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Patient Price Information List

Disclaimer: Salina Surgical 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, Salina Surgical Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/25. Salina Surgical Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Manhattan Surgical Center

Manhattan

KS

McPherson Hospital

McPherson

KS

Memorial Health System

Abilene

KS

Salina Regional Health Center

Salina

KS

Summit Surgical

Hutchinson

KS

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,055
$1,998

47% lower than market

MEDICINE (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Digestive tract imaging from the inside of the digestive tract [HCPCS 91110]

$2,621
$3,226

19% lower than market

Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]

$180
$230

22% lower than market

PATHOLOGY & LABORATORY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

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

$25
$172

85% lower than market

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

$15
$98

85% lower than market

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

$11
$43

75% lower than market

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

$15
$169

91% lower than market

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

$85
$174

51% lower than market

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

$37
$66

45% lower than market

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

$15
$101

85% lower than market

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test and automated differential white blood cell count [HCPCS 85025]

$18
$86

80% lower than market

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

$36
$133

73% lower than market

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

$15
$87

82% lower than market

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

$28
$93

70% lower than market

Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]

$93
$154

39% lower than market

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

$17
$105

84% lower than market

Lab analysis to measure the amount of C-reactive protein in serum to identify infection or inflammation [HCPCS 86140]

$25
$119

79% lower than market

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

$169
$167

2% higher than market

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

$54
$195

72% lower than market

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

$45
$147

69% lower than market

ORTHOPEDIC SURGERY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Total Knee or Hip Replacement

$29,701
$52,209

43% lower than market

Total Shoulder Replacement

$41,182
$68,364

40% lower than market

RADIOLOGY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

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

$93
$327

72% lower than market

SURGERY (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Esophagus, stomach, and/or upper small bowel examination and widening by balloon with endoscope (less than 30 mm) [HCPCS 43249]

$2,641
$4,799

45% lower than market

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

$1,745
$4,882

64% lower than market

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

$2,061
$5,799

64% lower than market

Uterus polyp biopsy and/or removal with endoscope [HCPCS 58558]

$7,459
$11,738

36% lower than market

Colon (lower large bowel) examination and biopsy with endoscope [HCPCS 45331]

$1,425
$5,948

76% lower than market

Complex cataract removal with lens insertion [HCPCS 66982]

$4,535
$8,539

47% lower than market

Sling around bladder canal (urethra) creation to control leakage [HCPCS 57288]

$12,294
$25,678

52% lower than market

Crushing of ureter (urinary duct) stone with endoscope [HCPCS 52353]

$14,007
$16,407

15% lower than market

Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]

$14,235
$27,044

47% lower than market

Small bladder tumor (0.5 to 2.0 cm) destruction and/or removal with endoscope [HCPCS 52234]

$7,937
$13,214

40% lower than market

Bladder, urethra (bladder canal), and ureter (urinary duct) or kidney examination with endoscope for diagnosis [HCPCS 52351]

$5,635
$21,572

74% lower than market

Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]

$1,743
$4,111

58% lower than market

Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]

$1,209
$4,661

74% lower than market

Colon (lower large bowel) examination with endoscope for diagnosis [HCPCS 45330]

$1,251
$3,363

63% lower than market

Esophagus widening (unguided) [HCPCS 43450]

$991
$2,662

63% lower than market

Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]

$9,519
$10,784

12% lower than market

Extracapsular cataract removal with insertion of intraocular lens prosthesis (1 stage procedure), manual or mechanical technique (eg, irrigation and aspiration or phacoemulsification); with insertion of intraocular (eg, trabe

$11,627
$20,549

43% lower than market

Tendon covering incision [HCPCS 26055]

$3,211
$8,928

64% lower than market

Anesthetic agent and/or steroid injection into brachial nerve bundle of arm [HCPCS 64415]

$25,206
$30,567

18% lower than market

Tunneled central venous catheter insertion for infusion with implanted port beneath the skin (5 years of age or older) [HCPCS 36561]

$5,374
$10,898

51% lower than market

Eye fluid drainage device insertion (external approach) [HCPCS 66183]

$13,918
$17,916

22% lower than market

Peripheral or gastric neurostimulator generator insertion or replacement [HCPCS 64590]

$53,394
$74,435

28% lower than market

Sacral nerve neurostimulator electrodes implantation [HCPCS 64561]

$18,767
$25,895

28% lower than market

Ureter (urinary duct) stent insertion with endoscope [HCPCS 52332]

$8,496
$11,536

26% lower than market

Unlisted front (anterior) eye procedure [HCPCS 66999]

$4,762
$10,343

54% lower than market

Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]

$48,526
$56,645

14% lower than market

Ulnar nerve at elbow release and/or relocation [HCPCS 64718]

$4,049
$11,916

66% lower than market

Median nerve of hand release and/or relocation (Carpal Tunnel Release) [HCPCS 64721]

$3,484
$9,527

63% lower than market

Shoulder examination and release of shoulder biceps tendon with endoscope [HCPCS 29828]

$27,597
$28,642

4% lower than market

Wrist ligament release with endoscope [HCPCS 29848]

$2,605
$9,852

74% lower than market

Knee cartilage removal with endoscope (both knees) [HCPCS 29880]

$6,589
$11,490

43% lower than market

Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]

$4,073
$7,639

47% lower than market

Excessive skin removal of upper eyelid and fat around eye [HCPCS 15823]

$3,547
$15,491

77% lower than market

Shoulder examination and removal of abnormal shoulder joint tissue with endoscope (extensive) [HCPCS 29823]

$8,572
$27,903

69% lower than market

Tendon lesion removal from finger or hand [HCPCS 26160]

$3,025
$7,513

60% lower than market

Knee cartilage removal with endoscope (one knee) [HCPCS 29881]

$6,415
$11,505

44% lower than market

Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]

$1,852
$6,799

73% lower than market

Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]

$8,769
$21,630

59% lower than market

Gallbladder and pancreatic, liver, and bile ducts examination and pancreatic or bile duct stone removal with endoscope [HCPCS 43264]

$14,680
$19,977

27% lower than market

Parathyroid glands removal or inspection [HCPCS 60500]

$10,135
$20,793

51% lower than market

Shoulder examination and shoulder rotator cuff repair with endoscope [HCPCS 29827]

$17,956
$26,092

31% lower than market

Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]

$25,884
$30,847

16% lower than market

Kidney stones crushing by shock wave [HCPCS 50590]

$5,701
$10,048

43% lower than market

HCPCS - J CODES (OUTPATIENT)

Description

Our Charge
Market Charge

Variance

Adrenalin epinephrine inject [HCPCS J0171]

$16
$26

38% lower than market

Ceftriaxone sodium injection [HCPCS J0696]

$12
$10

24% higher than market

Dexamethasone sodium phos [HCPCS J1100]

$1
$4

67% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$3
$9

60% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$4
$24

84% lower than market

Levofloxacin injection [HCPCS J1956]

$36
$38

6% lower than market

Morphine sulfate injection [HCPCS J2270]

$11
$25

58% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$39
$14

171% higher than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Salina Surgical Hospital for your healthcare needs. We want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Salina Surgical 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 Salina Surgical Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.

• Please respond promptly to any requests from your insurance provider.

You may receive multiple bills from your hospital visit, including your family doctor, specialists, physicians that read x-rays, providers that give anesthesia, or physicians that interpret blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Salina Surgical Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.

Questions about Price and Billing Information

Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.

To ask questions or get more information about a bill for services you've received, please contact our Billing Department at 785-827-0610.

If you need more information about the price of a future service, please contact our Customer Service at 785-827-0610. A physician’s order or CPT code is strongly encouraged when you call to assist us in providing you with the most accurate estimate. You can obtain the CPT code from the ordering physician.