower than market

Spinal canal injection of substance into lower back or sacrum with imaging guidance [HCPCS 62323]

$1,583
$1,776

11% lower than market

Total Knee or Hip Replacement

$54,861
$48,342

13% higher than market

OUTPATIENT CLINIC

Description

Our Charge
Market Charge

Variance

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

$169
$283

40% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

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

$59
$129

54% lower than market

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

$52
$102

49% lower than market

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

$205
$284

28% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$158
$250

37% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Biceps tendon repair of biceps tendon tear [HCPCS 23430]

$22,115
$35,675

38% lower than market

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

$23,053
$37,473

38% lower than market

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

$6,823
$8,265

17% lower than market

Bone implant removal (deep) [HCPCS 20680]

$7,429
$16,857

56% lower than market

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

$11,535
$13,406

14% lower than market

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

$6,522
$6,284

4% higher than market

Kidney stones crushing by shock wave [HCPCS 50590]

$8,511
$8,574

1% lower than market

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

$9,602
$12,587

24% lower than market

Knee joint alignment with anesthesia [HCPCS 27570]

$4,424
$7,311

39% lower than market

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

$1,008
$1,208

16% lower than market

Lower or sacral spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64636]

$5,777
$4,195

38% higher than market

Lower or sacral spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64635]

$5,250
$8,738

40% lower than market

Lower or sacral spine facet joint injections with imaging guidance (first level) [HCPCS 64493]

$2,536
$2,698

6% lower than market

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

$5,817
$9,385

38% lower than market

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

$13,386
$12,757

5% higher than market

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

$55,150
$50,729

9% higher than market

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

$19,873
$25,658

23% lower than market

Tendon covering incision [HCPCS 26055]

$8,205
$8,614

5% lower than market

Thigh bone replacement and hip joint prosthesis [HCPCS 27130]

$55,586
$57,497

3% lower than market

Upper or middle spinal facet joint nerves destruction with imaging guidance (each additional facet joint) [HCPCS 64634]

$4,692
$3,558

32% higher than market

Upper or middle spinal facet joint nerves destruction with imaging guidance (single facet joint) [HCPCS 64633]

$4,692
$3,374

39% higher than market

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

$12,872
$20,781

38% lower than market

OUTPATIENT VISION SERVICES

Description

Our Charge
Market Charge

Variance

Post chmbr intraocular lens [HCPCS V2632]

$343
$469

27% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

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

$239
$342

30% lower than market

Fluoroscopic guidance for needle placement [HCPCS 77002]

$210
$411

49% lower than market

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

$642
$637

1% higher than market

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

$222
$225

1% lower than market

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

$164
$386

58% lower than market

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

$294
$391

25% lower than market

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

$158
$225

30% lower than market

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

$239
$342

30% lower than market

Urinary tract imaging [HCPCS 74420]

$1,013
$1,184

14% 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.