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Patient Price Information List

Disclaimer: Adams Memorial 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, Adams Memorial Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2020. Adams Memorial Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Bluffton Regional Medical Center

Bluffton

IN

IU Health Blackford Hospital

Hartford City

IN

IU Health Jay Hospital

Portland

IN

Lutheran Hospital

Fort Wayne

IN

Parkview Regional Medical Center

Fort Wayne

IN

Van Wert County Hospital

Van Wert

OH

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,415
$1,756

19% lower than market

Semi-Private Room

$1,348
$1,526

12% lower than market

Intensive Care Unit

$3,062
$2,420

27% higher than market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with Level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Description

Our Charge
Market Charge

Variance

Emergency Department Visit - Level 2

$177
$615

71% lower than market

Emergency Department Visit - Level 3

$317
$1,132

72% lower than market

Emergency Department Visit - Level 4

$524
$1,758

70% lower than market

Emergency Department Visit - Level 5

$769
$2,709

72% lower than market

Emergency Critical Care, Each Additional 30 Minutes

$739
$1,334

45% lower than market

Emergency Critical Care, First 30 Minutes

$2,319
$4,062

43% lower than market

OUTPATIENT PHYSICAL THERAPY CHARGES

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Electric Stimulation for Therapy

$115
$133

13% lower than market

Gait Training - 15 Minutes

$155
$145

7% higher than market

PT Evaluation - Moderate Complexity

$309
$390

21% lower than market

Physical Therapy 1 or More Regions (15 min)

$90
$156

43% lower than market

Physical Therapy Exercise, 15 Minutes

$90
$148

39% lower than market

Physical Therapy, complex evaluation

$309
$429

28% lower than market

Physical Therapy, standard evaluation - 20 minutes

$309
$362

15% lower than market

OUTPATIENT OCCUPATIONAL THERAPY CHARGES

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Occupational Therapy Evaluation - Moderate Complexity

$180
$377

52% lower than market

Occupational Therapy, standard evaluation - 30 minutes

$180
$367

51% lower than market

Self Care - Home Management Training - 15 Minutes

$90
$153

41% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$90
$155

42% lower than market

OUTPATIENT PULMONARY THERAPY CHARGES

The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

CPAP Initiation & Management

$783
$1,174

33% lower than market

Pulmonary rehabilitation, including exercise (includes monitoring), one hour, per session, up to two sessions per day

$150
$450

67% lower than market

Routine EKG - Minimum 12 Leads

$158
$308

49% lower than market

Spirometry - medicated breathing procedure

$420
$1,456

71% lower than market

Stress Test with EKG tracing

$475
$1,406

66% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Evaluation of Speech Sound Production and Language Comprehenson

$365
$376

3% lower than market

Speech Therapy

$296
$360

18% lower than market

Swallow Treatment

$188
$203

7% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY CHARGES

The following charges reflect our most common laboratory procedures. For all lab specimens collected via blood draw, the venipuncture will be charged separately.

Description

Our Charge
Market Charge

Variance

Albumin (protein) level

$45
$66

32% lower than market

Ammonia level

$107
$178

40% lower than market

Arterial Blood Gases Measurement

$203
$231

12% lower than market

Bacterial Blood Culture

$85
$198

57% lower than market

Bacterial Culture for Aerobic Isolates

$55
$77

29% lower than market

Bacterial Culture, Any Source Except Urine, Blood, or Stool

$120
$163

26% lower than market

Bacterial urine culture; quantitative colony count

$50
$98

49% lower than market

Bilirubin level (Direct)

$45
$56

21% lower than market

Blood Typing, Rh (D)

$33
$107

69% lower than market

Blood Unit Compatibility Test; Electronic Technique

$104
$355

71% lower than market

Blood glucose (sugar) measurement using reagent strip

$18
$17

7% higher than market

Blood potassium level

$46
$46

1% lower than market

Blood test panel for electrolytes (sodium potassium, chloride, carbon dioxide)

$66
$101

35% lower than market

Blood test, basic group of blood chemicals

$117
$107

9% higher than market

Blood test, clotting time

$49
$43

13% higher than market

Blood test, comprehensive group of blood chemicals

$178
$179

Approximately equal to market

Blood test, lipids (cholesterol and triglycerides)

$138
$157

12% lower than market

Blood test, thyroid stimulating hormone (TSH)

$75
$149

50% lower than market

Calcium level

$45
$67

34% lower than market

Carcinoembryonic antigen (CEA) protein level

$98
$196

50% lower than market

Cholesterol level

$45
$63

29% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$59
$129

54% lower than market

Complete blood cell count - automated differential WBC count

$80
$87

8% lower than market

Complete blood cell count - automated test with out Differential

$75
$69

8% higher than market

Creatine kinase Level (cardiac enzyme) - Total

$86
$81

6% higher than market

Creatine kinase level (cardiac enzyme) - Muscle/Brain

$124
$154

19% lower than market

Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed

$29
$86

66% lower than market

Cyanocobalamin (vitamin B-12) level

$100
$139

28% lower than market

Detection test for Staphylococcus aureus (bacteria)

$80
$172

54% lower than market

Detection test for Staphylococcus aureus, methicillin resistant (MRSA bacteria)

$120
$184

35% lower than market

Detection test for bacteria toxin (shiga-like toxin)

$35
$74

53% lower than market

Detection test for clostridium difficile

$75
$166

55% lower than market

Detection test for multiple types influenza virus

$116
$272

57% lower than market

Ferritin (blood protein) level

$80
$173

54% lower than market

Folic acid; serum

$94
$155

39% lower than market

Gammaglobulin Measurement

$73
$126

42% lower than market

Glutamyltransferase (liver enzyme) level

$74
$84

12% lower than market

Hemoglobin A1C level

$70
$98

29% lower than market

Hemoglobin Measurement

$22
$50

56% lower than market

Hepatitis C Antibody Measurement

$107
$181

41% lower than market

Immunologic analysis for detection of tumor antigen (CA 125)

$122
$253

52% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); 12-25 targets

$284
$1,470

81% lower than market

Infusion, albumin (human), 25%, 50 ml

$199
$371

46% lower than market

Ionized Calcium

$92
$115

19% lower than market

Iron Binding Capacity

$84
$119

29% lower than market

Iron level

$74
$114

35% lower than market

Ketone bodies analysis, quantitative

$116
$175

33% lower than market

Kidney Function Blood Test Panel

$136
$154

12% lower than market

LDL cholesterol level

$102
$161

37% lower than market

Lactate dehydrogenase (enzyme) level

$71
$85

16% lower than market

Lactic acid level

$76
$151

50% lower than market

Levetiracetam level

$142
$347

59% lower than market

Lipase (fat enzyme) level

$76
$127

40% lower than market

Liver enzyme (SGOT), level

$53
$66

19% lower than market

Liver enzyme (SGPT), level

$53
$55

4% lower than market

Liver function blood test panel

$102
$115

12% lower than market

Measurement C-reactive protein

$46
$142

68% lower than market

Measurement of Antibody for Assessment of Autoimmune Disorder

$144
$168

14% lower than market

Measurement of Complement (Immune System Proteins)

$104
$123

15% lower than market

Microscopic genetic analysis of tumor; each single antibody stain procedure

$195
$533

63% lower than market

Natriuretic peptide (heart and blood vessel protein) level

$104
$266

61% lower than market

PSA (prostate specific antigen) measurement

$127
$155

18% lower than market

PSA Measurement; Free

$62
$151

59% lower than market

Parathormone

$153
$421

64% lower than market

Coagulation assessment blood test

$75
$96

22% lower than market

Pathology examination of tissue using a microscope, intermediate complexity

$80
$391

80% lower than market

Pathology examination of tissue using a microscope, moderately low complexity

$70
$293

76% lower than market

Phenobarbital level

$124
$221

44% lower than market

Phenytoin level

$124
$195

37% lower than market

Phosphate level

$45
$64

30% lower than market

Prealbumin (protein) level

$96
$112

14% lower than market

Procalcitonin (hormone) level

$107
$280

62% lower than market

Prostate Cancer Screening Test

$127
$153

17% lower than market

Protein Measurement, Serum

$89
$87

3% higher than market

Red Blood Cell Concentration Measurement

$22
$42

47% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$454
$1,031

56% lower than market

Red blood cell sedimentation rate, to detect inflammation

$39
$49

21% lower than market

Red blood count automated, with additional calculations

$49
$52

6% lower than market

Rheumatoid factor level

$89
$85

5% higher than market

Screening Test for Autoimmune Disorder

$100
$203

51% lower than market

Screening Test for Red Blood Cell Antibodies

$54
$192

72% lower than market

Smear for infectious agents

$57
$59

4% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$51
$93

45% lower than market

Special stained specimen slides to examine tissue

$286
$261

10% higher than market

Stool culture - salmonella and shigella species

$72
$96

25% lower than market

Stool culture - additional pathogens

$25
$48

47% lower than market

Strep Test

$48
$71

32% lower than market

Streptoccus

$99
$123

20% lower than market

Tacrolimus Level

$127
$485

74% lower than market

Testosterone (hormone) level

$180
$214

16% lower than market

Testosterone Level; Free

$182
$171

6% higher than market

Thyroid Hormone, T3 Measurement, Free

$106
$200

47% lower than market

Thyroid hormone, T3 measurement - Total

$99
$169

41% lower than market

Thyroxine (thyroid chemical) measurement - Free Thyroxine

$192
$176

9% higher than market

Thyroxine (thyroid chemical) measurement - Total

$64
$134

52% lower than market

Tissue or Cell Analysis by Immunologic Technique

$264
$759

65% lower than market

Total Protein Level, Urine

$63
$97

35% lower than market

Total protein level, blood

$45
$67

34% lower than market

Troponin (protein) analysis

$125
$190

34% lower than market

Urea nitrogen level to assess kidney function

$45
$50

10% lower than market

Uric acid level, blood

$48
$63

24% lower than market

Urinalysis with Examination, using Microscope

$45
$54

17% lower than market

Urinalysis, Automated Test

$31
$42

25% lower than market

Urinalysis, Manual Test

$21
$36

42% lower than market

Urine microalbumin (protein) level

$63
$79

21% lower than market

Valproic acid level

$99
$223

56% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Application of mechanical traction to 1 or more areas

$117
$156

25% lower than market

Fluoroscopic and video recorded motion evaluation of swallowing function

$359
$636

44% lower than market

Group psychotherapy

$391
$375

4% higher than market

Heart rhythm analysis, interpretation and report of 48-hour EKG

$250
$900

72% lower than market

Hydration Infusion into a Vein

$60
$186

68% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$60
$235

74% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$60
$175

65% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$100
$166

39% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$100
$203

51% lower than market

Medical nutrition therapy, assessment and intervention, each 15 minutes

$46
$68

32% lower than market

Multiple measurements of oxygen saturation in blood using ear or finger device

$110
$383

71% lower than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session

$153
$417

63% lower than market

Pneumococcal vaccine for injection into muscle; 13 valent (PCV13), for intramuscular use

$231
$1,215

81% lower than market

Psychotherapy, 30 minutes with patient

$160
$142

13% higher than market

Psychotherapy, 45 minutes with patient

$145
$263

45% lower than market

Pulmonary service or operation

$162
$169

4% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab

$2,219
$5,167

57% lower than market

Vaccine Injection for Pneumococcal Polysaccharide

$126
$596

79% lower than market

Vaccine for influenza administered into muscle, quadrivalent (IIV4) split virus, preservative free, 0.5 mL dosage

$18
$80

78% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Diabetes outpatient self-management training services, individual, per 30 minutes

$137
$176

22% lower than market

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)

$100
$143

30% lower than market

Epidural Injection Thoracic

$2,437
$6,456

62% lower than market

Injection, fosphenytoin, 50 mg phenytoin equivalent

$29
$31

7% lower than market

Injection, pantoprazole sodium, per vial

$58
$100

42% lower than market

Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity

$4
$9

56% lower than market

Therapeutic procedures to improve respiratory function or increase strength or endurance of respiratory muscles, two or more individuals (includes monitoring)

$73
$306

76% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$86
$139

38% lower than market

Administration of Influenza Virus Vaccine

$86
$103

16% lower than market

Administration of Pneumococcal Vaccine

$86
$108

20% lower than market

Infusion, normal saline solution , 1000 cc

$60
$171

65% lower than market

Infusion, normal saline solution, 250 cc

$60
$232

74% lower than market

Infusion, normal saline solution, sterile (500 ml = 1 unit)

$60
$169

65% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$184
$384

52% lower than market

Injection of New Drug into Vein for Therapy or Diagnosis

$100
$228

56% lower than market

Injection, Adrenalin, Epinephrine, 0.1 mg

$16
$45

65% lower than market

Injection, Cefazolin Sodium, 500 mg

$8
$23

64% lower than market

Injection, Ceftriaxone Sodium, per 250 mg

$15
$25

41% lower than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$4
$12

65% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$58
$57

1% higher than market

Injection, Enoxaparin Sodium, 10 mg

$15
$24

38% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$17
$51

68% lower than market

Injection, Furosemide, up to 20 mg

$18
$38

53% lower than market

Injection, Heparin Sodium, per 1000 Units

$4
$10

65% lower than market

Injection, Hydromorphone, Up to 4 mg

$17
$60

72% lower than market

Injection, Levofloxacin, 250 mg

$29
$37

23% lower than market

Injection, Lorazepam, 2 mg

$17
$51

67% lower than market

Injection, Magnesium Sulfate, per 500 mg

$9
$32

73% lower than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$62
$117

47% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$17
$52

67% lower than market

Injection, Midazolam Hydrochloride, per 1 mg

$6
$29

78% lower than market

Injection, Ondansetron Hydrochloride, per 1 mg

$3
$16

81% lower than market

Injection, Piperacillin Sodium/Tazobactam (1.125 grams)

$19
$41

52% lower than market

Injection, Promethazine HCL, up to 50 mg

$18
$53

67% lower than market

Injection, Vancomycin HCL, 500 mg

$29
$44

33% lower than market

Injection, abatacept, 10 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

$101
$172

41% lower than market

Injection, acetaminophen, 10 mg

$2
$4

53% lower than market

Injection, betamethasone acetate 3 mg and betamethasone sodium phosphate 3 mg

$18
$66

72% lower than market

Injection, daptomycin, 1 mg

$2
$3

38% lower than market

Injection, denosumab, 1 mg

$49
$150

67% lower than market

Injection, diazepam, up to 5 mg

$182
$171

7% higher than market

Injection, ferric carboxymaltose, 1mg

$3
$12

77% lower than market

Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram

$3
$9

71% lower than market

Injection, gadobutrol, 0.1 ml

$2
$3

28% lower than market

Injection, iron sucrose, 1 mg

$2
$3

43% lower than market

Injection, methylprednisolone acetate, 20 mg

$31
$57

46% lower than market

Injection, methylprednisolone acetate, 40 mg

$29
$110

74% lower than market

Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg

$18
$65

73% lower than market

Injection, orphenadrine citrate, up to 60 mg

$59
$163

64% lower than market

Injection, phytonadione (vitamin k), per 1 mg

$19
$45

57% lower than market

Injection, potassium chloride, per 2 meq

$6
$8

22% lower than market

Injection, propofol, 10 mg

$3
$4

17% lower than market

Injection, regadenoson, 0.1 mg

$136
$400

66% lower than market

Injection, succinylcholine chloride, up to 20 mg

$16
$17

5% lower than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$8
$26

70% lower than market

Injection, zoledronic acid, 1 mg

$82
$321

74% lower than market

Ringers lactate infusion, up to 1000 cc

$60
$104

42% lower than market

OUTPATIENT RESPIRATORY THERAPY CHARGES

The following charges reflect the most common services offered by our Respiratory Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Arterial Puncture

$85
$440

81% lower than market

CO Diffusion Capacity

$364
$604

40% lower than market

Nebulizer Treatment

$162
$196

17% lower than market

Pulse Oximetry

$54
$79

32% lower than market

Thoracic Gas Volume

$364
$862

58% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Technetium tc-99m sestamibi, diagnostic, per study dose

$497
$497

Approximately equal to market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of vein wound compression system lower leg below knee including ankle and foot

$456
$652

30% lower than market

Biopsy of Large Bowel, Using an Endoscope

$1,557
$3,861

60% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$1,129
$4,921

77% lower than market

Collection of blood specimen from a completely implantable venous access device

$100
$325

69% lower than market

Colonscopy

$1,557
$4,037

61% lower than market

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$2,109
$3,225

35% lower than market

Destruction of skin growth

$42
$135

69% lower than market

Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope

$1,741
$3,819

54% lower than market

Drainage of fluid from abdominal cavity using imaging guidance

$1,097
$2,750

60% lower than market

Electronic analysis reprogramming and refill of spinal canal drug infusion pump by physician

$575
$751

23% lower than market

Removal of cataract with insertion of lens

$1,824
$10,453

83% lower than market

Gallbladder Removal Using an Endoscope

$2,143
$21,544

90% lower than market

Injection procedure for sacroiliac joint; provision of anesthetic, steroid and/or other therapeutic agent, with or without arthrography

$3,060
$3,326

8% lower than market

Injection of anesthetic and/or steroid into lower spine nerve root using imaging

$2,437
$2,867

15% lower than market

Insertion of Indwelling Bladder Catheter

$100
$473

79% lower than market

Colonoscopy with removal of polyp(s)

$1,557
$3,755

59% lower than market

Repair of groin hernia patient age 5 years or older

$2,109
$17,067

88% lower than market

Strapping, Unna boot

$268
$455

41% lower than market

Transfusion of Blood or Blood Products

$378
$1,567

76% lower than market

Ultrasound measurement of bladder capacity after voiding

$175
$695

75% lower than market

OUTPATIENT TRANSPORTATION CHARGES

Description

Our Charge
Market Charge

Variance

Ambulance service, advanced life support, emergency transport, level 1 (als 1 - emergency)

$1,100
$2,729

60% lower than market

Ambulance service, advanced life support, non-emergency transport, level 1 (als 1)

$800
$2,349

66% lower than market

Ambulance service, basic life support, emergency transport (bls-emergency)

$750
$2,038

63% lower than market

Ambulance service, basic life support, non-emergency transport, (bls)

$600
$1,586

62% lower than market

Ground mileage, per statute mile

$16
$45

65% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL CHARGES

The following charges reflect our most common x-ray and radiological procedures. For all exams requiring contrast, the contrast will be charged separately.

Description

Our Charge
Market Charge

Variance

Bone Density Scan (DEXA Scan)

$263
$530

50% lower than market

CT Abdomen & Pelvis with Contrast

$2,050
$3,730

45% lower than market

CT Abdomen & Pelvis with and without Contrast

$2,350
$4,282

45% lower than market

CT Abdomen & Pelvis without Contrast

$1,700
$3,046

44% lower than market

CT Angiogram Chest with and without Contrast

$1,528
$1,961

22% lower than market

CT Chest with Contrast

$1,528
$1,580

3% lower than market

CT Chest without Contrast

$1,312
$1,527

14% lower than market

CT Head Brain without Contrast

$1,312
$1,209

9% higher than market

CT Pelvis with Contrast

$1,528
$2,021

24% lower than market

CT Spine Cervical without Contrast

$1,312
$1,940

32% lower than market

CT Spine Lumbar without Contrast

$1,312
$2,032

35% lower than market

Chest X-Ray; 2 Views

$201
$415

52% lower than market

Chest X-Ray; Single View

$176
$314

44% lower than market

Diagnostic mammography, bilateral

$310
$518

40% lower than market

Diagnostic mammography, unilateral

$200
$406

51% lower than market

Imaging for Evaluation of Swalling Function

$419
$784

46% lower than market

Imaging of Abdomen; 2 Views

$205
$586

65% lower than market

Imaging of Abdomen; Single View

$175
$425

59% lower than market

Low Osmolar Contrast Material, 300-399 mg/ml Iodine Concentration

$1
$2

71% lower than market

MRI Brain with and without Conrast

$2,473
$2,221

11% higher than market

MRI Brain without Contrast

$1,685
$1,711

2% lower than market

MRI Leg Joint without Contrast

$1,695
$2,172

22% lower than market

MRI Spine Cervical without Contrast

$1,685
$1,783

6% lower than market

MRI Spine Lumbar without Contrast

$1,685
$1,522

11% higher than market

Myocardial Perfusion, Tomographic

$2,700
$6,125

56% lower than market

Physical Therapy, ultrasound therapy - 15 minutes

$104
$137

24% lower than market

Screening Mammography, Bilateral, with CAD

$200
$521

62% lower than market

Screening digital breast tomosynthesis, bilateral

$100
$94

6% higher than market

Ultrasound Abdomen - Complete

$580
$1,379

58% lower than market

Ultrasound Abdomen - Limited

$373
$1,003

63% lower than market

Ultrasound Behind Abdominal Cavity - Complete

$579
$870

33% lower than market

Ultrasound Behind Abdominal Cavity - Limited

$288
$636

55% lower than market

Ultrasound Blood Flow Outside the Brain

$771
$1,644

53% lower than market

Ultrasound Head Neck

$423
$871

51% lower than market

Ultrasound Heart

$2,100
$3,087

32% lower than market

Ultrasound Pelvis NonOB

$366
$870

58% lower than market

Ultrasound Pelvis through Vagina

$366
$771

52% lower than market

Ultrasound Pregnant Uterus > 14 Weeks Pregnant

$564
$1,178

52% lower than market

Ultrasound Veins of One Arm or Leg

$544
$1,687

68% lower than market

X-Ray Ankle, 3 Views

$410
$434

5% lower than market

X-Ray Elbow, 3 Views

$354
$429

18% lower than market

X-Ray Foot, 3 Views

$397
$447

11% lower than market

X-Ray Hand, 3 Views

$397
$433

8% lower than market

X-Ray Hip and Pelvis, 2 Views

$208
$422

51% lower than market

X-Ray Knee, 1-2 Views

$373
$434

14% lower than market

X-Ray Knee, 3 Views

$417
$450

7% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$231
$671

66% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$354
$879

60% lower than market

X-Ray Neck Spine, 2-3 Views

$275
$500

45% lower than market

X-Ray Shoulder, 2 Views

$373
$474

21% lower than market

X-Ray Upper Spine, 4-5 Views

$367
$728

50% lower than market

X-Ray Wrist, 3 Views

$410
$410

Approximately equal to market

X-Ray of Middle Spine; 3 Views

$198
$691

71% lower than market

X-ray Ribs One Side, Minimum 3 Views

$276
$612

55% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Stomach Disorder without complications

$11,832
$20,631

43% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Total Knee or Hip Replacement

$35,208
$83,316

58% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Pneumonia with major complications

$24,873
$33,973

27% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$9,796
$19,602

50% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Adams Memorial 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 Adams Memorial 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 Adams Memorial 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 Adams Memorial 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 260-724-2145.

If you need more information about the price of a future service, please contact our Customer Service at 260-724-2145. 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.