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 3/31/2019. Elbert Memorial Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

AnMed Health Medical Center

Anderson

SC

Piedmont Athens Regional Medical Center

Athens

GA

Saint Mary's Sacred Heart Hospital

Lavonia

GA

St. Mary's Hospital

Athens

GA

Stephens County Hospital

Toccoa

GA

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$825
$1,163

29% lower than market

Semi-Private Room

$625
$1,140

45% lower than market

Intensive Care Unit

$1,205
$2,572

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 - Level 1

$92
$241

62% lower than market

Emergency Department Visit - Level 2

$147
$424

65% lower than market

Emergency Department Visit - Level 3

$250
$713

65% lower than market

Emergency Department Visit - Level 4

$385
$1,141

66% lower than market

Emergency Department Visit - Level 5

$1,481
$1,724

14% lower than market

Emergency Critical Care, Each Additional 30 Minutes

$349
$985

65% lower than market

Emergency Critical Care, First 30 Minutes

$758
$2,205

66% 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 - 15 Minutes

$35
$100

65% lower than market

Electric Stimulation for Therapy

$50
$93

46% lower than market

Gait Training - 15 Minutes

$51
$110

54% lower than market

PT to Re-Educate Brain to Muscle Function (15 min)

$62
$91

32% lower than market

Physical Therapy Exercise, 15 Minutes

$150
$97

55% higher than market

Physical Therapy, re-evaluation

$78
$184

58% 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

Occupational Therapy, re-evaluation

$60
$174

65% lower than market

Paraffin Wax Bath

$20
$41

51% lower than market

Therapeutic Activities Involving Functional Activities (15 min)

$64
$98

35% 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

Holter Testing - 48-Hour EKG

$193
$589

67% lower than market

Routine EKG - Minimum 12 Leads

$246
$293

16% lower than market

Spirometry - breathing test

$100
$316

68% lower than market

Spirometry - medicated breathing procedure

$248
$588

58% lower than market

OUTPATIENT SPEECH THERAPY CHARGES

Description

Our Charge
Market Charge

Variance

Evaluation of Speech Sound Production

$172
$399

57% lower than market

Speech Therapy

$77
$296

74% lower than market

Swallow Evaluation

$137
$424

68% lower than market

Swallow Treatment

$122
$316

61% 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

Analysis for antibody to Herpes simplex virus, type 1

$26
$58

55% lower than market

Analysis for antibody to Herpes simplex virus, type 2

$25
$81

69% lower than market

Analysis for antibody to Influenza virus

$51
$244

79% lower than market

Analysis for antibody to Mycoplasma (bacteria)

$36
$103

65% lower than market

Analysis for antibody to Rotavirus (intestinal virus)

$18
$61

70% lower than market

Analysis for antibody to histoplasma (fungus)

$25
$62

60% lower than market

Arterial Blood Gases Measurement

$115
$248

54% lower than market

Bacterial Blood Culture

$93
$187

50% lower than market

Bacterial Culture for Aerobic Isolates

$33
$47

30% lower than market

Bacterial Culture, Any Source Except Urine, Blood, or Stool

$63
$100

37% lower than market

Bacterial urine culture; quantitative colony count

$56
$77

27% lower than market

Blood Typing, ABO

$78
$114

31% lower than market

Blood Typing, Rh (D)

$28
$82

66% lower than market

Blood Unit Compatibility Test; Antiglobulin Technique

$106
$252

58% lower than market

Blood glucose (sugar) level after receiving dose of glucose

$22
$58

62% lower than market

Blood glucose (sugar) tolerance test (Added Samples)

$19
$56

66% lower than market

Blood test, basic group of blood chemicals

$78
$64

22% higher than market

Blood test, clotting time

$31
$38

18% lower than market

Blood test, comprehensive group of blood chemicals

$87
$90

4% lower than market

Blood test, lipids (cholesterol and triglycerides)

$178
$77

130% higher than market

Blood test, thyroid stimulating hormone (TSH)

$161
$75

114% higher than market

Body fluid cell count with cell identification

$48
$174

72% lower than market

Catecholamines (organic nitrogen) level

$77
$158

51% lower than market

Catheterization for collection of specimen, single patient, all places of service

$60
$226

73% lower than market

Clozapine level

$40
$89

55% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$85
$187

54% lower than market

Complete blood cell count - automated differential WBC count

$49
$55

12% lower than market

Complete blood cell count - automated test with out Differential

$39
$72

46% lower than market

Copper level

$54
$114

53% lower than market

Cortisol (hormone) measurement

$70
$193

64% lower than market

Creatinine level to test for kidney function or muscle injury

$27
$37

26% lower than market

Cryoglobulin (protein) measurement

$28
$61

54% lower than market

Cryoprecipitate, each unit

$39
$201

81% lower than market

Culture, typing; identification by nucleic acid (DNA or RNA) probe, direct probe technique, per culture or isolate, each organism probed

$81
$264

69% lower than market

Detection test for Strep (Streptococcus, group B)

$63
$160

61% lower than market

Detection test for identification of organism

$28
$72

61% lower than market

Detection test for organism; amplified probe technique

$61
$168

64% lower than market

Drug Test(s) by Chemistry Analyzer

$124
$616

80% lower than market

Drug test(s); includes specimen validity testing, per day; 8-14 drug class(es)

$155
$149

4% higher than market

Ferritin (blood protein) level

$53
$74

28% lower than market

Fibrinogen (factor 1) activity measurement

$64
$194

67% lower than market

Flow cytometry, cell cycle or DNA analysis

$138
$301

54% lower than market

Folic acid; serum

$53
$82

35% lower than market

Glucose Level on Body Fluid

$39
$90

57% lower than market

HDL cholesterol level

$30
$83

64% lower than market

Hemoglobin Measurement

$19
$30

36% lower than market

Hemoglobin fractionation and quantitation; electrophoresis (eg, A2, S, C, and/or F)

$34
$93

63% lower than market

Hydroxyindolacetic acid (product of metabolism) level

$49
$98

50% lower than market

IgE (immune system protein) level

$50
$101

51% lower than market

Immunologic analysis for detection of organism; qualitative or semiquantitative; multiple-step method

$66
$178

63% lower than market

Kidney Function Blood Test Panel

$67
$160

58% lower than market

Lactic acid level

$64
$96

34% lower than market

Lipoprotein measurement; nuclear resonance spectroscopy

$35
$142

75% lower than market

Liver function blood test panel

$70
$64

10% higher than market

Magnesium Level

$41
$42

1% lower than market

Measurement C-reactive protein

$39
$50

22% lower than market

Metanephrines level

$65
$145

55% lower than market

Microscopic genetic analysis of tumor; each single antibody stain procedure

$106
$492

78% lower than market

Natriuretic peptide (heart and blood vessel protein) level

$110
$150

26% lower than market

Obstetric panel (includes HIV testing)

$53
$101

48% lower than market

PSA (prostate specific antigen) measurement

$182
$79

130% higher than market

PSA Measurement; Free

$41
$107

62% lower than market

Parathormone

$124
$178

30% lower than market

Coagulation assessment blood test

$48
$113

58% lower than market

Pathology examination of tissue using a microscope, intermediate complexity

$98
$278

65% lower than market

Phenobarbital level

$55
$92

40% lower than market

Phenytoin level

$55
$85

35% lower than market

Phosphatase (enzyme) level

$19
$42

54% lower than market

Phosphate level

$30
$30

1% lower than market

Platelets, each unit

$102
$344

70% lower than market

Platelets, pheresis, leukocytes reduced, irradiated, each unit

$676
$1,942

65% lower than market

Primidone level

$33
$87

62% lower than market

Progesterone (reproductive hormone) level

$108
$105

3% higher than market

Red Blood Cell Concentration Measurement

$20
$31

35% lower than market

Red blood cell sedimentation rate, to detect inflammation; non-automated

$91
$87

4% higher than market

Red blood cell sickling measurement

$42
$84

50% lower than market

Red blood cells, each unit

$197
$373

47% lower than market

Red blood cells, leukocytes reduced, irradiated, each unit

$269
$935

71% lower than market

Removal of antibodies from surface of red blood cell

$106
$331

68% lower than market

Screening Test for Red Blood Cell Antibodies

$56
$138

59% lower than market

Screening test for presence of antibody

$41
$179

77% lower than market

Smear for infectious agents

$43
$86

50% lower than market

Special Stain for Microorganism; Gram or Glemsa Stain

$32
$43

26% lower than market

Special stained specimen slides to identify organisms including interpretation and report

$38
$165

77% lower than market

Specific gravity (liquid weight) measurement

$33
$90

63% lower than market

Strep Test

$55
$113

51% lower than market

Streptoccus

$42
$59

29% lower than market

Test for Influenza Virus

$50
$60

17% lower than market

Tissue culture for tumor disorders of bone marrow and blood cells

$345
$845

59% lower than market

Tissue or Cell Analysis by Immunologic Technique

$160
$375

57% lower than market

Tobramycin (antibiotic) level

$79
$180

56% lower than market

Total Protein Level, Urine

$31
$35

11% lower than market

Transferrin (iron binding protein) level

$41
$100

59% lower than market

Urinalysis with Examination, using Microscope

$35
$89

61% lower than market

Urinalysis, Automated Test

$71
$50

42% higher than market

Urinalysis, Manual Test

$26
$66

61% lower than market

Urine Pregnancy Test

$48
$119

60% lower than market

Urine calcium level

$28
$65

57% lower than market

Urine phosphate level

$20
$59

66% lower than market

Vitamin D-3 Level

$126
$108

17% higher than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

APPLICATION MODALITY 1/> AREAS HOT/COLD PACKS

$14
$40

65% lower than market

Application of blood vessel compression or decompression device to 1 or more areas

$35
$91

62% lower than market

Application of medication through skin using electrical current, each 15 minutes

$48
$103

53% lower than market

Behavioral and qualitative analysis of voice and resonance

$167
$401

58% lower than market

Community or work reintegration training, each 15 minutes

$32
$96

67% lower than market

Debridement (eg, high pressure waterjet with/without suction, sharp selective debridement with scissors, scalpel and forceps), open wound

$141
$347

59% lower than market

Demonstration and/or evaluation of manual maneuvers to chest wall to assist movement of lung secreti

$78
$222

65% lower than market

Evaluation for use and/or fitting of voice prosthetic device to supplement oral speech

$112
$298

62% lower than market

External shock to heart to regulate heart beat

$557
$1,683

67% lower than market

Hydration Infusion into a Vein

$91
$209

56% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$74
$255

71% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$55
$220

75% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$161
$510

68% lower than market

Injection Beneath the Skin for Therapy, Diagnosis, or Prevention

$49
$135

64% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$72
$129

44% lower than market

Irrigation of implanted venous access drug delivery device

$58
$166

65% lower than market

Measurement and recording of brain wave (EEG) activity, awake and asleep

$430
$1,027

58% lower than market

Medical nutrition therapy re-assessment and intervention, each 15 minutes

$29
$62

53% lower than market

Medical nutrition therapy, assessment and intervention, each 15 minutes

$33
$71

54% lower than market

Moderate sedation services - each additional 15 minutes intraservice time

$71
$237

70% lower than market

Moderate sedation services - initial 15 minutes, patient age 5 or older

$71
$227

69% lower than market

Multiple measurements of oxygen saturation in blood using ear or finger device

$53
$131

60% lower than market

Negative pressure wound therapy; surface area less than or equal to 50 square centimeters

$231
$773

70% lower than market

Overnight measurement of oxygen saturation in blood using ear or finger device

$114
$243

53% lower than market

Removal of devitalized tissue from wound(s), non-selective debridement without anesthesia

$262
$244

7% higher than market

Training in use of prosthesis for arms and/or legs each 15 minutes

$41
$166

75% lower than market

Vaccine for rabies injection into muscle

$548
$1,522

64% lower than market

Vein Infusion for Therapy, Prevention or Diagnosis, Concurrent with Another Infusion

$65
$223

71% lower than market

Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes

$38
$120

68% lower than market

Wheelchair management, each 15 minutes

$32
$156

79% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital Observation per Hour

$49
$69

29% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Ankle control orthosis, stirrup style, rigid, includes any type interface (e.g., pneumatic, gel), prefabricated, off-the-shelf

$98
$340

71% lower than market

Cervical, flexible, non-adjustable, prefabricated, off-the-shelf (foam collar)

$28
$87

68% lower than market

Diabetes outpatient self-management training services, individual, per 30 minutes

$54
$113

52% lower than market

Diagnostic digital breast tomosynthesis, unilateral or bilateral (list separately in addition to g0204 or g0206)

$148
$126

17% higher than market

Direct admission of patient for hospital observation care

$387
$729

47% lower than market

Injection of anesthetic agent, other peripheral nerve or branch

$661
$2,801

76% lower than market

Magnetic resonance angiography without contrast, chest (excluding myocardium)

$1,033
$2,097

51% lower than market

Removal of recurring cataract in lens capsule using laser

$1,500
$1,276

18% higher than market

Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries

$234
$1,080

78% lower than market

Technetium tc-99m pertechnetate, diagnostic, per millicurie

$7
$21

67% lower than market

Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries

$129
$281

54% lower than market

Thallium tl-201 thallous chloride, diagnostic, per millicurie

$33
$159

79% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$40
$107

62% lower than market

Infusion, d5w, 1000 cc

$60
$184

67% lower than market

Injection of Drug or Substance into Vein for Therapy or Diagnosis

$138
$262

47% lower than market

Injection, Cefazolin Sodium, 500 mg

$20
$42

52% lower than market

Injection, Ceftriaxone Sodium, per 250 mg

$20
$39

48% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$20
$70

71% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$39
$69

44% lower than market

Injection, Furosemide, up to 20 mg

$20
$34

41% lower than market

Injection, Hydromorphone, Up to 4 mg

$28
$61

54% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$20
$56

64% lower than market

Injection, Levofloxacin, 250 mg

$53
$107

50% lower than market

Injection, Lorazepam, 2 mg

$28
$84

67% lower than market

Injection, Magnesium Sulfate, per 500 mg

$40
$34

17% higher than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$20
$91

78% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$20
$68

71% lower than market

Injection, Midazolam Hydrochloride, per 1 mg

$28
$35

21% lower than market

Injection, Morphine Sulfate, up to 10 mg

$28
$69

59% lower than market

Injection, Ondansetron Hydrochloride, per 1 mg

$20
$20

2% lower than market

Injection, Piperacillin Sodium/Tazobactam (1.125 grams)

$40
$74

46% lower than market

Injection, Promethazine HCL, up to 50 mg

$20
$72

72% lower than market

Injection, ampicillin sodium, 500 mg

$20
$44

55% lower than market

Injection, ceftazidime, per 500 mg

$20
$69

71% lower than market

Injection, chlorpromazine hcl, up to 50 mg

$68
$141

52% lower than market

Injection, denosumab, 1 mg

$37
$74

50% lower than market

Injection, digoxin, up to 0.5 mg

$20
$79

75% lower than market

Injection, garamycin, gentamicin, up to 80 mg

$20
$84

76% lower than market

Injection, haloperidol, up to 5 mg

$20
$100

80% lower than market

Injection, hydroxyzine hcl, up to 25 mg

$20
$73

73% lower than market

Injection, meperidine hydrochloride, per 100 mg

$28
$94

70% lower than market

Injection, phytonadione (vitamin k), per 1 mg

$40
$36

11% higher than market

Injection, potassium chloride, per 2 meq

$20
$23

14% lower than market

Injection, succinylcholine chloride, up to 20 mg

$20
$25

19% lower than market

Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg

$20
$90

78% lower than market

Injection, ziprasidone mesylate, 10 mg

$81
$138

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

Nebulizer Treatment

$141
$273

48% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Mesh (implantable)

$1,412
$2,999

53% lower than market

Port, indwelling (implantable)

$563
$1,864

70% lower than market

Technetium tc-99m sestamibi, diagnostic, per study dose

$203
$487

58% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of Short Leg Splint (Calf to Foot)

$138
$376

63% lower than market

Application of long arm splint (shoulder to hand)

$140
$466

70% lower than market

Application of rigid total contact leg cast

$210
$650

68% lower than market

Aspiration of abscess, blood accumulation, blister, or cyst

$231
$545

58% lower than market

Biopsy of Large Bowel, Using an Endoscope

$1,500
$3,599

58% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$1,500
$2,426

38% lower than market

Bladder irrigation and/or instillation

$212
$439

52% lower than market

Change of stomach feeding, accessed through the skin

$270
$580

53% lower than market

Closed treatment of broken ankle with manipulation, bimalleolar ankle fracture

$966
$3,397

72% lower than market

Closed treatment of broken finger or thumb with manipulation

$160
$434

63% lower than market

Closed treatment of broken finger or thumb with manipulation, with or without skin traction

$160
$481

67% lower than market

Closed treatment of broken or growth plate separate of forearm bone at wrist with manipulation

$966
$2,617

63% lower than market

Closed treatment of dislocated finger joint with manipulation

$160
$519

69% lower than market

Closed treatment of dislocated foot bone

$166
$445

63% lower than market

Closed treatment of dislocated forearm bone of elbow, child

$166
$537

69% lower than market

Closed treatment of dislocated hand bone with manipulation

$166
$591

72% lower than market

Closed treatment of radial shaft fracture; with manipulation

$966
$2,434

60% lower than market

Closed treatment of shoulder dislocation with manipulation

$166
$730

77% lower than market

Closed treatment of shoulder dislocation with manipulation under anesthesia

$966
$2,687

64% lower than market

Colonoscopy, flexible; with removal of tumor(s), polyp(s), or other lesion(s) by hot biopsy forceps

$750
$2,089

64% lower than market

Colonscopy

$1,500
$2,555

41% lower than market

Control Nose Bleed - Simple Case

$200
$430

53% lower than market

Diagnostic Examination of Esophagus, Stomach, and/or Upper Small Bowel with Endoscope

$1,500
$2,496

40% lower than market

Drainage of Abscess

$250
$1,070

77% lower than market

Drainage of abscess, cyst, hematoma, vestibule of mouth; simple

$426
$1,078

60% lower than market

Drainage of finger abscess; simple

$130
$352

63% lower than market

Dressing change and/or removal of burn tissue (less than 5% total body surface)

$138
$346

60% lower than market

Exploration of penetrating wound of arm or leg

$426
$2,088

80% lower than market

Removal of cataract with insertion of lens

$5,000
$7,615

34% lower than market

Gallbladder Removal Using an Endoscope

$7,000
$11,153

37% lower than market

Incision and drainage of abscess in scrotal sac of testicle

$1,012
$4,693

78% lower than market

Incision and drainage of pilonidal cyst; complicated

$478
$1,398

66% lower than market

Injections of trigger points in 1 or 2 muscles

$268
$1,149

77% lower than market

Insertion of Breathing Tube Using an Endoscope

$259
$692

63% lower than market

Insertion of Central Venous Catheter for Infusion

$1,084
$2,237

52% lower than market

Insertion of Indwelling Bladder Catheter

$285
$273

5% higher than market

Insertion of nasal or oral stomach tube using fluoroscopic guidance

$256
$825

69% lower than market

Insertion of needle for infusion into bone

$256
$547

53% lower than market

Insertion of temporary bladder catheter

$78
$249

69% lower than market

Removal of one knee cartilage using an endoscope

$7,000
$9,171

24% lower than market

Non-needle measurement and recording of electrical activity of muscles at bladder and bowel openings

$138
$405

66% lower than market

Removal of Polyps in Large Bowel, Using an Endoscope

$750
$2,919

74% lower than market

Removal of fluid from between lung and chest cavity, open procedure

$805
$2,418

67% lower than market

Removal of foreign body from ear canal

$78
$244

68% lower than market

Removal of foreign body in external eye, conjunctiva

$78
$346

77% lower than market

Removal of impact ear wax, one ear

$55
$237

77% lower than market

Removal or bivalving of full arm or leg cast

$173
$677

74% lower than market

Repair of groin hernia patient age 5 years or older

$7,000
$9,584

27% lower than market

Repair of prolapsing hemorrhoids

$2,124
$7,848

73% lower than market

Repair of separation of wound closure with insertion of packing

$231
$668

65% lower than market

Repair of wound (1.1 to 2.5 centimeters) of scalp, arms, and/or legs

$355
$906

61% lower than market

Simple wound repair of scalp, neck, external genitalia; 2.5 cm or less

$161
$468

66% lower than market

Skin graft at trunk, arms, or legs (first 100 sq cm or less, or 1% body are of infants and children)

$2,130
$5,530

61% lower than market

Spinal tap for diagnosis

$441
$1,308

66% lower than market

Strapping of elbow or wrist

$61
$188

68% lower than market

Strapping of toes

$138
$442

69% lower than market

THROMBOLYSIS CEREBRAL IV INFUSION

$212
$647

67% lower than market

Transfusion of Blood or Blood Products

$306
$1,277

76% lower than market

Treatment of elbow dislocation

$166
$703

76% lower than market

Treatment of hip dislocation

$166
$510

67% 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

Acute digestive tract blood loss imaging

$699
$2,020

65% lower than market

Bone and/or joint imaging

$571
$1,883

70% lower than market

CT Abdomen & Pelvis with Contrast

$2,871
$2,530

13% higher than market

CT Abdomen & Pelvis with and without Contrast

$3,208
$2,820

14% higher than market

CT Angiogram Abdomen & Pelvis with and without Contrast

$1,393
$4,362

68% lower than market

CT Angiogram Abdomen with and without Contrast

$1,393
$2,920

52% lower than market

CT Face without Contrast

$849
$1,518

44% lower than market

CT Head Brain without Contrast

$2,452
$1,782

38% higher than market

CT Leg with Contrast

$949
$1,971

52% lower than market

CT Pelvis with Contrast

$1,900
$1,525

25% higher than market

CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast

$1,724
$3,636

53% lower than market

CT Spine Cervical without Contrast

$1,032
$1,994

48% lower than market

CT Spine Lumbar without Contrast

$1,029
$1,868

45% lower than market

CT scan limited or follow-up study

$580
$1,193

51% lower than market

CT scan of arm blood vessels with contrast

$1,037
$2,343

56% lower than market

CT scan of pelvic blood vessels with contrast

$1,201
$3,131

62% lower than market

Chest X-Ray; 2 Views

$96
$305

69% lower than market

Chest X-Ray; Single View

$69
$259

73% lower than market

Diagnostic mammography, bilateral

$753
$398

89% higher than market

Diagnostic mammography, unilateral

$676
$297

128% higher than market

Fluoroscopic guidance for insertion of needle

$332
$820

60% lower than market

Imaging for Evaluation of Swalling Function

$266
$592

55% lower than market

Imaging for bone length assessment

$83
$392

79% lower than market

Imaging guidance for procedure, more than 1 hour

$403
$929

57% lower than market

Imaging of Abdomen and Chest

$244
$547

55% lower than market

Imaging of Abdomen; 2 Views

$191
$511

63% lower than market

Imaging of Abdomen; Single View

$140
$324

57% lower than market

Imaging of liver and spleen

$653
$1,556

58% lower than market

Imaging of urinary tract

$335
$813

59% lower than market

Imaging of urinary tract with injection of contrast into a vein

$386
$1,146

66% lower than market

Kidney imaging with assessment of blood flow and function; multiple studies without pharmacological intervention

$740
$2,507

70% lower than market

Kidney imaging with assessment of blood flow and function; single study without pharmacological intervention

$536
$2,068

74% lower than market

Low dose ct scan (ldct) for lung cancer screening

$200
$459

56% lower than market

MRI Abdomen without Contrast

$1,120
$2,303

51% lower than market

MRI Brain with Contrast

$1,162
$2,987

61% lower than market

MRI Brain with and without Conrast

$3,170
$2,510

26% higher than market

MRI Brain without Contrast

$1,033
$1,837

44% lower than market

MRI Leg Joint without Contrast

$2,579
$1,796

44% higher than market

MRI Leg with and without Contrast

$1,033
$2,443

58% lower than market

MRI Orbit, Face, Neck with and without Contrast

$1,320
$3,066

57% lower than market

MRI Spine Lumbar without Contrast

$1,700
$2,197

23% lower than market

MRI Spine Thoracic with and without Contrast

$1,750
$3,678

52% lower than market

MRI scan of jaw joints

$1,098
$2,474

56% lower than market

MRI scan of leg with contrast

$303
$1,547

80% lower than market

MRI scan of upper spinal canal with contrast

$1,103
$2,558

57% lower than market

Nuclear Medicine Study of Heart Wall Motion at Rest or with Stress

$737
$2,224

67% lower than market

Nuclear medicine study of radioactive material distribution at site of inflammation, limited area

$905
$3,332

73% lower than market

Nuclear medicine study of radioactive material distribution at sites of inflammation in whole body

$905
$3,425

74% lower than market

Parathyroid Planar Imaging

$499
$1,324

62% lower than market

Physical Therapy, ultrasound therapy - 15 minutes

$47
$103

54% lower than market

Radiologic examination, chest; 3 views

$163
$413

60% lower than market

Radiological supervision and interpretation X-ray of bile and/or pancreatic ducts during surgery

$382
$916

58% lower than market

Radiological supervision and interpretation X-ray of shoulder joint

$284
$1,012

72% lower than market

Radiological supervision and interpretation X-ray of urinary bladder and urethra, voiding

$197
$844

77% lower than market

Radiological supervision and interpretation X-ray of urinary bladder, minimum of 3 views

$284
$923

69% lower than market

Radiological supervision and interpretation of CT guidance for needle insertion

$958
$2,156

56% lower than market

Radiological supervision and interpretation of change of tube (accessed through the skin) or drainag

$372
$839

56% lower than market

Radiological supervision and interpretation of imaging of veins of both arms or legs

$805
$1,908

58% lower than market

Screening Mammography, Bilateral, with CAD

$531
$314

69% higher than market

Ultrasound Abdomen - Complete

$778
$979

21% lower than market

Ultrasound Abdomen - Limited

$803
$742

8% higher than market

Ultrasound Behind Abdominal Cavity - Complete

$383
$783

51% lower than market

Ultrasound Blood Flow Outside the Brain

$525
$1,133

54% lower than market

Ultrasound Guidance for Insertion of Needle

$374
$987

62% lower than market

Ultrasound Heart

$1,513
$1,849

18% lower than market

Ultrasound Pelvis through Vagina

$797
$598

33% higher than market

Ultrasound Pregnant Uterus < 14 Weeks Pregnant

$140
$675

79% lower than market

Ultrasound Pregnant Uterus > 14 Weeks Pregnant

$238
$982

76% lower than market

Ultrasound Veins of Both Arms or Legs

$1,390
$1,328

5% higher than market

Ultrasound examination of the heart performed during rest, exercise, and/or drug-induced stress with

$366
$1,602

77% lower than market

Ultrasound guidance for accessing into blood vessel

$267
$655

59% lower than market

Ultrasound of Arteries of Both Legs

$461
$1,200

62% lower than market

Ultrasound of Arteries of One Leg

$140
$704

80% lower than market

Ultrasound of pregnant uterus, 1 or more fetus(es)

$165
$449

63% lower than market

Ultrasound scan of blood flow of aorta, vena cava, bypass graphs, or one side of the groin or limite

$400
$1,151

65% lower than market

X-Ray Foot, 3 Views

$149
$354

58% lower than market

X-Ray Hip and Pelvis, 2 Views

$423
$367

15% higher than market

X-Ray Knee, 4 or More Views

$83
$435

81% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$212
$438

52% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$713
$557

28% higher than market

X-Ray Shoulder Blade

$83
$316

74% lower than market

X-Ray Shoulder, 2 Views

$437
$410

7% higher than market

X-Ray Upper GI with Small Bowel Films

$516
$1,207

57% lower than market

X-ray of bones of face, less than 3 views

$143
$304

53% lower than market

X-ray of breast bone, minimum of 2 views

$137
$341

60% lower than market

X-ray of jaw joints on both sides of the face

$142
$372

62% lower than market

X-ray of paranasal sinus, complete, minimum of 3 views

$192
$423

55% lower than market

X-ray of sacroiliac joints, less than 3 views

$83
$320

74% lower than market

X-ray of skull, less than 4 views

$83
$390

79% lower than market

X-ray of upper digestive tract, kidneys, urinary ducts (ureters), and bladder

$148
$750

80% lower than market

X-ray of upper digestive tract, kidneys, urinary ducts (ureters), and bladder with contrast

$243
$743

67% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Heart Failure with major complications

$12,182
$29,408

59% lower than market

INPATIENT GYNECOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Uterus or Ovary Surgery Not Related to Cancer without complications

$18,904
$34,477

45% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Blood Infection with major complications

$16,045
$43,570

63% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Pneumonia with complications

$11,119
$23,411

53% lower than market

Pneumonia with major complications

$15,483
$32,286

52% lower than market

Pneumonia without complications

$8,882
$18,686

52% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$9,977
$19,605

49% 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.