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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 6/30/24. 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

LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Lab analysis of any culture (except blood) to identify aerobic isolates (each isolate) [HCPCS 87077]

$61
$86

29% lower than market

Lab analysis of blood culture to identify bacteria [HCPCS 87040]

$110
$151

27% lower than market

Lab analysis of stool culture to identify bacteria [HCPCS 87045]

$108
$50

115% higher than market

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

$43
$62

30% lower than market

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

$33
$36

7% lower than market

Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by microdilution or agar dilution (each multi-antimicrobial, per plate) [HCPCS 87186]

$61
$133

54% lower than market

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

$51
$73

31% lower than market

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

$44
$40

10% higher than market

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

$116
$107

8% higher than market

Lab analysis to measure blood glucose (sugar) level with hand-held instrument [HCPCS 82962]

$13
$25

50% lower than market

Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]

$85
$94

9% lower than market

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

$61
$73

16% 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]

$103
$97

6% higher than market

Lab analysis to measure free thyroxine (thyroid chemical) in serum specimen [HCPCS 84439]

$83
$97

15% 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

$88
$72

22% higher than market

Lab analysis to measure the amount of glucose (sugar) in blood specimen with reagent strip [HCPCS 82948]

$13
$22

43% lower than market

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

$116
$95

23% higher than market

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

$128
$100

29% higher than market

Lab analysis to measure the amount of total calcium, carbon dioxide (bicarbonate), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN) in blood specimen [HCPCS 80048]

$51
$113

55% lower than market

Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]

$138
$190

27% lower than market

Lab analysis to measure the amylase (enzyme) level in serum specimen [HCPCS 82150]

$63
$96

34% lower than market

Lab analysis to measure the creatine kinase (cardiac enzyme) level (MB fraction only) [HCPCS 82553]

$110
$177

38% lower than market

Lab analysis to measure the creatinine level in blood specimen to test for kidney function or muscle injury [HCPCS 82565]

$48
$60

21% lower than market

Lab analysis to measure the direct bilirubin level [HCPCS 82248]

$89
$51

73% higher than market

Lab analysis to measure the ferritin (blood protein) level [HCPCS 82728]

$83
$97

15% lower than market

Lab analysis to measure the iron binding capacity [HCPCS 83550]

$43
$65

34% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$30
$49

39% lower than market

Lab analysis to measure the lipase (fat enzyme) level [HCPCS 83690]

$110
$123

10% lower than market

Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]

$53
$75

29% lower than market

Lab analysis to measure the natriuretic peptide (heart and blood vessel protein) level in plasma specimen [HCPCS 83880]

$205
$223

8% lower than market

Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]

$154
$269

43% lower than market

Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]

$72
$85

16% lower than market

Lab analysis to measure the vitamin D-3 level in serum or plasma specimen [HCPCS 82306]

$190
$212

11% lower than market

Lab analysis to measure total testosterone (hormone) level in serum specimen [HCPCS 84403]

$215
$98

119% higher than market

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

$103
$199

48% lower than market

Lab blood analysis to confirm blood unit compatibility by immediate spin technique [HCPCS 86920]

$102
$249

59% lower than market

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's Rh (D) type (Rh positive or Rh negative) [HCPCS 86901]

$39
$58

33% lower than market

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's blood group type (ABO) [HCPCS 86900]

$39
$90

57% lower than market

Lab blood analysis to screen for antibodies to red blood cell antigens (each serum technique) [HCPCS 86850]

$109
$214

49% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue (each additional procedure) [HCPCS 88341]

$116
$224

48% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue (initial procedure) [HCPCS 88342]

$116
$302

62% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$468
$783

40% lower than market

Unlisted lab analysis by immunoassay for identification of organism [HCPCS 87899]

$82
$32

157% higher than market

Lab analysis by immunoassay (ELISA) to identify infectious organism antigen (multiple-step method, each organism) [HCPCS 87449]

$77
$56

37% higher than market

Lab analysis by immunoassay to identify Strep (streptococcus) [HCPCS 87880]

$78
$67

17% higher than market

Lab analysis by nucleic acid (DNA or RNA) to identify antigen of severe acute respiratory syndrome coronavirus 2 (Covid-19) [HCPCS 87635]

$441
$140

216% higher than market

Lab analysis by nucleic acid (DNA or RNA) to identify multiple types of the influenza virus (first 2 types or sub-types) [HCPCS 87502]

$171
$177

4% lower than market

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Semi-Private Room

$679
$1,186

43% lower than market

Intensive Care Unit

$797
$2,332

66% lower than market

CT SCAN

Description

Our Charge
Market Charge

Variance

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

$2,453
$2,839

14% lower than market

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

$4,383
$5,091

14% lower than market

Abdominal and pelvic CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74176]

$3,345
$3,789

12% lower than market

Abdominal and pelvic CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74178]

$4,543
$5,391

16% lower than market

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

$1,571
$1,713

8% lower than market

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

$3,137
$3,559

12% lower than market

CTA scan of head blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70496]

$3,137
$3,189

2% lower than market

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

$3,137
$3,334

6% lower than market

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

$1,811
$2,542

29% lower than market

Chest CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 71250]

$1,513
$1,781

15% lower than market

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

$1,398
$1,998

30% lower than market

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

$1,490
$1,711

13% lower than market

Head or brain CT scan without contrast, followed by contrast to examine injury, foreign bodies, or tumors [HCPCS 70470]

$2,200
$2,660

17% lower than market

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

$1,420
$2,067

31% lower than market

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

$2,117
$2,503

15% lower than market

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

$2,079
$2,759

25% lower than market

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

$1,613
$1,821

11% lower than market

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

$1,645
$2,055

20% lower than market

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

$1,513
$2,111

28% lower than market

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

$1,513
$2,223

32% lower than market

CHEMOTHERAPY

Description

Our Charge
Market Charge

Variance

Chemotherapy administration beneath the skin or into muscle (hormonal, anti-cancer) [HCPCS 96402]

$110
$150

27% lower than market

Chemotherapy administration beneath the skin or into muscle (non-hormonal, anti-cancer) [HCPCS 96401]

$199
$268

26% lower than market

Chemotherapy administration into vein by infusion (each additional hour) [HCPCS 96415]

$121
$200

40% lower than market

Chemotherapy administration into vein by push technique (single drug) [HCPCS 96409]

$369
$476

23% lower than market

MRI

Description

Our Charge
Market Charge

Variance

Imaging of arm joint by MRI without contrast [HCPCS 73221]

$2,224
$2,651

16% lower than market

Imaging of brain by MRI without contrast [HCPCS 70551]

$2,386
$2,975

20% lower than market

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

$3,490
$4,434

21% lower than market

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

$2,542
$2,739

7% lower than market

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

$2,619
$2,839

8% lower than market

Imaging of lower spinal canal by MRI without contrast, followed by contrast [HCPCS 72158]

$4,683
$4,770

2% lower than market

Imaging of upper spinal canal by MRI without contrast [HCPCS 72141]

$2,888
$3,049

5% lower than market

EKG/ECG/ECHO

Description

Our Charge
Market Charge

Variance

Physician services for outpatient heart rehab with continuous EKG monitoring (per session) [HCPCS 93798]

$149
$282

47% lower than market

EMERGENCY ROOM

Description

Our Charge
Market Charge

Variance

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

$1,693
$2,173

22% lower than market

Emergency department visit for minor problem [HCPCS 99281]

$51
$239

79% lower than market

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

$688
$1,187

42% lower than market

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

$276
$390

29% lower than market

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

$438
$643

32% lower than market

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

$996
$1,652

40% lower than market

MAMMOGRAPHY

Description

Our Charge
Market Charge

Variance

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

$215
$333

35% lower than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$270
$590

54% lower than market

Mammography of one breast for diagnosis [HCPCS 77065]

$237
$325

27% lower than market

OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$28
$60

53% lower than market

OTHER OUTPATIENT PROCEDURES

Description

Our Charge
Market Charge

Variance

Drug administration beneath the skin or into muscle by injection for therapy, diagnosis, or prevention [HCPCS 96372]

$54
$149

64% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (each additional hour) [HCPCS 96366]

$98
$160

39% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96365]

$264
$518

49% lower than market

Drug administration into vein by infusion of additional sequential infusion of new drug for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96367]

$148
$271

45% lower than market

Heart and lungs restart (attempt) [HCPCS 92950]

$948
$642

48% higher than market

Hydration administration into vein by infusion (31 minutes to 1 hour) [HCPCS 96360]

$264
$464

43% lower than market

Hydration administration into vein by infusion (each additional hour) [HCPCS 96361]

$93
$171

46% lower than market

Mechanical traction application to 1 or more areas [HCPCS 97012]

$103
$122

15% lower than market

Medication application by electic current through skin (each 15 minutes) [HCPCS 97033]

$118
$155

24% lower than market

Oth resp proc, group [HCPCS G0239]

$102
$124

18% lower than market

Oxygen saturation measurement in blood by ear or finger device (continuous overnight monitoring) [HCPCS 94762]

$124
$291

57% lower than market

Physical performance test or measurement with report (each 15 minutes) [HCPCS 97750]

$137
$144

5% lower than market

Telehealth facility fee [HCPCS Q3014]

$86
$235

64% lower than market

Voice and resonance bhavioral and qualitative analysis [HCPCS 92524]

$294
$271

8% higher than market

Whole blood removal by needle to correct blood level imbalance [HCPCS 99195]

$108
$231

53% lower than market

IMAGING

Description

Our Charge
Market Charge

Variance

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

$380
$450

16% lower than market

Fluoroscopic guidance for needle placement [HCPCS 77002]

$448
$588

24% lower than market

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

$199
$618

68% lower than market

Imaging of bone and/or joint (whole body) [HCPCS 78306]

$1,500
$2,119

29% lower than market

Liver and bile duct system imaging with the use of oral medication [HCPCS 78227]

$1,332
$2,161

38% lower than market

PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Admin influenza virus vac [HCPCS G0008]

$34
$101

67% lower than market

Alteplase recombinant [HCPCS J2997]

$245
$375

35% lower than market

Amiodarone hcl [HCPCS J0282]

$22
$18

19% higher than market

Cefoxitin sodium injection [HCPCS J0694]

$84
$84

Approximately equal to market

Chemotherapy administration into vein by infusion (up to 1 hour, single drug) [HCPCS 96413]

$532
$725

27% lower than market

Diazepam injection [HCPCS J3360]

$56
$90

37% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of new drug) [HCPCS 96375]

$114
$288

60% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (initial drug) [HCPCS 96374]

$114
$296

61% lower than market

Ertapenem injection [HCPCS J1335]

$100
$183

45% lower than market

Furosemide injection [HCPCS J1940]

$27
$21

28% higher than market

Hydralazine hcl injection [HCPCS J0360]

$55
$54

1% higher than market

Inj enoxaparin sodium [HCPCS J1650]

$14
$16

16% lower than market

Inj magnesium sulfate [HCPCS J3475]

$44
$42

4% higher than market

Ketorolac tromethamine inj [HCPCS J1885]

$27
$42

35% lower than market

Lidocaine injection [HCPCS J2001]

$79
$6

1179% higher than market

Methylprednisolone injection [HCPCS J2920]

$52
$70

26% lower than market

Methylprednisolone injection [HCPCS J2930]

$52
$82

36% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$54
$37

44% higher than market

Prochlorperazine injection [HCPCS J0780]

$55
$79

30% lower than market

Sincalide injection [HCPCS J2805]

$334
$393

15% lower than market

Tetanus, diphtheria toxoids and acellular pertussis (whooping cough) vaccine for injection into muscle (7 years of age or older) [HCPCS 90715]

$117
$272

57% lower than market

Vancomycin hcl injection [HCPCS J3370]

$55
$70

22% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$280
$189

48% higher than market

Triamcinolone acet inj nos [HCPCS J3301]

$14
$24

43% lower than market

PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Elec stim other than wound [HCPCS G0283]

$77
$90

14% lower than market

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

$108
$107

1% higher than market

Occupational therapy evaluation (typically 45 minutes) [HCPCS 97166]

$204
$296

31% lower than market

Occupational therapy re-evaluation with established plan of care (typically 30 minutes) [HCPCS 97168]

$139
$166

16% lower than market

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

$177
$290

39% lower than market

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

$200
$290

31% lower than market

Physical therapy evaluation (typically 45 minutes) [HCPCS 97163]

$296
$297

Approximately equal to market

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

$130
$111

17% higher than market

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

$123
$144

14% lower than market

Speech sound production evaluation with evaluation of language comprehension and expression [HCPCS 92523]

$248
$447

44% lower than market

RESPIRATORY/PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Airway inhalation treatment to relieve airway obstruction or for sputum collection (inhaled pressure or nonpressure treatment) [HCPCS 94640]

$157
$423

63% lower than market

CPAP (continuous positive airway pressure) mask or breathing tube initiation and management for night time respiratory muscle rest [HCPCS 94660]

$525
$560

6% lower than market

SUPPLIES

Description

Our Charge
Market Charge

Variance

Non-covered item or service [HCPCS A9270]

$6
$7

11% lower than market

ULTRASOUND

Description

Our Charge
Market Charge

Variance

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

$299
$397

25% lower than market

Abdominal ultrasound (complete) [HCPCS 76700]

$853
$915

7% lower than market

Abdominal ultrasound (limited) [HCPCS 76705]

$673
$580

16% higher than market

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (complete, both arms or legs) [HCPCS 93970]

$1,111
$1,188

6% lower than market

Arteries and arterial grafts ultrasound of one leg (limited study) [HCPCS 93926]

$521
$740

30% lower than market

Breast ultrasound (one breast, limited) [HCPCS 76642]

$259
$341

24% lower than market

Head and neck ultrasound [HCPCS 76536]

$601
$656

8% lower than market

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

$574
$630

9% lower than market

Imaging of scrotum by ultrasound [HCPCS 76870]

$558
$714

22% lower than market

Leg ultrasound of arteries and arterial grafts of both legs (complete study) [HCPCS 93925]

$1,038
$1,053

1% lower than market

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

$640
$751

15% lower than market

Ultrasound application to 1 or more areas (each 15 minutes) [HCPCS 97035]

$77
$124

38% lower than market

VACCINE ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Immunization administration of vaccine into, between, or beneath the skin or into muscle (single vaccine) [HCPCS 90471]

$88
$110

19% lower than market

X-RAY

Description

Our Charge
Market Charge

Variance

Abdominal x-ray (2 views) [HCPCS 74019]

$292
$334

12% lower than market

Abdominal x-ray (single view) [HCPCS 74018]

$226
$234

3% lower than market

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

$370
$462

20% lower than market

Ankle x-ray (2 views) [HCPCS 73600]

$243
$266

9% lower than market

Ankle x-ray (minimum of 3 views) [HCPCS 73610]

$303
$363

16% lower than market

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

$259
$326

20% lower than market

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

$219
$358

39% lower than market

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

$175
$277

37% lower than market

Chest x-ray (single view) [HCPCS 71045]

$177
$269

34% lower than market

Elbow x-ray (2 views) [HCPCS 73070]

$144
$298

52% lower than market

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

$270
$348

22% lower than market

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

$452
$544

17% lower than market

Finger(s) x-ray (minimum of 2 views) [HCPCS 73140]

$210
$282

26% lower than market

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

$270
$322

16% lower than market

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

$265
$348

24% lower than market

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

$278
$283

2% lower than market

Knee x-ray (1 or 2 views) [HCPCS 73560]

$248
$302

18% lower than market

Knee x-ray (4 or more views) [HCPCS 73564]

$337
$431

22% lower than market

Lower leg x-ray (2 views) [HCPCS 73590]

$270
$328

18% lower than market

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

$199
$303

34% lower than market

Rib cage x-ray of ribs on one side of body including chest (minimum of 3 views) [HCPCS 71101]

$309
$386

20% lower than market

Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]

$276
$366

25% lower than market

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

$375
$381

2% lower than market

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

$419
$510

18% lower than market

Spinal x-ray of middle spine (3 views) [HCPCS 72072]

$425
$399

6% higher than market

Spinal x-ray of upper spine (2 or 3 views) [HCPCS 72040]

$337
$335

1% higher than market

Spinal x-ray of upper spine (4 or 5 views) [HCPCS 72050]

$447
$540

17% lower than market

Thighbone x-ray (minimum of 2 views) [HCPCS 73552]

$188
$343

45% lower than market

Wrist x-ray (2 views) [HCPCS 73100]

$148
$235

37% lower than market

Wrist x-ray, complete study (minimum of 3 views) [HCPCS 73110]

$203
$348

42% lower than market

X-ray of sacrum and tailbone (minimum of 2 views) [HCPCS 72220]

$265
$264

Approximately equal to market

CARDIOLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat with complications

$5,196
$16,054

68% lower than market

Abnormal or Irregular Heartbeat without complications

$4,944
$18,207

73% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$11,774
$28,352

58% lower than market

Heart Failure with complications

$19,511
$16,968

15% higher than market

Heart Failure with major complications

$8,235
$20,425

60% lower than market

Heart failure & shock without complications

$2,601
$10,083

74% lower than market

Hypertension without major complications

$1,479
$25,304

94% lower than market

GENERAL SURGERY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Major small & large bowel procedures with complications

$33,160
$72,218

54% lower than market

MEDICINE (INPATIENT)

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$8,866
$30,282

71% lower than market

Blood Infection with major complications

$13,438
$31,323

57% lower than market

Blood infection without major complications

$11,611
$19,491

40% lower than market

Diabetes with complications

$10,157
$15,167

33% lower than market

Digestive System Bleeding with complications

$13,572
$25,497

47% lower than market

Dysequilibrium

$10,641
$27,317

61% lower than market

G.I. hemorrhage with major complications

$4,309
$32,761

87% lower than market

G.I. hemorrhage without complications

$8,109
$15,246

47% lower than market

G.I. obstruction with complications

$5,869
$16,623

65% lower than market

G.I. obstruction without complications

$3,371
$14,848

77% lower than market

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

$8,563
$25,187

66% lower than market

Infection of the skin

$7,719
$16,897

54% lower than market

Major gastrointestinal disorders & peritoneal infections with complications

$7,360
$26,822

73% lower than market

Nutritional or Metabolic Disorders without major complications

$5,856
$17,238

66% lower than market

Other digestive system diagnoses with complications

$5,705
$26,210

78% lower than market

Signs & symptoms with major complications

$6,343
$25,323

75% lower than market

Stomach Disorder without complications

$4,423
$14,909

70% lower than market

ORTHOPEDICS (INPATIENT)

Description

Our Charge
Market Charge

Variance

Fractures of hip & pelvis without major complications

$3,327
$15,813

79% lower than market

Fractures of hip, pelvis & thigh without major complications

$8,678
$13,544

36% lower than market

PSYCHIATRY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Alcohol or Drug Abuse without rehab or major complications [MSDRG 897]

$5,576
$21,433

74% lower than market

PULMONOLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$9,511
$19,670

52% lower than market

Chronic Lung Disease without complications

$5,524
$18,739

71% lower than market

Pneumonia with complications

$7,315
$17,189

57% lower than market

Pneumonia with major complications

$11,447
$24,084

52% lower than market

Pneumonia without complications

$8,455
$14,290

41% lower than market

Pulmonary embolism without major complications

$7,436
$20,557

64% lower than market

Respiratory Failure

$6,922
$26,049

73% lower than market

Respiratory infections & inflammations without complications

$5,686
$18,135

69% lower than market

Respiratory infections and inflammations with major complications

$12,323
$33,023

63% lower than market

UROLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection with major complications

$4,978
$22,333

78% lower than market

Kidney & urinary Infection without complications

$6,760
$14,783

54% lower than market

Kidney failure with complications

$4,536
$16,732

73% lower than market

Renal failure without complications

$5,151
$10,749

52% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Ashe 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 Ashe 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 Ashe 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 Ashe 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 336-846-7101.

If you need more information about the price of a future service, please contact our Customer Service at 336-846-7101. 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.