Patient Price Information List

Disclaimer: Mason General 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, Mason General Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2021. Mason General Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Capital Medical Center

Olympia

WA

Grays Harbor Community Hospital

Aberdeen

WA

Harrison Medical Center

Bremerton

WA

Providence Centralia Hospital

Centralia

WA

Providence St Peter Hospital

Olympia

WA

Summit Pacific Medical Center

Elma

WA

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]

$5,435
$4,605

18% higher than market

Abdominal ultrasound (complete) [HCPCS 76700]

$1,137
$1,068

6% higher 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]

$12,348
$9,114

35% higher than market

Cervical spinal fusion without complications

$66,857
$86,480

23% lower than market

Gallbladder removal with an endoscope [HCPCS 47562]

$45,281
$35,490

28% higher than market

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

$2,677
$2,546

5% higher than market

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

$4,897
$3,922

25% higher than market

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

$3,696
$2,476

49% higher than market

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

$4,075
$2,555

59% higher than market

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

$946
$905

5% higher than market

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

$138
$83

66% higher than market

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

$20
$68

71% lower than market

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

$11
$47

77% lower than market

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

$166
$122

36% higher than market

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

$93
$97

3% lower than market

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

$57
$235

76% lower than market

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

$127
$83

53% higher 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]

$87
$131

34% lower 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

$128
$155

18% lower than market

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

$80
$150

47% lower than market

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

$56
$217

74% 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]

$151
$171

12% lower than market

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

$68
$201

66% lower than market

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

$196
$212

8% lower than market

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

$552
$575

4% lower than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$603
$618

2% lower than market

Mammography of one breast for diagnosis [HCPCS 77065]

$468
$503

7% lower than market

Pelvis CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 72193]

$3,175
$3,114

2% higher than market

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

$68
$108

37% lower than market

Spinal fusion other than the neck without major complications

$79,539
$243,887

67% lower than market

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

$1,128
$577

95% higher than market

Total Knee or Hip Replacement

$52,410
$96,206

46% lower 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]

$2,576
$3,524

27% lower than market

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

$5,728
$7,203

20% lower than market

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

$1,900
$1,974

4% lower than market

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

$149
$746

80% lower than market

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

$251
$1,190

79% lower than market

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

$3,406
$3,890

12% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Elec stim other than wound [HCPCS G0283]

$103
$106

2% lower than market

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

$129
$99

30% higher than market

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

$336
$303

11% higher than market

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

$122
$114

7% higher than market

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

$259
$371

30% lower than market

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

$309
$393

21% lower than market

Physical therapy re-evaluation (typically 20 minutes) [HCPCS 97164]

$178
$192

7% lower than market

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

$140
$149

6% lower than market

Speech, language, voice, communication, and/or hearing processing disorder treatment [HCPCS 92507]

$370
$382

3% lower than market

Swallowing function evaluation [HCPCS 92610]

$438
$487

10% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$1,492
$1,477

1% higher than market

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

$213
$300

29% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

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

$87
$124

30% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

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

$53,487
$37,464

43% higher 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]

$4,247
$4,571

7% lower than market

Abdominal aorta ultrasound for screening of abdominal aortic aneurysm [HCPCS 76706]

$242
$799

70% lower than market

Abdominal CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74160]

$2,823
$3,261

13% lower than market

Abdominal CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74170]

$3,756
$3,590

5% higher than market

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

$636
$715

11% lower than market

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

$2,374
$2,387

1% lower than market

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

$464
$438

6% higher than market

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

$464
$356

30% higher than market

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

$1,460
$1,387

5% higher than market

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

$525
$516

2% higher than market

Chest CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 71260]

$2,963
$3,173

7% lower than market

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

$416
$404

3% higher than market

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

$4,362
$4,945

12% lower than market

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

$4,362
$4,515

3% lower than market

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

$71
$74

4% lower than market

Elbow x-ray, complete study (minimum of 3 views) [HCPCS 73080]

$509
$471

8% higher than market

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

$724
$852

15% lower than market

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

$1,790
$2,248

20% lower than market

Fluoroscopic guidance for needle placement [HCPCS 77002]

$1,078
$994

8% higher than market

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

$647
$670

3% lower than market

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

$670
$374

79% higher than market

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

$670
$371

81% higher than market

Head and neck ultrasound [HCPCS 76536]

$900
$876

3% higher than market

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

$3,797
$3,610

5% higher than market

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

$541
$539

Approximately equal to market

Hip x-ray of hip with pelvis (single view) [HCPCS 73501]

$450
$448

Approximately equal to market

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

$5,423
$6,549

17% lower than market

Imaging of scrotum by ultrasound [HCPCS 76870]

$888
$1,093

19% lower than market

Leg CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73700]

$2,306
$2,669

14% lower than market

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

$2,294
$2,775

17% lower than market

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

$357
$396

10% lower than market

Pelvis CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 72192]

$2,889
$3,105

7% lower than market

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

$1,069
$1,233

13% lower than market

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

$608
$549

11% higher than market

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

$2,218
$3,016

26% lower than market

Spinal CT scan of middle spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72128]

$3,100
$3,565

13% lower than market

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

$2,889
$3,298

12% lower than market

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

$572
$543

5% higher than market

Tte w or wo fol wcon,doppler [HCPCS C8929]

$3,797
$4,452

15% lower than market

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

$1,289
$2,264

43% lower than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Heart Failure with complications

$29,065
$34,031

15% lower than market

Heart Failure with major complications

$35,459
$46,441

24% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Blood Infection with major complications

$53,431
$63,974

16% lower than market

Blood infection without major complications

$36,651
$41,833

12% lower than market

G.I. obstruction without complications

$19,707
$30,444

35% lower than market

Stomach Disorder without complications

$44,632
$32,875

36% higher than market

INPATIENT NEUROLOGY

Description

Our Charge
Market Charge

Variance

Stroke with complications

$23,033
$43,498

47% lower than market

INPATIENT ORTHOPEDIC SURGERY

Description

Our Charge
Market Charge

Variance

Hip & femur procedures except major joint with complications

$81,728
$100,093

18% lower than market

Total Shoulder Replacement

$88,442
$107,896

18% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with complications

$21,703
$81,728

73% lower than market

Chronic Lung Disease with major complications

$38,680
$37,504

3% higher than market

Chronic Lung Disease without complications

$19,743
$20,843

5% lower than market

Pneumonia with complications

$42,093
$35,752

18% higher than market

Pneumonia without complications

$18,291
$21,367

14% lower than market

Respiratory infections & inflammations with complications

$40,191
$34,448

17% higher than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$21,105
$35,001

40% lower than market

Kidney failure with complications

$35,891
$29,614

21% higher than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Mason General 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 Mason General 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 Mason General 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 Mason General 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 360-427-3601.

If you need more information about the price of a future service, please contact our Price Hotline at 360-427-3601. A CPT code is strongly encouraged when you call. You can obtain the CPT code from the ordering physician.

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.

Mason General Hospital's Charity Care Policy

Mason General Hospital provides high quality care to everyone, regardless of their ability to pay.

Mason General 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, Mason General Hospital offers interest free loans for up to one year to assist patients.

For more information, please contact our Customer Call Center at 360-427-3601.