St Mary s Hospital Patient Pricing Information

Transcription

1 St Mary s Hospital Patient Pricing Information The below charges represent Hospital charges only. These charges do not include charges for services provided by physicians or advanced practitioners (ex. anesthesiologists, attending physicians, emergency room physicians, hospitalists, pathologist, radiologists, surgeons, etc.). Emergency Department Charges The following represents the hospital charges for each level of emergency care provided to patients. The charges below do not include the fees for drugs, supplies or additional procedures that may be rendered during the emergency department visit. CPT Code Charge Level $ Level $ Level $ Level $ Level $ 1, Critical Care Visit $ 2, Operating Room Charges The following represents the hospital charges for each increment of surgery room and labor time that is provided at our hospital. The following list does not include charges for anesthesia, drugs, supplies or implants/devices for services rendered. ½ Hour $2, ¼ Hour $4, Hour $6, ¾ Hour $2, ½ Hour $4, ¼ Hour $6, Hour $2, ¾ Hour $4, ½ Hour $6, ¼ Hour $2, Hour $4, ¾ Hour $6, ½ Hour $3, ¼ Hour $5, Hour $6, ¾ Hour $3, ½ Hour $5, ¼ Hour $6, Hour $3, ¾ Hour $5, ½ Hour $6, ¼ Hour $3, Hour $5, ¾ Hour $6, ½ Hour $3, ¼ Hour $5, Hour $6, ¾ Hour $4, ½ Hour $5, ¼ Hour $6, Hour $4, ¾ Hour $6, ½ Hour $6, ¾ Hour + $7, Lithotripsy $15, Endoscopic Lithotrip Hom Laser $16,500.00

2 Recovery Room Charges The following represents the hospital charges for each increment of recovery room time that is provided at our hospital. Patients may have additional charges, Charge Rec Extensive Minutes $ Rec Extensive Minutes $ Rec Extensive Minutes $ 1, Rec Extensive Minutes $ 1, Rec Extensive Minutes $ 1, Rec Extensive Minutes $ 1, Rec Extensive Minutes $ 2, Physical Therapy Charges The following charges reflect the hospital s 10 most common services offered by our Physical Therapy department. Patients may have additional charges, Aquatic Therapy Grp Per Visit $ Electrical Stim Unattended $ PT Evaluation Various $ Gait/Stairs Train 15 Min $ Lymph Drainage Ea 15 Min $ Manual Therapy Ea 15 Min $ Neuromuscular Re Ed Ea 15 Min $ Traction-Mechanical $ Ther Exercise 15 Min $ Ultrasound/Phono Ea 15 Min $ Occupational Therapy Charges The following charges reflect the hospital s 10 most common services offered by our Occupational Therapy department. Patients may have additional charges,

3 Fluidotherapy/Whirlpool $ Manual Therapy Ea 15 Min $ Massage Ea 15 Min $ Nueromuscular Re Educ 15Min $ OT Elec Stim UA $ OT Evaluation Various $ Paraffin Treatment $ Ther Exercise 15 Min $ Therapy Activity Ea 15 Min $ Ultrasound 15 Min $ Speech Therapy Charges The following charges reflect the services offered by our Speech Therapy department. Patients may have additional charges, Cognitive Therapy Ea 15 Min $ Evaluate Speech Sound Production $ Evaluation of Speech Fluency $ Speech Eval Sound W/Lang Comp $ Speech Swallowing Evaluation $ Speech Therapy $ Speech Videoflouroscopy $ Swallowing Therapy $ X-Ray and Radiological Charges The following charges reflect the hospital s 30 most common x-ray and radiological procedures. There may be additional supply and contract media charges depending on the procedure. Abd & Pelvis With Contrast $ 3, Abd & Pelvis Wo Contrast $ 2, Abdomen KUB/Flat Plate $ Carotid Doppler Bilateral $ 1,405.00

4 Chest (1 View) $ Chest (PA & LAT) $ Complete Obstetric Exam $ 1, CT Angiography Chest $ 3, CT Chest W/O Contra $ 2, Dexa Axial Skeleton (Spine) $ Foot 3+ Views Rt $ Hand Rt $ Head/Brain W/O Contrast $ 1, Kidney Bil (Renal) $ Knee 3 Views Rt $ Mammogram 2-d LT G0206 $ Mammogram Screening G0202 $ Pelvis $ Pelvis Transvaginal $ Preg Diag 1st Trimester $ Renal (Kidneys) And Bladder $ Shoulder Rt $ Spine Cervical $ Spine Lumbosacral $ Tomosynthesis Breast Dx Bil $ Tomosynthesis Breast Scr Bil $ Transvaginal Early Pregnancy $ 1, Upper Abdomen $ US Doppler Venous Lower/Lt $ 1, US Doppler Venous Lower/Rt $ 1, Laboratory Charges The following charges reflect the hospital s 30 most common laboratory tests. Amylase $ APTT Act.Partial Thrombo.Time $ B-Type Natriuretic Peptid $ CBC W Complete Diff Automated $ 60.00

5 CBC Without Diff Automated $ Comprehen Metabolic Panel $ Creatine Kinase (CPK) $ Culture Blood $ Culture Quant Urine $ Ferritin $ Folic Acid $ Glycohemoglobin (HgbA1c) $ Gram Stain $ Gross/Micro Level IV $ Iron $ Lactic Acid $ Lipase $ Lipid Panel $ Magnesium $ Manual Differential $ Metabolic Panel Basic $ Phosphorus $ Pregnancy Test, Urine $ Prothrombin Time (PT) w/ INR $ T4 Free $ Troponin $ TSH $ Urinalysis w/out Microscopic $ Urinalysis with Microscopic $ Vitamin B $ Cardiology Charges The following represents the hospital charges for the procedures for the Cardiology department. Patients may have additional charges, Card Event Recording $

6 Comprehensive Eval W/O ECG $ Cr Visit W/ECG $ Echo Stress $ 1, Echo-2D/M-Mode $ 3, EKG - Regular $ Holt Mon Data Analysis -SAM/SM $ 2, Holter Monitor-Hook-Up/Record $ 2, Stress Test $ 1, Transesophageal Tee $ 2, TTE-Reg W/ IV Contrast C8929 $ 3, Endoscopy Charges The following represents the hospital charges for the procedures for the Endoscopy department. Patients may have additional charges, Capsule Imaging Exam Sm Intest $ 4, Colon Diagnostic Various $ 2, Colon Flex With Hot Biopsy Various $ 2, Colonoscopy Flex W/Biopsy Various $ 2, Colonoscopy Flex W/Cont Bleed Various $ 3, Colonoscopy Flex W/Rem Polyp Various $ 3, Colonoscopy W/Ablation Various $ 3, Dilation Of Esophagus Various $ 1, EGD Diag W/Ablation Of Tumor Various $ 2, EGD Diag W/Ballon Dilat Esoph Various $ 1, EGD Diag W/Biopsy (Sing/Mult) Various $ 1, EGD Diag W/Control Of Bleeding Various $ 2, EGD Diag W/End Retro Rem Stone Various $ 4, EGD Diag W/Insert Guide Wire Various $ 2, EGD Diag W/Place Perc Gastro Various $ 2, EGD Diag W/Rem Tumor-Hot Biop Various $ 2, EGD Diag W/Rem Tumor-Snare Tec Various $ 2, EGD Diagnostic Various $ 1,588.00

7 EGD W/Inject Sclerosis Of Esop Various $ 2, ERCP Diag W/Endo Retro Insert Various $ 4, ERCP Diag W/Or W/O Spec Collec Various $ 3, ERCP W Stent Various $ 4, Esophageal Dilitation Rigid Various $ Esophageal Motility $ 1, Flex Sigmoid Various $ 1, Flex Sigmoid W/Biopsy Various $ 1, Prolonged Esophageal Func Test $ 1, Tee-Placement Of Probe Various $ Respiratory Charges The following represents the hospital charges for the procedures for the Respiratory department. Patients may have additional charges, Arterial Puncture $ CPAP Treatment Initial $ CPT Initial $ CPT Subsequent Evalutation $ HART Nebulizer/Initial Eval $ Heart NEB EA ADD HR $ Intubation Various $ 1, MDI Initial $ MDI Subsequent Each Additional $ Nebulizer TX, Initial $ Oximetry Exercise $ Oxygen Admin & Setup Various $ Sputum Collect $ Ventilator - 1st Day Charge $ 1, Ventilator - Subsequent Day $ Coumadin Clinic Charges

8 The following represents the hospital charges for the procedures for the Coumadin Clinic department. Patients may have additional charges, Finger Stick $ Level 1 Established Patient $ Hyperbaric Charges The following represents the hospital charges for the procedures for the Hyperbaric department. Patients may have additional charges, HBOT Full Body Cham Per 30 Minutes $ Incontinence/ Wound Care Charges The following charges reflect the hospital s 30 most common procedures for the Incontinence/ Wound Care departments. Patients may have additional charges, Apply Grft T/A/L <100 1st $ Apply Total Contact Cast $ Apply Unna Boot W/Proc $ Bladder Scan $ Chemical Cauterization $ Cutting Benign Lesion 2 To $ Debr Subcutaneious Tissue $ Debridement Of Nail 1 to $ Debridement Of Nail 6 Or More $ Debridement Selective $ Est Patient Level $ Est Patient Level $ Est Patient Level $ Est Patient Level $ Est Patient Level $

9 Multilayer Compress Wrap Bilat $ Nail Cutting $ New Patient Level $ New Patient Level $ New Patient Level $ New Patient Level $ NH Subsequent Level $ NH Subsequent Level $ NH Subsequent Level $ Nrsg Home Init Moderate $ Nursing Home Init Complx $ Pelvic Health Vaginal Irrig $ Pelvic Health VLLP $ 1, Pessary Management $ Unna Paste Boot Application $ Uroflow Complex $