Samaritan Hospital Patient Pricing Information

Transcription

1 Samaritan 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.). Room and Board Per Day Charges The following represents the hospital charges for room and care services only. The charges below do not include the fees for drugs, non-routine supplies and procedures that may be rendered during the inpatient visit. Charge Medical/Surgical Semi Private Medical/Surgical Private Psychiatry Intensive Care $ 1, $ 1, $ 1, $ 2, 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 $ Critical Care $ Critical Care- Additional 30 Min $ SANE $ 1, 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.

2 Level 1 OR 1/2 Hour $2, OR 3 Hours $6, OR 3/4 Hour $3, OR 3 1/4 Hours $7, OR 1 Hour $3, OR 3 1/2 Hours $7, OR 1 1/4 Hours $3, OR 3 3/4 Hours $8, OR 1 1/2 Hours $4, OR 4 Hours $8, OR 1 3/4 Hours $4, OR 4 1/4 Hours $8, OR 2 Hours $5, OR 4 3/4 Hours $8, OR 2 1/4 Hours $5, OR 5 3/4 Hours $8, OR 2 1/2 Hours $6, OR 6 Hours $8, OR 2 3/4 Hours $6, Level 2 OR 1/2 Hour $2, OR 3 Hours $7, OR 5 1/2 Hours $9, OR 3/4 Hour $3, OR 3 1/4 Hours $7, OR 5 3/4 Hours $9, OR 1 Hour $3, OR 3 1/2 Hours $8, OR 6 Hours $9, OR 1 1/4 Hours $4, OR 3 3/4 Hours $8, OR 6 1/4 Hours $9, OR 1 1/2 Hour $4, OR 4 Hours $9, OR 6 3/4 Hours $9, OR 1 3/4 Hours $4, OR 4 1/4 Hours $9, OR 7 3/4 Hours $9, OR 2 Hours $5, OR 4 1/2 Hours $9, OR 8 1/2 Hours $9, OR 2 1/4 Hours $5, OR 4 3/4 Hours $9, OR 9 1/4 Hours $9, OR 2 1/2 Hours $6, OR 5 Hours $9, OR 10 1/2 Hours $9, OR 2 3/4 Hours $6, OR 5 1/4 Hours $9, OR 13 Hours $9, DaVinci Robot $5, Recovery Room Charges The following represents the hospital charges for each level of recovery care provided to patients. Patients may have additional charges, depending on the services performed. Charge Rec Room Level A $ Rec Room Level B $ Rec Room Level C $ Rec Room Level D $ Rec Room Level E $ Rec Room Level F $ Rec Room Level G $ Rec Room Level H $ Rec Room Level I $ Rec Room Level J $

3 Rec Room Level K $ 1, Rec Room Level L $ 1, Rec Room Level M $ Rec Room Level N $ 1, Rec Room Level 0 $ 2, Rec Room Level P $ 2, Physical Therapy Charges The following charges reflect the 10 most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed. Elec Stim UA $ Gait/Stairs Train 15 Min $ Heat Pack $ Manual Therapy 15 Min $ PT Evaluation Various $ PT Re-Evaluation $ PT Self Care Management 15 Min $ Ther Exercise 15 Min $ Therapeutic Activities $ Ultrasound 15 Min $ Occupational Therapy Charges The following charges reflect the 10 most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed. ADL Training 15 Min $ Manual Therapy 15 Min $ Orthotic Fab $ Orthotic Training $ OT Evaluation Various $ OT Nueromuscular Re Educ 15Min $ OT Re-Evaluation $ 89.00

4 Perc/Cog Training 15 Min $ Ther Exercise 15 Min $ Therap Activity 15 Min $ Speech Therapy Charges The following charges reflect the services offered by our Speech Therapy department. Patients may have additional charges, depending on the services performed. Aphasia Assessment Per Hour $ Behav-Qualitative Analys Voice $ Eval Speech Sound Prod $ Eval Speech Sound W Lang Comp $ Speech Swallowing Evaluation $ Speech Swallowing Therapy $ Speech Therapy $ Speech Videoflouroscopy $ 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 Without Contrast $ 3, Abdomen 2 Postion $ Abdomen KUB/Flat Plate $ Carotid Doppler Bil $ 1, Chest (1 View) $ Chest (PA & LAT) $ Chest W Contrast $ 1, Chest W/O Contrast $ 1, CT Angiography Chest $ 1, Duplex Scan Art/Vein Abd $ Head/Brain W Contrast $ 1, Head/Brain W/O Contrast $ 1,636.00

5 Ird Rel Surg Procedure 0-30 Various $ 3, Kidney Bil (Renal) $ 1, Knee 3 Views Rt $ Knee 3 Views Lt $ Pelvis Transvaginal $ 1, Pelvis With Doppler $ 1, Renal (Kidneys) And Bladder $ 1, Ruq Biliary $ 1, Shoulder Lt $ Shoulder Rt $ Soft Tissue Head/Neck $ Spine Cervical W/O Contrast $ 1, Spine Lumbar 2-3 View $ Stress Test With CCA $ 1, US Doppler Venous Lower/Bil $ 1, 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. Basic Metabolic Panel $ CBC w/ Automated Differential $ CBC Without Diff $ Comprehensive Metabolic Pan $ Culture Blood $ Culture Quant Urine $ Culture Throat $ Drug Scr Cls A Inst Test P/Day $ Erythrocyte Sedimentation Rate $ Glucose Nova $ Glycohemoglobin (HgbA1c) $ Gram Stain $ Gross/Micro Level IV $

6 Identification - Urine $ Lipase $ Lipid Panel $ Magnesium $ Manual Differential $ Microalbumin, Random Urine $ Phosphorus $ Prothrombin Time (PT) w/ INR $ Sensitivity MIC $ Sero Agglu Grping - Antisera $ T4 Free $ Troponin $ TSH $ Urinalysis w/out Microscopic $ Urinalysis with Microscopic $ Vitamin B $ Vitamin D 25-Hydroxy SPH $ Cardiac Cath Charges The following represents the hospital charges for the 30 most common procedures for the Cardiology department. Patients may have additional charges, depending on the services performed. 2D/M Mode Echocardio $ 3, Abdominal Aorogram $ 6, Cardioversion $ 1, Coronary (S) Angio Only $ 10, Coronary W/ Lft Heart $ 10, Coronary W/ Lft Heart & Bypass $ 10, Coronary W/ Rt & Lt Heart $ 10, Diagnostic Init Cath Placement Various $ Ext Bilateral Angio $ 6, Ext Unilateral Angio Left $ 6, Ext Unilateral Angio Right $ 6, Inject Aorta $ 75.00

7 Interv Angio Init Stent Various $ 30, IVUS-Non Coronary Various $ IVUS-Non Coronary S&I $ IVUS-Non Coronary S&I-Ea Add $ IVUS-Non Coronary, Ea Add Various $ LC-Des-Stent 1 Art/Branch $ 14, LD-Des-Stent 1 Art/Branch $ 14, Limited Echocardiogram $ 1, Place Angioseal GO269 $ RC-Des-Revas Stemi Initial Ves $ 14, RC-Des-Stent 1 Art/Branch $ 14, Reveal Insertion $ 19, Tilt Table Study $ Trans Venous Pacemaker Insert Various $ 19, Transesophageal Echo $ 1, Vein Arm/Leg Unilateral $ 2, Vein Arms/Legs Bilateral $ 2, Venography Caval Infrr S&I $ 7, Cardiology Charges The following represents the hospital charges for the procedures for the Cardiology department. Patients may have additional charges, depending on the services performed. Card Event Recording $ EKG $ Holt Mon Data Analysis $ Holter Monitor-Hook-Up/Record $ Stress Test-AAC $ 1, Stress Test-CCA $ 1, Endoscopy Charges The following represents the hospital charges for the procedures for the Endoscopy department. Patients may have additional charges, depending on the services performed.

8 EBUS Service Various $ 6, GI Service Various $ 4, Glucose Fingerstick $ Infusion Non Chemo 1 Hour $ Injection IV $ Nebulizer Treatment $ Nebulizer Tx, Initial $ Sequential Infusion Addl $ Radiation Therapy Charges The following represents the hospital charges for the 30 most common procedures for the Radiation Therapy department. Patients may have additional charges, depending on the services performed. 3D Treatment Planning $ 3, Brachy 1 Channel $ 4, Brachy Therapy Or Implant $ CT For Radiation Planning $ Dosimetry Basic $ Dosimetry Special PDM TLD Etc $ Guid Loc Target Rad Treat Del $ IMRT Delivery $ 1, IMRT Planning $ 5, Intensity Modul Rad Tx Dlvr Co $ 1, Intensity Modul Rad Tx Dlvr SI $ 1, Interstitial 11+ Ribn/Source $ 1, Isodose Plan Brachy Complex $ Isodose Plan Rad Complex $ 1, Meas Prostate Pr Brachy Seed $ Port Verification Films $ Preport Films $ Simulation Complex $ 1, Simulation Intermediate $ Special Med Physics Consult $ Special Treatment Procedure $ 1,861.00

9 Superv/Handle/Load Element $ Therapy Evaluation Initial Vis $ Therapy Evaluation Re-Visit $ Treatment >1 Mev Complex $ 1, Treatment Devices - IMRT $ 1, Treatment Devices Complex $ 1, Treatment Devices Intermed $ Treatment Devices Simple $ Weekly Physics Review Qa $ Mental Health OP Charges The following represents the hospital charges for the 30 most common procedures for the Mental Health OP departments. Patients may have additional charges, depending on the services performed. BH Geropsych Assessmnt BH MH Assessmnt BH MICA Assessmnt Fac Ind Psychother 30 Min Fac Ind Psychother 45 Min Fac Psych DX Eval Group Therapy Facility MD Est Pt Assess Lev 1 MD Est Pt Assess Lev 2 MD Est Pt Assess Lev 3 MD Est Pt Assess Lev 4 MD Ind Psychother 30 Min MD Ind Psychother 45 Min MD Ind Psychother 60 Min MD Office Visit Level 2 MD Office Visit Level 3 MD Office Visit Level 4 MD Psych Dx Eval MSW Family Therapy W/Pt MSW Group Therapy $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $

10 MSW Ind Psychother 30 Min MSW Ind Psychother 45 Min MSW Ind Psychother 60 Min MSW Psych Dx Eval NP Est Pt Assess Lev 1 NP Est Pt Assess Lev 2 NP Est Pt Assess Lev 3 NP Est Pt Assess Lev 4 PHD Psych Testing/Hr Therapeutic Injections $ $ $ $ $ $ $ $ $ $