Patient Price Information List

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

Hospital Name
Location

Piedmont Athens Regional Medical Center

Athens

GA

St. Mary's Hospital

Athens

GA

Wills Memorial Hospital

Washington

GA

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$825
$1,208

32% lower than market

Semi-Private Room

$625
$1,316

53% 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]

$92
$248

63% lower than market

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

$147
$451

67% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$250
$715

65% lower than market

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

$385
$1,139

66% lower than market

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

$1,481
$1,766

16% lower than market

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

$758
$2,615

71% 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

Elec stim other than wound [HCPCS G0283]

$50
$118

57% lower than market

Walking training to 1 or more areas, each 15 minutes [CPT 97116]

$51
$103

51% lower than market

Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes [CPT 97112]

$62
$122

49% lower than market

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

$150
$112

34% higher 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 30 minutes [CPT 97165]

$156
$278

44% lower than market

Self-care or home management training, each 15 minutes [CPT 97535]

$64
$119

46% lower than market

Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes [CPT 97530]

$64
$113

44% 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

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

$789
$903

13% lower than market

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$246
$276

11% 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

Blood gases measurement [CPT 82803]

$210
$217

3% lower than market

Bacterial blood culture [CPT 87040]

$93
$227

59% lower than market

Bacterial culture for aerobic isolates [CPT 87077]

$33
$38

14% lower than market

Blood group typing (ABO) [CPT 86900]

$78
$82

5% lower than market

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

$28
$83

66% lower than market

Blood unit compatibility test, antiglobulin technique [CPT 86922]

$106
$279

62% lower than market

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

$13
$23

44% lower than market

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

$78
$137

43% lower than market

Blood test, clotting time [CPT 85610]

$31
$32

2% lower than market

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

$87
$49

77% higher than market

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

$178
$60

194% higher than market

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

$161
$70

129% higher than market

Coagulation function measurement, D-dimer; quantitative [CPT 85379]

$85
$127

33% lower than market

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

$90
$36

148% higher than market

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

$39
$79

51% lower than market

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

$131
$124

6% higher than market

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

$27
$33

17% lower than market

Drug test def 1-7 classes [HCPCS G0480]

$124
$336

63% lower than market

Ferritin (blood protein) level [CPT 82728]

$53
$57

7% lower than market

Folic acid level, serum [CPT 82746]

$53
$61

13% lower than market

Blood count, hemoglobin [CPT 85018]

$19
$34

44% lower than market

Kidney function blood test panel [CPT 80069]

$67
$40

67% higher than market

Lactic acid level [CPT 83605]

$64
$88

28% lower than market

Liver function blood test panel [CPT 80076]

$70
$39

81% higher than market

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

$110
$162

32% lower than market

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

$182
$76

138% higher than market

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

$41
$76

46% lower than market

Parathormone (parathyroid hormone) level [CPT 83970]

$124
$179

31% lower than market

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

$48
$97

51% lower than market

Pathology examination of tissue using a microscope, intermediate complexity [CPT 88305]

$98
$298

67% lower than market

Phenytoin level, total [CPT 80185]

$55
$60

8% lower than market

Red blood cell concentration measurement [CPT 85014]

$20
$35

43% lower than market

Screening test for red blood cell antibodies [CPT 86850]

$56
$134

58% lower than market

Stool analysis for blood, by fecal hemoglobin determination by immunoassay [CPT 82274]

$75
$80

6% lower than market

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

$42
$41

2% higher than market

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

$160
$427

62% lower than market

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

$35
$66

47% lower than market

Automated urinalysis test [CPT 81003]

$71
$51

38% higher than market

Vitamin D-3 level [CPT 82306]

$126
$122

4% higher than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Attempt to restart heart and lungs [CPT 92950]

$1,213
$2,105

42% lower than market

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

$284
$407

30% lower than market

Removal of tissue from wounds per session, each additional 20 sq cm [CPT 97598]

$141
$424

67% lower than market

Hydration infusion into a vein [CPT 96361]

$91
$192

53% lower than market

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

$144
$434

67% lower than market

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

$55
$219

75% lower than market

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

$161
$524

69% lower than market

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

$49
$144

66% lower than market

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

$72
$162

56% lower than market

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

$36
$86

58% lower than market

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

$78
$384

80% lower than market

Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older [CPT 90732]

$242
$358

32% lower than market

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

$79
$178

56% lower than market

Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older [CPT 90714]

$38
$193

80% lower than market

Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion [CPT 96368]

$65
$267

76% lower than market

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

$904
$1,795

50% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$49
$64

23% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Direct refer hospital observ [HCPCS G0379]

$387
$835

54% lower than market

Non-covered item or service [HCPCS A9270]

$3
$3

1% lower than market

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

$1,500
$1,340

12% higher than market

Repair of trapped groin hernia patient age 5 years or older [CPT 49507]

$3,500
$10,853

68% lower than market

Tc99m maa [HCPCS A9540]

$164
$245

33% lower than market

Tc99m medronate [HCPCS A9503]

$126
$140

10% lower than market

Technetium tc-99m aerosol [HCPCS A9567]

$124
$337

63% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

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

$138
$241

43% lower than market

Adrenalin epinephrine inject [HCPCS J0171]

$2
$7

70% lower than market

Azithromycin [HCPCS J0456]

$20
$62

67% lower than market

Cefazolin sodium injection [HCPCS J0690]

$10
$18

44% lower than market

Dexamethasone sodium phos [HCPCS J1100]

$2
$3

37% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$20
$25

21% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$7
$29

77% lower than market

Fentanyl citrate injection [HCPCS J3010]

$28
$29

5% lower than market

Furosemide injection [HCPCS J1940]

$20
$20

Approximately equal to market

Inj heparin sodium per 1000u [HCPCS J1644]

$2
$6

74% lower than market

Hydromorphone injection [HCPCS J1170]

$28
$34

18% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$10
$14

28% lower than market

Levofloxacin injection [HCPCS J1956]

$20
$35

43% lower than market

Lorazepam injection [HCPCS J2060]

$28
$34

18% lower than market

Inj magnesium sulfate [HCPCS J3475]

$20
$31

35% lower than market

Methylprednisolone injection [HCPCS J2930]

$20
$85

76% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$14
$17

18% lower than market

Morphine sulfate injection [HCPCS J2270]

$28
$34

18% lower than market

Ondansetron hcl injection [HCPCS J2405]

$5
$9

42% lower than market

Promethazine hcl injection [HCPCS J2550]

$20
$23

13% lower than market

Vancomycin hcl injection [HCPCS J3370]

$10
$51

80% lower than market

Alpha 1 proteinase inhibitor [HCPCS J0256]

$9
$25

66% lower than market

Inj ceftazidime per 500 mg [HCPCS J0713]

$10
$16

36% lower than market

Ciprofloxacin iv [HCPCS J0744]

$10
$42

76% lower than market

Meperidine hydrochl /100 mg [HCPCS J2175]

$28
$47

41% lower than market

Methylprednisolone injection [HCPCS J2920]

$20
$50

60% lower than market

Neostigmine methylslfte inj [HCPCS J2710]

$29
$45

36% lower than market

Inj potassium chloride [HCPCS J3480]

$2
$9

79% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$97
$476

80% 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

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

$101
$314

68% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of short leg splint (calf to foot) [CPT 29515]

$138
$597

77% lower than market

Application of long arm splint (shoulder to hand) [CPT 29105]

$140
$512

73% lower than market

Application of long leg splint (thigh to ankle or toes) [CPT 29505]

$335
$712

53% lower than market

Biopsy and/or removal of polyp of the uterus using an endoscope [CPT 58558]

$7,500
$8,236

9% lower than market

Biopsy of breast accessed through the skin with ultrasound guidance, first lesion [CPT 19083]

$2,063
$3,259

37% lower than market

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

$1,125
$2,539

56% lower than market

Release and/or relocation of median nerve of hand [CPT 64721]

$7,500
$10,610

29% lower than market

Removal of tissue abnormalities, tumors, or polyps of large bowel by hot biopsy forceps, using a flexible endoscope [CPT 45384]

$1,125
$3,793

70% lower than market

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

$2,250
$3,274

31% lower than market

Colon ca scrn not hi rsk ind [HCPCS G0121]

$2,250
$2,519

11% lower than market

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43235]

$2,250
$2,946

24% lower than market

Dilation of esophagus unguided [CPT 43450]

$1,125
$5,678

80% lower than market

Examination of uterus with destruction of uterine lining using an endoscope [CPT 58563]

$7,500
$11,398

34% lower than market

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

$7,500
$8,731

14% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$7,000
$14,099

50% lower than market

Emergent insertion of breathing tube into windpipe cartilage using an endoscope [CPT 31500]

$259
$701

63% lower than market

Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled [CPT 36556]

$973
$2,764

65% lower than market

Placement of mesh to repair incisional or abdominal hernia, open procedure [CPT 49568]

$3,500
$5,132

32% lower than market

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

$7,500
$10,124

26% lower than market

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

$1,125
$3,231

65% lower than market

Removal of both knee cartilages using an endoscope [CPT 29880]

$5,250
$11,705

55% lower than market

Repair of wound (7.6 to 12.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs [CPT 12004]

$229
$512

55% lower than market

Repair of knee joint with drilling and or scraping of the joint [CPT 29879]

$5,250
$8,579

39% lower than market

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

$451
$570

21% lower than market

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

$161
$474

66% lower than market

Partial thickness skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children) [CPT 15100]

$3,500
$3,900

10% lower than market

Incision of tendon covering [CPT 26055]

$7,500
$9,300

19% lower than market

Release and/or relocation of ulnar nerve at elbow [CPT 64718]

$2,500
$6,283

60% 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

Ultrasound of one breast, complete [CPT 76641]

$431
$435

1% lower than market

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

$2,871
$2,722

5% higher than market

CT scan abdomen before and after contrast [CPT 74170]

$2,342
$2,178

8% higher than market

CT scan of abdominal and pelvic blood vessels with contrast [CPT 74174]

$1,393
$2,721

49% lower than market

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

$1,405
$2,172

35% lower than market

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

$1,340
$2,289

41% lower than market

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

$1,340
$2,309

42% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$1,138
$2,277

50% lower than market

CT scan of face [CPT 70486]

$849
$1,300

35% lower than market

CT scan head or brain [CPT 70450]

$2,452
$1,598

53% higher than market

CT scan of neck [CPT 70490]

$853
$1,289

34% lower than market

CT scan of upper spine [CPT 72125]

$1,032
$1,634

37% lower than market

CT scan of lower spine [CPT 72131]

$1,029
$1,534

33% lower than market

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

$96
$287

67% lower than market

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

$69
$264

74% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$753
$486

55% higher than market

Diagnostic mammography of one breast [CPT 77065]

$676
$464

46% higher than market

Digital tomography of both breasts [CPT 77062]

$284
$291

2% lower than market

Digital tomography of one breast [CPT 77061]

$237
$291

18% lower than market

Imaging for evaluation of swallowing function [CPT 74230]

$490
$873

44% lower than market

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

$244
$512

52% lower than market

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

$348
$429

19% lower than market

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

$140
$341

59% lower than market

Imaging of liver and bile duct system [CPT 78226]

$1,511
$1,515

Approximately equal to market

Ultrasound study of arteries of both arms and legs, limited [CPT 93922]

$608
$740

18% lower than market

Ldct for lung ca screen [HCPCS G0297]

$750
$788

5% lower than market

MRI scan of arm joint [CPT 73221]

$1,878
$2,191

14% lower than market

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

$3,170
$2,604

22% higher than market

MRI scan brain [CPT 70551]

$1,033
$1,774

42% lower than market

MRI scan of leg joint [CPT 73721]

$2,579
$2,016

28% higher than market

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

$1,878
$2,505

25% lower than market

MRI scan of upper spinal canal [CPT 72141]

$2,000
$2,322

14% lower than market

MRI scan of lower spinal canal [CPT 72148]

$1,700
$2,327

27% lower than market

MRI scan of middle spinal canal [CPT 72146]

$2,039
$2,872

29% lower than market

Nuclear medicine study of lung ventilation and blood circulation in the lungs [CPT 78582]

$1,964
$1,863

5% higher than market

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

$47
$88

46% lower than market

Screening mammography of both breasts [CPT 77067]

$162
$429

62% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$778
$1,036

25% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$750
$800

6% lower than market

Ultrasound behind abdominal cavity [CPT 76770]

$383
$734

48% lower than market

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

$525
$1,114

53% lower than market

Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]

$1,513
$1,796

16% lower than market

Ultrasound pelvis through vagina [CPT 76830]

$531
$568

7% lower than market

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

$1,390
$1,291

8% higher than market

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

$998
$909

10% higher than market

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

$461
$1,378

67% lower than market

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

$374
$676

45% lower than market

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

$1,555
$2,049

24% lower than market

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

$260
$318

18% lower than market

X-ray of both hips with pelvis, 3-4 views [CPT 73522]

$546
$654

16% lower than market

X-ray of collar bone [CPT 73000]

$286
$339

16% lower than market

X-ray of large bowel with contrast [CPT 74270]

$614
$754

19% lower than market

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

$250
$299

16% lower than market

X-ray of foot, 2 views [CPT 73620]

$133
$300

56% lower than market

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

$149
$385

61% lower than market

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

$263
$365

28% lower than market

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

$423
$398

6% higher than market

X-ray of knee, 3 views [CPT 73562]

$310
$399

22% lower than market

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

$212
$469

55% lower than market

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

$713
$538

33% higher than market

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

$276
$270

2% higher than market

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

$174
$317

45% lower than market

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

$437
$426

3% higher than market

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

$204
$442

54% lower than market

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

$153
$322

52% lower than market

X-ray of both sides of the ribs including the chest, minimum of 4 views [CPT 71111]

$633
$620

2% higher than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat with complications

$5,776
$20,049

71% lower than market

Abnormal or Irregular Heartbeat without complications

$5,500
$17,675

69% lower than market

Acute myocardial infarction, discharged alive with complications

$7,093
$23,122

69% lower than market

Acute myocardial infarction, discharged alive with major complications

$12,616
$28,033

55% lower than market

Acute myocardial infarction, discharged alive without complications

$7,772
$26,581

71% lower than market

Acute myocardial infarction, expired with complications

$12,611
$20,107

37% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$14,046
$31,120

55% lower than market

Heart Failure with complications

$8,825
$15,842

44% lower than market

Heart Failure with major complications

$13,416
$26,348

49% lower than market

Heart failure & shock without complications

$6,151
$12,818

52% lower than market

Other circulatory system diagnoses with complications

$5,616
$18,625

70% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Infectious & parasitic diseases w O.R. procedure with complications

$33,496
$53,446

37% lower than market

Other O.R. procedures for injuries with complications

$21,609
$66,839

68% lower than market

Other skin, subcutaneous tissue & breast procedure with complications

$16,581
$53,357

69% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$10,418
$17,403

40% lower than market

Blood Infection with major complications

$14,023
$34,487

59% lower than market

Blood infection without major complications

$11,641
$21,794

47% lower than market

Cellulitis with major complications

$5,236
$26,416

80% lower than market

Diabetes with complications

$8,394
$18,779

55% lower than market

Diabetes with major complications

$10,064
$31,173

68% lower than market

Diabetes without complications

$5,634
$13,156

57% lower than market

Digestive System Bleeding with complications

$9,506
$18,933

50% lower than market

Disorders of liver except malignancy with major complications

$14,221
$35,893

60% lower than market

Disorders of pancreas except malignancy with complications

$12,271
$18,780

35% lower than market

Disorders of pancreas except malignancy with major complications

$28,361
$37,183

24% lower than market

Disorders of pancreas except malignancy without complications

$7,358
$13,811

47% lower than market

Disorders of the biliary tract with complications

$18,637
$41,552

55% lower than market

Disorders of the biliary tract with major complications

$20,990
$49,792

58% lower than market

Disorders of the biliary tract without complications

$9,111
$19,221

53% lower than market

Drug poisoning without complications

$4,237
$17,916

76% lower than market

Esophagitis, gastroent & misc digest disorders with major complications

$15,501
$29,543

48% lower than market

G.I. hemorrhage without complications

$7,929
$15,840

50% lower than market

G.I. obstruction with complications

$13,515
$30,538

56% lower than market

G.I. obstruction without complications

$9,901
$14,951

34% lower than market

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

$9,171
$16,580

45% lower than market

Infection of the skin

$6,215
$17,050

64% lower than market

Major gastrointestinal disorders & peritoneal infections with complications

$14,147
$22,627

37% lower than market

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

$12,614
$37,356

66% lower than market

Nutritional & misc metabolic disorders with major complications

$8,697
$30,531

72% lower than market

Nutritional or Metabolic Disorders without major complications

$8,620
$13,164

35% lower than market

Other ear, nose, mouth & throat diagnoses with complications

$7,040
$25,831

73% lower than market

Stomach Disorder without complications

$8,969
$17,506

49% lower than market

Traumatic injury without major complications

$9,172
$25,326

64% lower than market

Viral illness without major complications

$15,603
$23,598

34% lower than market

INPATIENT NEUROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Intracranial hemorrhage or cerebral infarction without complications

$9,901
$17,597

44% lower than market

Seizures without major complications

$9,096
$27,032

66% lower than market

Stroke with complications

$12,917
$20,733

38% lower than market

Stroke with major complications

$17,540
$32,237

46% lower than market

Transient ischemia

$11,203
$23,996

53% lower than market

INPATIENT ONCOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Nervous system neoplasms without major complications

$8,935
$31,379

72% lower than market

INPATIENT ORTHOPEDICS CHARGES

Description

Our Charge
Market Charge

Variance

Bone diseases & arthropathies without major complications

$6,705
$17,493

62% lower than market

Fractures of hip, pelvis & thigh with major complications

$14,236
$30,812

54% lower than market

Medical back problems without major complications

$9,674
$16,349

41% lower than market

Osteomyelitis w major complications

$13,161
$55,529

76% lower than market

INPATIENT PSYCHIATRY CHARGES

Description

Our Charge
Market Charge

Variance

Alcohol or Drug Abuse without rehab or major complications

$10,112
$22,418

55% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Bronchitis & asthma with major complications

$11,265
$18,957

41% lower than market

Bronchitis or asthma without complications

$7,215
$19,147

62% lower than market

Chronic Lung Disease with complications

$6,356
$22,801

72% lower than market

Chronic Lung Disease with major complications

$10,498
$25,580

59% lower than market

Chronic Lung Disease without complications

$6,570
$16,126

59% lower than market

Interstitial lung disease with major complications

$11,378
$26,036

56% lower than market

Pneumonia with complications

$11,021
$19,618

44% lower than market

Pneumonia with major complications

$13,117
$27,452

52% lower than market

Pneumonia without complications

$11,040
$15,453

29% lower than market

Pulmonary embolism without major complications

$8,436
$16,608

49% lower than market

Respiratory Failure

$13,654
$29,461

54% lower than market

Respiratory infections & inflammations with complications

$12,555
$30,993

59% lower than market

Respiratory infections & inflammations without complications

$12,668
$20,959

40% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Inflammation of the male reproductive system withou major complications

$4,169
$18,201

77% lower than market

Kidney & urinary Infection with major complications

$13,306
$20,707

36% lower than market

Kidney & urinary Infection without complications

$10,868
$17,100

36% lower than market

Kidney failure with complications

$10,756
$14,603

26% lower than market

Kidney failure with major complications

$8,492
$24,658

66% lower than market

Other kidney & urinary tract diagnoses with complications

$23,124
$21,096

10% higher than market

Renal failure without complications

$7,620
$15,149

50% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Elbert Memorial Hospital for your healthcare needs. As part of our commitment to delivering EXCELLENT service, 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 Elbert 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 Elbert 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 for your hospital visit, including your family doctor, specialists, physicians to read x-rays, give anesthesia, or do 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 Elbert 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 Customer Call Center at 706-213-2593.

If you need more information about the price of a future service, please contact our Price Hotline at 706-213-2593. A CPT code is strongly encouraged when you call. You can obtain the CPT code from the ordering physician.

Financial Assistance

We are pleased to offer financial assistance to patients with limited resources and inadequate medical insurance coverage. Eligibility is determined by total family income/assets. The patient must agree to apply for other assistance available to pay hospital charges (Medicaid, Medicare, private insurance) before being discharged.

Elbert Memorial Hospital's Charity Care Policy

Elbert Memorial Hospital provides high quality care to everyone, regardless of their ability to pay.

Elbert Memorial Hospital's charity care policy includes:

• Substantial charity care guidelines that provide free care for individuals and families who earn less than 200 percent of the federal poverty level.

• Sliding scale fees to provide substantially discounted care for individuals and families who are between 200 and 400 percent of the federal poverty level.

• Hardship policy for those patients who would not otherwise qualify for charity care but have unique circumstances.

In many cases, Elbert Memorial Hospital offers interest free loans for up to one year to assist patients.

For more information, please contact our Customer Call Center at 706-213-2593.