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Patient Price Information List

Disclaimer: Salina 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, Salina Surgical Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2022. Salina Surgical Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Manhattan Surgical Center

Manhattan

KS

McPherson Hospital

McPherson

KS

Memorial Health System

Abilene

KS

Salina Regional Health Center

Salina

KS

Summit Surgical

Hutchinson

KS

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,105
$1,841

40% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Breast cyst removal, male or female (1 or more cysts) [HCPCS 19120]

$9,018
$10,017

10% 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]

$3,656
$5,930

38% lower than market

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

$2,896
$4,899

41% lower than market

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

$2,935
$4,842

39% lower than market

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

$1,712
$4,166

59% lower than market

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

$2,928
$4,666

37% lower than market

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

$2,557
$3,789

33% lower than market

Gallbladder removal with an endoscope [HCPCS 47562]

$7,836
$15,955

51% lower than market

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

$11,438
$17,711

35% lower than market

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

$8,285
$10,928

24% lower than market

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

$15
$63

76% lower than market

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

$10
$10

2% lower than market

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

$63
$42

49% higher than market

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

$31
$169

82% lower than market

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

$48
$75

36% 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
$66

74% 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

$23
$147

84% lower than market

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

$13
$121

89% lower than market

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

$110
$93

19% higher than market

Prostate gland biopsy [HCPCS 55700]

$2,940
$5,243

44% lower than market

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

$19,603
$21,599

9% lower than market

Total Knee or Hip Replacement

$30,150
$52,006

42% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Esophageal swallowing movement measurement [HCPCS 91010]

$1,084
$1,627

33% lower than market

Gastroesophageal reflux test with pH electrode insertion including recording, analysis and interpretation [HCPCS 91035]

$2,347
$1,450

62% higher than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Cefazolin sodium injection [HCPCS J0690]

$22
$19

13% higher than market

Diphenhydramine hcl injectio [HCPCS J1200]

$13
$25

50% lower than market

Fentanyl citrate injection [HCPCS J3010]

$12
$21

43% lower than market

Garamycin gentamicin inj [HCPCS J1580]

$8
$30

74% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$2
$11

79% lower than market

Levofloxacin injection [HCPCS J1956]

$7
$41

83% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$10
$27

63% lower than market

Neostigmine methylslfte inj [HCPCS J2710]

$8
$57

85% lower than market

Promethazine hcl injection [HCPCS J2550]

$7
$27

74% lower than market

Vancomycin hcl injection [HCPCS J3370]

$18
$45

60% lower than market

OUTPATIENT SUPPLIES

Description

Our Charge
Market Charge

Variance

Ocular imp, aqueous drain de [HCPCS C1783]

$4,725
$4,625

2% higher than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Anti-cancer drug injection into bladder [HCPCS 51720]

$13,240
$3,146

321% higher than market

Bladder and urethra (bladder canal) examination with endoscope for diagnosis [HCPCS 52000]

$1,510
$3,970

62% lower than market

Blood or fluid collection incision and drainage [HCPCS 10140]

$1,979
$7,402

73% lower than market

Bone implant removal (deep) [HCPCS 20680]

$13,854
$11,153

24% higher than market

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

$3,853
$19,320

80% lower than market

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

$22,726
$22,516

1% higher than market

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

$6,284
$8,072

22% lower than market

Colorectal cancer screening; colonoscopy on invididual not meeting high risk [HCPCS G0121]

$948
$4,009

76% lower than market

Colorectal scrn; hi risk ind [HCPCS G0105]

$950
$3,871

75% lower than market

Dialysis graft repair (open procedure) [HCPCS 36832]

$5,539
$11,034

50% lower than market

Esophagus, stomach, and/or upper small bowel examination and injections with endoscope [HCPCS 43236]

$4,817
$6,781

29% lower than market

Eye fluid drainage device insertion (external approach) [HCPCS 66183]

$12,901
$17,281

25% lower than market

Fluid accumulation removal in sperm reservoir [HCPCS 54840]

$3,588
$6,229

42% lower than market

Foreign body, stone, or stent removal from urethra (bladder canal) or bladder with endoscope (simple) [HCPCS 52310]

$2,630
$7,027

63% lower than market

Gallbladder and pancreatic, liver, and bile ducts examination and pancreatic or bile duct widening by balloon with endoscope [HCPCS 43277]

$33,926
$18,140

87% higher than market

Healthy skin and tissue transfer to repair adjacent wound of forehead, cheeks, chin, mouth, neck, underarms, genitalia, hands, and/or feet (10 sq cm or less) [HCPCS 14040]

$2,766
$9,877

72% lower than market

Intermediate repair of wound of scalp, underarms, trunk, arms, and/or legs (12.6 to 20.0 cm) [HCPCS 12035]

$2,586
$4,202

38% lower than market

Intermediate repair of wound of scalp, underarms, trunk, arms, and/or legs (2.6 to 7.5 cm) [HCPCS 12032]

$4,862
$5,888

17% lower than market

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

$1,183
$2,083

43% lower than market

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

$6,550
$7,365

11% lower than market

Mesh placement to repair incisional or abdominal hernia (open procedure) [HCPCS 49568]

$7,749
$25,004

69% lower than market

Palm tissue removal with release of finger (1 finger) [HCPCS 26123]

$3,626
$10,924

67% lower than market

Relocation of arm vein with connection to arm artery (at any site) [HCPCS 36821]

$5,496
$9,595

43% lower than market

Removal of cancerous skin lesion of trunk, arms, or legs (over 4.0 cm) [HCPCS 11606]

$5,155
$6,324

18% lower than market

Skin and tissue removal (each additional 20 sq cm) [HCPCS 11045]

$1,192
$3,359

65% lower than market

Skin and tissue removal (first 20 sq cm or less) [HCPCS 11042]

$1,192
$1,454

18% lower than market

Tendon covering incision [HCPCS 26055]

$5,608
$7,974

30% lower than market

Tendon lesion removal from finger or hand [HCPCS 26160]

$4,326
$23,772

82% lower than market

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

$5,970
$11,387

48% lower than market

Underarm lymph nodes biopsy or removal (open procedure) [HCPCS 38525]

$9,147
$22,051

59% lower than market

Ureter (urinary duct) catheter insertion with endoscope through the bladder area [HCPCS 52005]

$3,490
$13,784

75% lower than market

Uterus polyp biopsy and/or removal with endoscope [HCPCS 58558]

$6,342
$8,599

26% lower than market

Wrist cyst removal (initial or primary) [HCPCS 25111]

$1,971
$8,769

78% lower than market

Wrist ligament release with endoscope [HCPCS 29848]

$3,794
$8,358

55% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

X-ray of bile and/or pancreatic ducts during surgery including radiological supervision of procedure and interpretation of results [HCPCS 74300]

$300
$757

60% lower than market

INPATIENT GENERAL SURGERY

Description

Our Charge
Market Charge

Variance

Major small & large bowel procedures with complications

$38,979
$78,168

50% lower than market

Major small & large bowel procedures without complications

$24,659
$52,983

53% lower than market

INPATIENT ORTHOPEDIC SURGERY

Description

Our Charge
Market Charge

Variance

Hip & femur procedures except major joint with complications

$28,788
$65,163

56% lower than market

Knee procedures without pdx of infection without complications

$24,803
$36,371

32% lower than market

Lower extrem & humer proc except hip,foot,femur without complications

$11,679
$114,282

90% lower than market

Revision of hip or knee replacement with complications

$50,493
$70,396

28% lower than market

Total Knee or Hip Revision

$40,347
$54,282

26% lower than market

Total Shoulder Replacement

$41,186
$55,919

26% lower than market

INPATIENT SURGERY FOR MALIGNANCY

Description

Our Charge
Market Charge

Variance

Kidney & ureter procedures for neoplasm without complications

$24,551
$36,737

33% lower than market

INPATIENT VASCULAR SURGERY

Description

Our Charge
Market Charge

Variance

Extracranial procedures without complications

$16,158
$33,975

52% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Salina 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 Salina 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 Salina 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 Salina 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 785-827-0610.

If you need more information about the price of a future service, please contact our Customer Service at 785-827-0610. 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.