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 3/31/2020. 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 ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]

$1,366
$947

44% higher than market

Automated urinalysis test [CPT 81003]

$19
$65

71% lower than market

Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]

$145
$164

11% lower than market

Blood test, clotting time [CPT 85610]

$93
$81

15% higher than market

Blood test, comprehensive group of blood chemicals [CPT 80053]

$188
$240

22% lower than market

Blood test, lipids (cholesterol and triglycerides) [CPT 80061]

$53
$205

74% lower than market

Blood test, thyroid stimulating hormone (TSH) [CPT 84443]

$256
$227

13% higher than market

CT scan head or brain [CPT 70450]

$2,625
$2,456

7% higher than market

CT scan of abdomen and pelvis with contrast [CPT 74177]

$5,329
$4,418

21% higher than market

CT scan pelvis with contrast [CPT 72193]

$3,113
$2,947

6% higher than market

Complete blood cell count (red cells, white blood cell, platelets), automated test [CPT 85027]

$122
$79

54% higher than market

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]

$84
$125

33% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$580
$601

3% lower than market

Diagnostic mammography of one breast [CPT 77065]

$450
$490

8% lower than market

Kidney function blood test panel [CPT 80069]

$160
$114

40% higher than market

Liver function blood test panel [CPT 80076]

$123
$152

19% lower than market

MRI scan of brain before and after contrast [CPT 70553]

$4,801
$3,861

24% higher than market

MRI scan of leg joint [CPT 73721]

$3,623
$2,368

53% higher than market

MRI scan of lower spinal canal [CPT 72148]

$3,995
$2,438

64% higher than market

Manual urinalysis test with examination using microscope, automated [CPT 81001]

$133
$80

65% higher than market

PSA (prostate specific antigen) measurement, free [CPT 84154]

$267
$146

83% higher than market

PSA (prostate specific antigen) measurement, total [CPT 84153]

$65
$184

65% lower than market

Removal of cataract with insertion of lens, simple [CPT 66984]

$4,221
$3,621

17% higher than market

Removal of gallbladder using an endoscope [CPT 47562]

$29,691
$17,847

66% higher than market

Screening mammography of both breasts [CPT 77067]

$531
$558

5% lower than market

Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes [CPT 97110]

$122
$126

3% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$1,093
$1,018

7% higher than market

Ultrasound pelvis through vagina [CPT 76830]

$910
$863

5% higher than market

Urinalysis, manual test [CPT 81002]

$10
$45

77% lower than market

X-ray of lower and sacral spine, minimum of 4 views [CPT 72110]

$1,085
$568

91% higher than market

Cervical spinal fusion without complications

$80,106
$106,598

25% lower than market

Spinal fusion other than the neck without major complications

$95,469
$218,536

56% lower than market

Total Knee or Hip Replacement

$61,092
$86,303

29% lower than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

Critical care delivery critically ill or injured patient [CPT 99292]

$2,454
$3,257

25% lower than market

Critical care delivery critically ill or injured patient, first 30-74 minutes [CPT 99291]

$5,455
$6,756

19% lower than market

Emergency department visit, low to moderately severe problem [CPT 99282]

$781
$692

13% higher than market

Emergency department visit, moderately severe problem [CPT 99283]

$1,161
$1,195

3% lower than market

Emergency department visit, problem of high severity [CPT 99284]

$1,810
$2,003

10% lower than market

Emergency department visit, problem with significant threat to life or function [CPT 99285]

$3,244
$3,611

10% lower than market

Emergency department visit, self limited or minor problem [CPT 99281]

$357
$393

9% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Application of electrical stimulation to 1 or more areas, each 15 minutes [CPT 97032]

$68
$89

23% lower than market

Elec stim other than wound [HCPCS G0283]

$98
$102

3% lower than market

Evaluation of occupational therapy, typically 30 minutes [CPT 97165]

$320
$295

9% higher than market

Evaluation of physical therapy, typically 20 minutes [CPT 97161]

$247
$366

33% lower than market

Evaluation of physical therapy, typically 30 minutes [CPT 97162]

$295
$386

24% lower than market

Manual (physical) therapy techniques to 1 or more regions, each 15 minutes [CPT 97140]

$123
$143

13% lower than market

Re-evaluation of physical therapy, typically 20 minutes [CPT 97164]

$169
$187

10% lower than market

Walking training to 1 or more areas, each 15 minutes [CPT 97116]

$116
$112

4% higher than market

Evaluation of swallowing function [CPT 92610]

$417
$476

12% lower than market

Treatment of speech, language, voice, communication, and/or hearing processing disorder [CPT 92507]

$353
$376

6% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring [CPT 93017]

$1,492
$1,438

4% higher than market

Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration [CPT 94060]

$670
$925

28% lower than market

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$199
$290

32% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Measurement of lung diffusing capacity [CPT 94729]

$498
$555

10% lower than market

Measurement of oxygen saturation in blood using ear or finger device [CPT 94760]

$81
$118

31% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Repair of knee joint, lower or upper part of joint, inside and outside area [CPT 27447]

$20,166
$25,891

22% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]

$504
$506

Approximately equal to market

CT scan abdomen before and after contrast [CPT 74170]

$3,682
$3,399

8% higher than market

CT scan abdomen with contrast [CPT 74160]

$2,768
$3,063

10% lower than market

CT scan leg [CPT 73700]

$2,261
$2,545

11% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$4,164
$4,340

4% lower than market

CT scan of arm [CPT 73200]

$2,374
$2,278

4% higher than market

CT scan of blood vessels in chest with contrast [CPT 71275]

$4,277
$4,724

9% lower than market

CT scan of face [CPT 70486]

$1,927
$2,643

27% lower than market

CT scan of lower spine [CPT 72131]

$2,175
$2,805

22% lower than market

CT scan of middle spine [CPT 72128]

$3,039
$3,300

8% lower than market

CT scan of neck blood vessels with contrast [CPT 70498]

$4,277
$4,427

3% lower than market

CT scan of neck with contrast [CPT 70491]

$2,249
$2,759

18% lower than market

CT scan of upper spine [CPT 72125]

$2,833
$3,209

12% lower than market

CT scan pelvis [CPT 72192]

$2,833
$2,916

3% lower than market

Complete X-ray study of abdomen with single X-ray of chest [CPT 74022]

$611
$678

10% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$2,905
$2,990

3% lower than market

Fluoroscopic guidance for insertion of needle [CPT 77002]

$1,036
$941

10% higher than market

Imaging guidance for procedure, up to 1 hour [CPT 76000]

$622
$761

18% lower than market

Nuclear medicine study of vessels of heart using drugs or exercise multiple studies [CPT 78452]

$5,265
$6,361

17% lower than market

Screening digital tomography of both breasts [CPT 77063]

$68
$71

4% lower than market

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

$2,700
$3,934

31% lower than market

Ultrasonic guidance imaging supervision and interpretation for insertion of needle [CPT 76942]

$1,063
$1,978

46% lower than market

Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm) [CPT 76706]

$233
$762

69% lower than market

Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]

$3,651
$3,529

3% higher than market

Ultrasound of head and neck [CPT 76536]

$865
$835

4% higher than market

Ultrasound of pelvis, complete, not pregnancy related [CPT 76856]

$1,028
$1,174

12% lower than market

Ultrasound of scrotum [CPT 76870]

$854
$1,035

17% lower than market

Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck [CPT 93880]

$1,404
$1,362

3% higher than market

X-ray of chest, 2 views [CPT 71046]

$400
$485

17% lower than market

X-ray of elbow, minimum of 3 views [CPT 73080]

$489
$451

9% higher than market

X-ray of esophagus with single contrast [CPT 74220]

$697
$993

30% lower than market

X-ray of foot, minimum of 3 views [CPT 73630]

$670
$366

83% higher than market

X-ray of forearm, 2 views [CPT 73090]

$446
$423

5% higher than market

X-ray of hand, minimum of 3 views [CPT 73130]

$670
$363

84% higher than market

X-ray of hip with pelvis, 1 view [CPT 73501]

$450
$441

2% higher than market

X-ray of hip with pelvis, 2-3 views [CPT 73502]

$520
$532

2% lower than market

X-ray of lower and sacral spine, 2 or 3 views [CPT 72100]

$550
$531

4% higher than market

X-ray of pelvis, 1 or 2 views [CPT 72170]

$584
$534

10% higher than market

X-ray of soft tissue of neck [CPT 70360]

$343
$379

9% lower than market

X-ray of upper arm, minimum of 2 views [CPT 73060]

$446
$422

6% higher than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Heart Failure with complications

$28,331
$31,229

9% lower than market

Heart Failure with major complications

$41,453
$44,929

8% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Blood Infection with major complications

$51,729
$57,355

10% lower than market

Blood infection without major complications

$42,431
$37,294

14% higher than market

G.I. obstruction without complications

$14,948
$24,660

39% lower than market

Stomach Disorder without complications

$40,855
$29,305

39% higher than market

INPATIENT NEUROLOGY

Description

Our Charge
Market Charge

Variance

Stroke with complications

$32,732
$42,731

23% lower than market

INPATIENT ORTHOPEDIC SURGERY

Description

Our Charge
Market Charge

Variance

Hip & femur procedures except major joint with complications

$56,758
$86,369

34% lower than market

Total Shoulder Replacement

$71,085
$105,675

33% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with complications

$25,584
$45,760

44% lower than market

Chronic Lung Disease with major complications

$31,752
$42,075

25% lower than market

Chronic Lung Disease without complications

$15,621
$27,711

44% lower than market

Pneumonia with complications

$28,919
$34,322

16% lower than market

Pneumonia without complications

$25,824
$23,226

11% higher than market

Respiratory infections & inflammations with complications

$47,328
$47,862

1% lower than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$21,619
$29,781

27% lower than market

Kidney failure with complications

$37,308
$34,152

9% 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.