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Patient Price Information List

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

Hospital Name
Location

Alleghany Memorial Hospital

Sparta

NC

Charles A. Cannon, Jr. Memorial Hospital

Linville

NC

Chatham Hospital

Siler City

NC

Novant Health Forsyth Medical Center

Winston-Salem

NC

Wake Forest Baptist Health - Wilkes Medical Center

North Wilkesboro

NC

Watauga Medical Center

Boone

NC

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$616
$1,127

45% lower than market

Semi-Private Room

$593
$1,494

60% lower than market

Intensive Care Unit

$723
$2,042

65% lower 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, self limited or minor problem [CPT 99281]

$183
$192

5% lower than market

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

$254
$318

20% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$397
$528

25% lower than market

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

$624
$990

37% lower than market

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

$903
$1,335

32% lower than market

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

$326
$439

26% lower than market

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

$1,535
$1,933

21% lower than market

Initial hospital inpatient care, typically 50 minutes per day [CPT 99222]

$394
$403

2% lower than market

Initial hospital inpatient care, typically 70 minutes per day [CPT 99223]

$516
$597

14% 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

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

$98
$111

12% lower than market

Elec stim other than wound [HCPCS G0283]

$70
$88

21% lower than market

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

$181
$245

26% lower than market

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

$111
$125

11% lower than market

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

$118
$103

15% higher than market

Evaluation of physical therapy, typically 45 minutes [CPT 97163]

$268
$252

7% higher than market

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

$160
$252

36% 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

Evaluation of occupational therapy, typically 45 minutes [CPT 97166]

$185
$248

26% lower than market

Evaluation of occupational therapy established plan of care, typically 60 minutes [CPT 97167]

$246
$259

5% lower than market

Re-evaluation of occupational therapy established plan of care, typically 30 minutes [CPT 97168]

$126
$116

9% higher than market

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

$137
$250

45% lower than market

Application of hot wax bath to 1 or more areas [CPT 97018]

$40
$118

66% 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

Demonstration and/or evaluation of patient use of aerosol generator, nebulizer, metered dose inhaler or intermittent positive pressure breathing (IPPB) device [CPT 94664]

$95
$195

51% lower than market

Initiation and management of continued pressured respiratory assistance by mask or breathing tube [CPT 94660]

$476
$490

3% lower than market

Measurement and graphic recording of total and timed exhaled air capacity [CPT 94010]

$200
$338

41% lower than market

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

$290
$413

30% lower than market

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

$609
$771

21% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Evaluation of speech sound production [CPT 92522]

$200
$265

24% lower than market

Evaluation of speech sound production with evaluation of language comprehension and expression [CPT 92523]

$225
$404

44% 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

Amylase (enzyme) level [CPT 82150]

$57
$66

13% lower than market

Blood gases measurement [CPT 82803]

$230
$231

Approximately equal to market

Bacterial blood culture [CPT 87040]

$100
$135

26% lower than market

Bacterial culture for aerobic isolates [CPT 87077]

$55
$75

27% lower than market

Bilirubin level, direct [CPT 82248]

$40
$44

9% lower than market

Blood glucose (sugar) test performed by hand-held instrument [CPT 82962]

$21
$28

28% lower than market

Blood group typing (ABO) [CPT 86900]

$50
$68

26% lower than market

Blood typing for Rh (D) antigen [CPT 86901]

$39
$50

23% lower than market

Blood unit compatibility test, immediate spin technique [CPT 86920]

$92
$161

43% lower than market

Blood creatinine level [CPT 82565]

$43
$60

29% lower than market

Blood glucose (sugar) measurement using reagent strip [CPT 82948]

$11
$18

37% lower than market

Blood potassium level [CPT 84132]

$40
$35

14% higher than market

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

$48
$77

38% lower than market

Blood test, clotting time [CPT 85610]

$40
$34

16% higher than market

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

$145
$172

15% lower than market

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

$105
$85

23% higher than market

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

$106
$95

12% higher than market

Calcium level, total [CPT 82310]

$50
$40

24% higher than market

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

$94
$86

9% higher than market

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

$55
$66

17% lower than market

Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [CPT 87635]

$400
$105

283% higher than market

Creatine kinase (cardiac enzyme) level, total [CPT 82550]

$65
$77

16% lower than market

Creatine kinase (cardiac enzyme) level, MB fraction only [CPT 82553]

$100
$147

32% lower than market

Creatinine level to test for kidney function or muscle injury [CPT 82570]

$30
$29

4% higher than market

Cyanocobalamin (vitamin B-12) level [CPT 82607]

$80
$79

1% higher than market

Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique [CPT 87491]

$95
$126

25% lower than market

Detection test by immunoassay technique for Hepatitis B surface antigen [CPT 87340]

$95
$92

3% higher than market

Detection test by nucleic acid for Neisseria gonorrhoeae (gonorrhoeae bacteria), amplified probe technique [CPT 87591]

$105
$138

24% lower than market

Detection test by immunoassay for identification of organism [CPT 87899]

$76
$72

6% higher than market

Detection test by nucleic acid for multiple types influenza virus [CPT 87502]

$155
$235

34% lower than market

Ferritin (blood protein) level [CPT 82728]

$75
$85

12% lower than market

Gonadotropin, chorionic (reproductive hormone) level [CPT 84702]

$145
$126

15% higher than market

Hemoglobin A1C level [CPT 83036]

$65
$60

7% higher than market

Blood count, hemoglobin [CPT 85018]

$30
$28

6% higher than market

Immunologic analysis for detection of organism by immunoassay technique, multiple-step method [CPT 87449]

$118
$112

5% higher than market

Iron binding capacity [CPT 83550]

$39
$73

47% lower than market

Iron level [CPT 83540]

$29
$42

32% lower than market

Kidney function blood test panel [CPT 80069]

$46
$116

61% lower than market

Lipase (fat enzyme) level [CPT 83690]

$100
$107

7% lower than market

Liver function blood test panel [CPT 80076]

$80
$62

29% higher than market

Magnesium level [CPT 83735]

$48
$64

25% lower than market

Natriuretic peptide (heart and blood vessel protein) level [CPT 83880]

$185
$206

10% lower than market

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

$116
$89

31% higher than market

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

$126
$89

42% higher than market

Parathormone (parathyroid hormone) level [CPT 83970]

$202
$252

20% lower than market

Coagulation assessment blood test, plasma or whole blood [CPT 85730]

$77
$76

1% higher than market

Platelet pheres leukoreduced [HCPCS P9035]

$961
$1,761

45% lower than market

Progesterone (reproductive hormone) level [CPT 84144]

$85
$82

4% higher than market

Prolactin (milk producing hormone) level [CPT 84146]

$205
$165

24% higher than market

Rbc leukocytes reduced [HCPCS P9016]

$425
$680

38% lower than market

Screening test for autoimmune disorder [CPT 86038]

$146
$97

50% higher than market

Screening test for red blood cell antibodies [CPT 86850]

$99
$169

42% lower than market

Special stained specimen slides to examine tissue, each additional procedure [CPT 88341]

$105
$190

45% lower than market

Stool analysis for blood, by peroxidase activity [CPT 82272]

$40
$38

6% higher than market

Stool culture [CPT 87045]

$98
$111

11% lower than market

Strep test by immunoassay for Streptococcus [CPT 87880]

$65
$69

5% lower than market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution [CPT 87186]

$88
$115

24% lower than market

Testosterone (hormone) level, total [CPT 84403]

$195
$169

15% higher than market

Testosterone (hormone) level, free [CPT 84402]

$230
$162

42% higher than market

Thyroxine (thyroid chemical), free [CPT 84439]

$75
$85

11% lower than market

Special stained specimen slides to examine tissue, initial procedure [CPT 88342]

$112
$319

65% lower than market

Total protein level, urine [CPT 84156]

$60
$45

34% higher than market

Troponin (protein) analysis, quantitative [CPT 84484]

$125
$166

25% lower than market

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

$41
$51

19% lower than market

Automated urinalysis test [CPT 81003]

$30
$30

2% lower than market

Urinalysis, manual test [CPT 81002]

$32
$16

102% higher than market

Urine microalbumin (protein) level [CPT 82043]

$75
$46

62% higher than market

Vitamin D-3 level [CPT 82306]

$172
$192

10% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Administration of vaccine [CPT 90472]

$49
$67

27% lower than market

Application of blood vessel compression or decompression device to 1 or more areas [CPT 97016]

$67
$63

6% higher than market

Application of mechanical traction to 1 or more areas [CPT 97012]

$94
$123

24% lower than market

Application of medication through skin using electrical current, each 15 minutes [CPT 97033]

$106
$120

12% lower than market

Attempt to restart heart and lungs [CPT 92950]

$336
$556

40% lower than market

Behavioral and qualitative analysis of voice and resonance [CPT 92524]

$280
$257

9% higher than market

Removal of tissue from wounds per session, first 20 sq cms or less [CPT 97597]

$358
$348

3% higher than market

Education and training for patient self-management, each 30 minutes [CPT 98960]

$38
$76

51% lower than market

Heart rhythm analysis, interpretation and report of 48-hour EKG [CPT 93226]

$560
$663

16% lower than market

Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle [CPT 96402]

$104
$141

26% lower than market

Hydration infusion into a vein [CPT 96361]

$89
$144

39% lower than market

Hydration infusion into a vein 31 minutes to 1 hour [CPT 96360]

$252
$366

31% lower than market

Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour [CPT 96367]

$134
$218

38% lower than market

Infusion into a vein for therapy, prevention, or diagnosis [CPT 96366]

$94
$136

31% lower than market

Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour [CPT 96365]

$252
$444

43% lower than market

Infusion of chemotherapy into a vein [CPT 96415]

$147
$165

11% lower than market

Infusion of chemotherapy into a vein using push technique [CPT 96409]

$351
$335

5% higher than market

Injection beneath the skin or into muscle for therapy, diagnosis, or prevention [CPT 96372]

$49
$115

58% lower than market

Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility [CPT 96376]

$112
$165

32% lower than market

Irrigation of implanted venous access drug delivery device [CPT 96523]

$85
$117

28% lower than market

Manual maneuvers to chest wall to assist movement of lung secretions [CPT 94668]

$36
$107

66% lower than market

Measurement and recording of brain wave (EEG) activity, awake and asleep [CPT 95819]

$1,043
$1,065

2% lower than market

Measurement of esophageal swallowing movement [CPT 91010]

$1,050
$3,171

67% lower than market

Medical nutrition therapy, assessment and intervention, each 15 minutes [CPT 97802]

$36
$41

11% lower than market

Monitoring of gastroesophageal reflux including analysis and interpretation [CPT 91037]

$1,051
$1,711

39% lower than market

Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle [CPT 96401]

$190
$185

2% higher than market

Overnight measurement of oxygen saturation in blood using ear or finger device [CPT 94762]

$112
$232

52% lower than market

Physical performance test or measurement with report, each 15 minutes [CPT 97750]

$124
$124

Approximately equal to market

Physician services for outpatient heart cardiac rehabilitation per session [CPT 93797]

$77
$151

49% lower than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session [CPT 93798]

$135
$252

47% lower than market

Pneumococcal vaccine for injection into muscle [CPT 90670]

$297
$434

32% lower than market

Refilling and maintenance of implantable pump or reservoir for drug delivery [CPT 96522]

$263
$490

46% lower than market

Refilling and maintenance of portable pump [CPT 96521]

$352
$363

3% lower than market

Removal of tissue from wounds per session [CPT 97602]

$175
$299

41% lower than market

Standardized thought processing testing, interpretation, and report per hour [CPT 96125]

$189
$186

1% higher than market

Therapeutic removal of whole blood to correct blood level imbalance [CPT 99195]

$98
$208

53% lower than market

Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes [CPT 97760]

$114
$110

3% higher than market

Vaccine for influenza for administration into muscle, 0.5 ml dosage, quadrivalent, preservation free [CPT 90686]

$69
$103

33% lower than market

Vaccine for influenza for injection into muscle, split virus, preservation free [CPT 90662]

$179
$251

29% lower than market

Vaccine for rabies injection into muscle [CPT 90675]

$949
$1,135

16% lower than market

Ventilation assistance and management, hospital inpatient or observation, initial day [CPT 94002]

$835
$1,232

32% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$27
$91

71% lower than market

Hospital observation care on day of discharge [CPT 99217]

$183
$215

15% lower than market

Hospital observation care, typically 30 minutes [CPT 99218]

$228
$294

23% lower than market

Hospital observation care, typically 50 minutes [CPT 99219]

$309
$401

23% lower than market

Hospital observation care, typically 70 minutes [CPT 99220]

$389
$548

29% lower than market

Hospital observation or inpatient care high severity, 55 minutes per day [CPT 99236]

$537
$643

16% lower than market

Hospital observation or inpatient care low severity, 40 minutes per day [CPT 99234]

$324
$393

18% lower than market

Hospital observation or inpatient care moderate severity, 50 minutes per day' [CPT 99235]

$435
$499

13% lower than market

Subsequent observation care, typically 25 minutes per day [CPT 99225]

$162
$215

25% lower than market

Subsequent observation care, typically 35 minutes per day [CPT 99226]

$242
$310

22% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Inj multihance [HCPCS A9577]

$7
$22

67% lower than market

Non-covered item or service [HCPCS A9270]

$5
$7

26% lower than market

Removal of recurring cataract in lens capsule using laser [CPT 66821]

$685
$881

22% lower than market

Telehealth facility fee [HCPCS Q3014]

$77
$109

29% lower than market

Oth resp proc, group [HCPCS G0239]

$92
$99

7% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 vaccine [CPT 90471]

$80
$75

6% higher than market

Admin influenza virus vac [HCPCS G0008]

$32
$62

48% lower than market

Infusion of chemotherapy into a vein up to 1 hour [CPT 96413]

$506
$607

17% lower than market

Injection of drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96374]

$112
$248

55% lower than market

Injection of different drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96375]

$112
$180

37% lower than market

Adrenalin epinephrine inject [HCPCS J0171]

$5
$9

47% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$12
$35

65% lower than market

Furosemide injection [HCPCS J1940]

$25
$41

39% lower than market

Hydralazine hcl injection [HCPCS J0360]

$50
$81

39% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$25
$31

21% lower than market

Inj magnesium sulfate [HCPCS J3475]

$26
$26

1% higher than market

Methylprednisolone injection [HCPCS J2930]

$50
$73

32% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$34
$31

10% higher than market

Vancomycin hcl injection [HCPCS J3370]

$25
$36

31% lower than market

Alteplase recombinant [HCPCS J2997]

$178
$287

38% lower than market

Amiodarone hcl [HCPCS J0282]

$10
$27

63% lower than market

Atropine sulfate injection [HCPCS J0461]

$1
$1

5% higher than market

Cefoxitin sodium injection [HCPCS J0694]

$52
$74

30% lower than market

Diazepam injection [HCPCS J3360]

$36
$94

62% lower than market

Ertapenem injection [HCPCS J1335]

$169
$280

40% lower than market

Fosaprepitant injection [HCPCS J1453]

$9
$10

4% lower than market

In gemcitabine hcl nos 200mg [HCPCS J9201]

$51
$57

10% lower than market

Lidocaine injection [HCPCS J2001]

$5
$6

11% lower than market

Methylprednisolone injection [HCPCS J2920]

$50
$55

10% lower than market

Prochlorperazine injection [HCPCS J0780]

$50
$102

52% lower than market

Inj, propofol, 10 mg [HCPCS J2704]

$2
$3

16% lower than market

Regadenoson injection [HCPCS J2785]

$225
$220

2% higher than market

Sincalide injection [HCPCS J2805]

$194
$458

58% lower than market

Succinycholine chloride inj [HCPCS J0330]

$50
$45

11% higher than market

Triamcinolone acet inj nos [HCPCS J3301]

$12
$32

62% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$231
$352

34% lower than market

Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older [CPT 90715]

$121
$204

41% 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 withdrawal of blood for diagnosis [CPT 36600]

$87
$112

23% lower than market

Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen [CPT 94640]

$143
$233

39% lower than market

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

$43
$53

20% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of non-moveable, short arm splint (forearm to hand) [CPT 29125]

$99
$299

67% lower than market

Aspiration and/or injection of large joint or joint capsule [CPT 20610]

$420
$563

25% lower than market

Biopsy of the large bowel using an endoscope (colonoscopy) [CPT 45380]

$1,212
$2,846

57% lower than market

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43239]

$1,840
$1,614

14% higher than market

Collection of blood specimen from a completely implantable venous access device [CPT 36591]

$45
$197

77% lower than market

Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk [CPT 45378]

$1,212
$2,271

47% lower than market

Drainage of abscess [CPT 10060]

$290
$398

27% lower than market

Drainage of fluid from abdominal cavity using imaging guidance [CPT 49083]

$1,198
$1,795

33% lower than market

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

$1,212
$3,788

68% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$3,536
$10,044

65% lower than market

Insertion of central venous catheter and implanted device for infusion beneath the skin, patient 5 years or older [CPT 36561]

$1,474
$4,806

69% lower than market

Insertion of indwelling bladder catheter, simple [CPT 51702]

$143
$182

22% lower than market

Removal of one knee cartilage using an endoscope [CPT 29881]

$3,621
$4,979

27% lower than market

Removal of 1 or more breast growth, open procedure [CPT 19120]

$3,621
$2,321

56% higher than market

Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare [CPT 45385]

$1,212
$3,184

62% lower than market

Removal of fluid from chest cavity with imaging guidance [CPT 32555]

$1,198
$1,947

38% lower than market

Removal of gallbladder with X-ray study of bile ducts using endoscope [CPT 47563]

$3,621
$11,140

67% lower than market

Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs [CPT 12002]

$170
$417

59% lower than market

Repair of groin hernia patient age 5 years or older [CPT 49505]

$3,621
$6,724

46% lower than market

Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes [CPT 12011]

$170
$486

65% lower than market

Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs [CPT 12001]

$170
$421

60% lower than market

Transfusion of blood or blood products [CPT 36430]

$595
$680

12% 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 measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]

$344
$376

8% lower than market

Ultrasound of one breast, complete [CPT 76641]

$275
$422

35% lower than market

Ultrasound of one breast, limited [CPT 76642]

$235
$311

24% lower than market

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

$3,975
$4,302

8% lower than market

CT scan of abdomen and pelvis before and after contrast [CPT 74178]

$4,121
$4,765

14% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$3,034
$3,343

9% lower than market

CT scan abdomen with contrast [CPT 74160]

$2,225
$2,502

11% lower than market

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

$2,845
$3,115

9% lower than market

CT scan of blood vessel of head with contrast [CPT 70496]

$2,845
$3,399

16% lower than market

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

$2,845
$3,384

16% lower than market

CT scan of arm with contrast [CPT 73201]

$1,745
$2,324

25% lower than market

CT scan of arm [CPT 73200]

$1,425
$1,658

14% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$1,642
$2,199

25% lower than market

Diagnostic CT scan of chest [CPT 71250]

$1,372
$1,535

11% lower than market

CT scan of face with contrast [CPT 70487]

$1,617
$2,156

25% lower than market

CT scan of face [CPT 70486]

$1,268
$1,762

28% lower than market

CT scan head or brain before and after contrast [CPT 70470]

$2,095
$2,336

10% lower than market

CT scan head or brain [CPT 70450]

$1,352
$1,475

8% lower than market

CT scan leg [CPT 73700]

$1,287
$1,530

16% lower than market

CT scan of neck with contrast [CPT 70491]

$1,920
$2,209

13% lower than market

CT scan pelvis with contrast [CPT 72193]

$1,980
$2,318

15% lower than market

CT scan pelvis [CPT 72192]

$1,463
$1,663

12% lower than market

CT scan of abdominal aorta and both leg arteries with contrast [CPT 75635]

$2,405
$2,128

13% higher than market

CT scan of upper spine with contrast [CPT 72126]

$1,690
$3,113

46% lower than market

CT scan of upper spine [CPT 72125]

$1,372
$1,922

29% lower than market

CT scan of lower spine [CPT 72131]

$1,491
$1,688

12% lower than market

CT scan of middle spine [CPT 72128]

$1,372
$1,740

21% lower than market

CT scan of lower leg blood vessels with contrast [CPT 73706]

$2,645
$2,369

12% higher than market

CT scan of lower spine before and after contrast [CPT 72133]

$2,298
$3,064

25% lower than market

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

$264
$247

7% higher than market

X-ray of chest, 1 view [CPT 71045]

$160
$240

33% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$245
$524

53% lower than market

Diagnostic mammography of one breast [CPT 77065]

$215
$379

43% lower than market

Fluoroscopic guidance for insertion of needle [CPT 77002]

$406
$511

21% lower than market

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

$180
$575

69% lower than market

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

$335
$404

17% lower than market

X-ray of abdomen, 2 views [CPT 74019]

$265
$291

9% lower than market

X-ray of abdomen, 1 view [CPT 74018]

$205
$205

Approximately equal to market

Imaging of liver and bile duct system with use of drugs [CPT 78227]

$1,208
$1,771

32% lower than market

Locm 300-399mg/ml iodine,1ml [HCPCS Q9967]

$2
$4

38% lower than market

MRA scan of head blood vessels [CPT 70544]

$2,605
$2,384

9% higher than market

MRA scan of neck blood vessels [CPT 70547]

$2,505
$2,345

7% higher than market

MRI scan of arm joint [CPT 73221]

$2,017
$2,327

13% lower than market

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

$3,165
$3,998

21% lower than market

MRI scan brain [CPT 70551]

$2,164
$2,670

19% lower than market

MRI scan of leg joint [CPT 73721]

$2,305
$2,433

5% lower than market

MRI scan of leg before and after contrast [CPT 73720]

$2,701
$3,602

25% lower than market

MRI scan of upper spinal canal [CPT 72141]

$2,619
$2,693

3% lower than market

MRI scan of lower spinal canal before and after contrast [CPT 72158]

$4,247
$4,096

4% higher than market

MRI scan of lower spinal canal [CPT 72148]

$2,375
$2,555

7% lower than market

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

$2,143
$3,240

34% lower than market

Application of ultrasound to 1 or more areas, each 15 minutes [CPT 97035]

$70
$110

37% lower than market

Screening mammography of both breasts [CPT 77067]

$195
$294

34% lower than market

Stomach emptying study [CPT 78264]

$1,162
$1,550

25% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$773
$811

5% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$610
$615

1% lower than market

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

$970
$964

1% higher than market

Ultrasound of head and neck [CPT 76536]

$545
$537

1% higher than market

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

$580
$657

12% lower than market

Ultrasound pelvis through vagina [CPT 76830]

$520
$557

7% lower than market

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]

$584
$391

49% higher than market

Ultrasound of scrotum [CPT 76870]

$506
$526

4% lower than market

Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers [CPT 93970]

$1,008
$1,082

7% lower than market

Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers [CPT 93971]

$815
$699

17% higher than market

Ultrasound study of arteries and arterial grafts of both legs [CPT 93925]

$941
$877

7% higher than market

Ultrasound study of arteries and arterial grafts of one leg or limited [CPT 93926]

$473
$547

14% lower than market

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

$271
$371

27% lower than market

Bone and/or joint imaging, whole body [CPT 78306]

$1,360
$1,755

22% lower than market

X-ray of ankle, 2 views [CPT 73600]

$220
$262

16% lower than market

X-ray of ankle, minimum of 3 views [CPT 73610]

$275
$320

14% lower than market

X-ray of both hips with pelvis, 2 views [CPT 73521]

$339
$328

3% higher than market

X-ray of elbow, 2 views [CPT 73070]

$130
$232

44% lower than market

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

$245
$305

20% lower than market

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

$410
$463

11% lower than market

X-ray of femur, minimum 2 views [CPT 73552]

$170
$264

36% lower than market

X-ray of fingers, minimum of 2 views [CPT 73140]

$200
$204

2% lower than market

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

$245
$276

11% lower than market

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

$235
$286

18% lower than market

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

$240
$241

Approximately equal to market

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

$252
$234

8% higher than market

X-ray of knee, 1 or 2 views [CPT 73560]

$225
$212

6% higher than market

X-ray of knee, 4 or more views [CPT 73564]

$305
$344

11% lower than market

X-ray of lower leg, 2 views [CPT 73590]

$245
$305

20% lower than market

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

$340
$335

2% higher than market

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

$380
$445

15% lower than market

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

$235
$313

25% lower than market

X-ray of spine of neck, 2 or 3 views [CPT 72040]

$305
$292

4% higher than market

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

$180
$250

28% lower than market

X-ray of pelvis, minimum of 2 views [CPT 72220]

$240
$241

1% lower than market

X-ray of shoulder blade [CPT 73010]

$250
$336

26% lower than market

X-ray of shoulder, 1 view [CPT 73020]

$186
$248

25% lower than market

X-ray of shoulder, minimum of 2 views [CPT 73030]

$250
$261

4% lower than market

X-ray of toes, minimum of 2 views [CPT 73660]

$170
$230

26% lower than market

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

$198
$257

23% lower than market

X-ray of upper digestive tract with single contrast [CPT 74240]

$390
$622

37% lower than market

X-ray of upper spine, 4 or 5 views [CPT 72050]

$405
$430

6% lower than market

X-ray of wrist, 2 views [CPT 73100]

$134
$236

43% lower than market

X-ray of wrist, minimum of 3 views [CPT 73110]

$245
$306

20% lower than market

X-ray of middle spine, 3 views [CPT 72072]

$385
$451

15% lower than market

X-ray of ribs on one side of body including the chest, minimum of 3 views [CPT 71101]

$280
$355

21% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat with complications

$7,798
$11,447

32% lower than market

Abnormal or Irregular Heartbeat without complications

$3,699
$8,114

54% lower than market

Acute myocardial infarction, discharged alive with complications

$6,824
$14,927

54% lower than market

Acute myocardial infarction, discharged alive with major complications

$19,321
$23,772

19% lower than market

Acute myocardial infarction, discharged alive without complications

$7,243
$14,214

49% lower than market

Angina pectoris

$3,586
$11,865

70% lower than market

Atherosclerosis without major complications

$5,100
$9,745

48% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$5,633
$18,862

70% lower than market

Heart Failure with complications

$5,707
$13,410

57% lower than market

Heart Failure with major complications

$9,389
$18,744

50% lower than market

Heart failure & shock without complications

$6,808
$10,359

34% lower than market

Hypertension with major complications

$12,094
$27,001

55% lower than market

Hypertension without major complications

$5,777
$12,405

53% lower than market

Peripheral vascular disorders with complications

$8,959
$16,485

46% lower than market

Syncope & collapse

$3,944
$12,726

69% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Appendectomy without complications

$16,928
$31,904

47% lower than market

Inguinal & femoral hernia procedures with complications

$12,439
$27,798

55% lower than market

Laparoscopic cholecystectomy with complications

$17,309
$30,496

43% lower than market

Laparoscopic cholecystectomy without complications

$18,957
$37,891

50% lower than market

Major small & large bowel procedures with complications

$47,339
$68,934

31% lower than market

Major small & large bowel procedures without complications

$27,566
$51,188

46% lower than market

Other O.R. procedures for injuries without complications

$23,044
$38,992

41% lower than market

Other digestive system O.R. procedures with complications

$16,835
$45,988

63% lower than market

Peritoneal adhesiolysis with complications

$21,866
$45,138

52% lower than market

Peritoneal adhesiolysis with major complications

$23,792
$72,468

67% lower than market

Wound debridements for injuries with complications

$29,510
$46,708

37% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$7,951
$15,099

47% lower than market

Blood Infection with major complications

$15,952
$29,446

46% lower than market

Blood infection without major complications

$13,507
$14,898

9% lower than market

Cirrhosis & alcoholic hepatitis with complications

$15,283
$17,244

11% lower than market

Complications of treatment with complications

$9,230
$19,664

53% lower than market

Diabetes with complications

$8,838
$17,006

48% lower than market

Digestive System Bleeding with complications

$9,417
$18,683

50% lower than market

Disorders of pancreas except malignancy with complications

$6,852
$16,082

57% lower than market

Disorders of pancreas except malignancy without complications

$4,844
$11,444

58% lower than market

Dysequilibrium

$13,437
$15,819

15% lower than market

Endocrine disorders with major complications

$8,580
$21,882

61% lower than market

Endocrine disorders without complications

$3,222
$10,276

69% lower than market

G.I. hemorrhage with major complications

$19,704
$38,195

48% lower than market

G.I. hemorrhage without complications

$7,639
$15,154

50% lower than market

G.I. obstruction with complications

$6,858
$13,891

51% lower than market

G.I. obstruction without complications

$7,274
$13,235

45% lower than market

General symptoms of illness such as fever, pain, shortness of breath

$6,007
$12,693

53% lower than market

Infection of the skin

$9,039
$11,706

23% lower than market

Inflammatory bowel disease without complications

$6,297
$17,267

64% lower than market

Major esophageal disorders with complications

$12,838
$19,880

35% lower than market

Major esophageal disorders with major complications

$11,383
$39,237

71% lower than market

Major gastrointestinal disorders & peritoneal infections with complications

$5,391
$17,270

69% lower than market

Major gastrointestinal disorders & peritoneal infections without complications

$7,692
$10,109

24% lower than market

Major hematol/immun diag exc sickle cell crisis & coagul with major complications

$16,097
$42,967

63% lower than market

Major hematol/immun diag exc sickle cell crisis & coagul without complications

$8,983
$17,597

49% lower than market

Nutritional or Metabolic Disorders without major complications

$6,090
$10,777

43% lower than market

Other digestive system diagnoses with complications

$7,689
$25,167

69% lower than market

Other digestive system diagnoses with major complications

$8,955
$27,773

68% lower than market

Other digestive system diagnoses without complications

$5,411
$15,475

65% lower than market

Other disorders of the eye without major complications

$2,303
$7,557

70% lower than market

Other ear, nose, mouth & throat diagnoses with complications

$7,232
$21,403

66% lower than market

Poisoning & toxic effects of drugs with major complications

$7,930
$24,036

67% lower than market

Postoperative & post-traumatic infections without major complications

$4,892
$14,776

67% lower than market

Signs & symptoms with major complications

$7,080
$18,723

62% lower than market

Stomach Disorder without complications

$7,949
$12,608

37% lower than market

INPATIENT NEUROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Bacterial & tuberculous infections of nervous system with major complications

$32,339
$80,671

60% lower than market

Degenerative nervous system disorders with major complications