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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.
Salina Surgical Hospital Patient Information Price List
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:
Manhattan Surgical Center
Manhattan
KS
McPherson Hospital
McPherson
KS
Memorial Health System
Abilene
KS
Salina Regional Health Center
Salina
KS
Summit Surgical
Hutchinson
KS
Salina Surgical Hospital Patient Information Price List
INPATIENT ROOM AND BOARD DAILY CHARGES
INPATIENT ROOM AND BOARD DAILY CHARGES
Description
Variance
Private Room
Private Room
47% lower than market
Salina Surgical Hospital Patient Information Price List
MEDICINE (OUTPATIENT)
MEDICINE (OUTPATIENT)
Description
Variance
Digestive tract imaging from the inside of the digestive tract [HCPCS 91110]
Digestive tract imaging from the inside of the digestive tract [HCPCS 91110]
19% lower than market
Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]
Routine EKG (electrocardiogram) tracing using at least 12 wires [HCPCS 93005]
An ECG is used to evaluate the electrical activity of the heart. The test is performed with the patient lying prone on the exam table. Small plastic patches are attached at specific locations on the chest, abdomen, arms, and/or legs. Leads (wires) from the ECG tracing device are then attached to the patches. A tracing is obtained of the electrical signals from the heart. Electrical activity begins in the sinoatrial node which generates an electrical stimulus at regular intervals, usually 60 to 100 times per minute. This stimulus travels through the conduction pathways to the sinoatrial node causing the atria to contract. The stimulus then travels along the bundle of His which divides into right and left pathways providing electrical stimulation of the ventricles causing them to contract. Each contraction of the ventricles represents one heart beat. The ECG tracing includes the following elements: P wave, QRS complex, ST segment, and T wave. The P wave, a small upward notch in the tracing, indicates electrical stimulation of the atria. This is followed by the QRS complex which indicates the ventricles are electrically stimulated to contract. The short flat ST segment follows and indicates the time between the end of the ventricular contraction and the T wave. The T wave represents the recovery period of the ventricles. The physician reviews, interprets, and provides a written report of the ECG recording taking care to note any abnormalities.
22% lower than market
Salina Surgical Hospital Patient Information Price List
PATHOLOGY & LABORATORY (OUTPATIENT)
PATHOLOGY & LABORATORY (OUTPATIENT)
Description
Variance
Lab analysis of blood culture to identify bacteria [HCPCS 87040]
Lab analysis of blood culture to identify bacteria [HCPCS 87040]
A blood sample is drawn and placed in a medium conducive to the growth of bacteria. Any bacteria present in the blood sample will then reveal themselves.
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]
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]
A basic metabolic blood panel is obtained that includes ionized calcium levels along with carbon dioxide (bicarbonate) (CO2), chloride, creatinine, glucose, potassium, sodium, and urea nitrogen (BUN). A basic metabolic panel with measurement of ionized calcium may be used to screen for or monitor overall metabolic function or identify imbalances. Ionized or free calcium flows freely in the blood, is not attached to any proteins, and represents the amount of calcium available to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Total carbon dioxide (bicarbonate) (CO2) level is composed of CO2, bicarbonate (HCO3-), and carbonic acid (H2CO3) with the primary constituent being bicarbonate, a negatively charged electrolyte that works in conjunction with other electrolytes, such as potassium, sodium, and chloride, to maintain proper acid-base balance and electrical neutrality at the cellular level. Chloride is also a negatively charged electrolyte that helps regulate body fluid and maintain proper acid-base balance. Creatinine is a waste product excreted by the kidneys that is produced in the muscles while breaking down creatine, a compound used by the muscles to create energy. Blood levels of creatinine provide a good measurement of renal function. Glucose is a simple sugar and the main source of energy for the body, regulated by insulin. When more glucose is available than is required, it is stored in the liver as glycogen or stored in adipose tissue as fat. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly. Both potassium and sodium are positively charged electrolytes that work in conjunction with other electrolytes to regulate body fluid, stimulate muscle contraction, and maintain proper acid-base balance and both are essential for maintaining normal metabolic processes. Urea is a waste product produced in the liver by the breakdown of protein from a sequence of chemical reactions referred to as the urea or Krebs-Henseleit cycle. Urea is taken up by the kidneys and excreted in the urine. Blood urea nitrogen, BUN, is a measure of renal function, and helps monitor renal disease and the effectiveness of dialysis.
85% lower than market
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
Lab analysis to evaluate the clotting time in plasma specimen and monitor drug effectiveness [HCPCS 85610]
Prothrombin time (PT) measures how long it takes for blood to clot. Prothrombin, also called factor II, is one of the clotting factors made by the liver and adequate levels of vitamin K are needed for the liver to produce sufficient prothrombin. Prothrombin time is used to help identify the cause of abnormal bleeding or bruising; to check whether blood thinning medication, such as warfarin (Coumadin), is working; to check for low levels of blood clotting factors I, II, V, VII, and X; to check for low levels of vitamin K; to check liver function, to see how quickly the body is using up its clotting factors. The test is performed using electromagnetic mechanical clot detection. If prothrombin time is elevated and the patient is not on a blood thinning medication, a second prothrombin time using substitution plasma fractions, also referred to as a prothrombin time mixing study, may be performed. This is performed by mixing patient plasma with normal plasma using a 1:1 mix. The mixture is incubated and the clotting time is again measured. If the result does not correct, it may be indicative that the patient has an inhibitor, such as lupus anticoagulant. If the result does correct, the patient may have a coagulation factor deficiency.
75% lower than market
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
Lab analysis via blood test to measure a comprehensive group of blood chemicals [HCPCS 80053]
A comprehensive metabolic panel is obtained that includes albumin, bilirubin, total calcium, carbon dioxide, chloride, creatinine, glucose, alkaline phosphatase, potassium, total protein, sodium, alanine amino transferase (ALT) (SGPT), aspartate amino transferase (AST) (SGOT), and urea nitrogen (BUN). This test is used to evaluate electrolytes and fluid balance as well as liver and kidney function. It is also used to help rule out conditions such as diabetes. Tests related to electrolytes and fluid balance include: carbon dioxide, chloride, potassium, and sodium. Tests specific to liver function include: albumin, bilirubin, alkaline phosphatase, ALT, AST, and total protein. Tests specific to kidney function include: BUN and creatinine. Calcium is needed to support metabolic processes such as heart function, muscle contraction, nerve function, and blood clotting. Glucose is the main source of energy for the body and is regulated by insulin. Glucose measurement determines whether the glucose/insulin metabolic process is functioning properly.
91% lower than market
Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]
Lab analysis to identify the thyroid stimulating hormone (tsh) in blood specimen [HCPCS 84443]
A blood test is performed to determine levels of thyroid stimulating hormone (TSH). TSH is produced in the pituitary and helps to regulate two other thyroid hormones, triiodothyronine (T3) and thyroxin (T4), which in turn help regulate the body's metabolic processes. TSH levels are tested to determine whether the thyroid is functioning properly. Patients with symptoms of weight gain, tiredness, dry skin, constipation, or menstrual irregularities may have an underactive thyroid (hypothyroidism). Patients with symptoms of weight loss, rapid heart rate, nervousness, diarrhea, feeling of being too hot, or menstrual irregularities may have an overactive thyroid (hypothyroidism). TSH levels are also periodically tested in individuals on thyroid medications. The test is performed by electrochemiluminescent immunoassay.
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]
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]
A blood specimen is tested to determine blood type (ABO) or Rh(D). In Rh(D), blood is tested for Rh factor, which is an antigen on red blood cells. Blood is Rh+ if the antigen is present or Rh- if the antigen is absent. Blood is tested by mixing the blood sample with antibodies against Rh factor and then checking for agglutination. If agglutination occurs, the blood is Rh+. If the blood does not agglutinate, it is Rh-.
45% lower than market
Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]
Lab analysis to measure coagulation in plasma or whole blood specimen [HCPCS 85730]
This test may also be referred to as an activated PTT or aPTT. PTT may be performed to diagnose the cause of bleeding or as a screening test prior to surgery to rule-out coagulation defects. A silica and synthetic phospholipid PTT reagent is mixed with the patient plasma. The silica provides a negatively-charged particulate surface that activates the contact pathway for coagulation. Clot formation is initiated by adding calcium chloride to the mixture. Clotting time is measured photo-optically.
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]
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]
An automated complete blood count (CBC) is performed with or without automated differential white blood cell (WBC) count. A CBC is used as a screening test to evaluate overall health and symptoms such as fatigue, bruising, bleeding, and inflammation, or to help diagnose infection. A CBC includes measurement of hemoglobin (Hgb) and hematocrit (Hct), red blood cell (RBC) count, white blood cell (WBC) count with or without differential, and platelet count. Hgb measures the amount of oxygen-carrying protein in the blood. Hct refers to the volume of red blood cells (erythrocytes) in a given volume of blood and is usually expressed as a percentage of total blood volume. RBC count is the number of red blood cells (erythrocytes) in a specific volume of blood. WBC count is the number of white blood cells (leukocytes) in a specific volume of blood. There are five types of WBCs: neutrophils, eosinophils, basophils, monocytes, and lymphocytes. If a differential is performed, each of the five types is counted separately. Platelet count is the number of platelets (thrombocytes) in the blood. Platelets are responsible for blood clotting. The CBC is performed with an automated blood cell counting instrument that can also be programmed to provide an automated WBC differential count.
80% lower than market
Lab analysis to measure the creatine kinase (cardiac enzyme) level (MB fraction only) [HCPCS 82553]
Lab analysis to measure the creatine kinase (cardiac enzyme) level (MB fraction only) [HCPCS 82553]
Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. Only creatine kinase (CK) MB fraction is measured. Testing for this isoenzyme can help identify heart muscle damage following a heart attack (myocardial infarction). A blood test is obtained by separately reportable venipuncture. Serum is tested using chemiluminescent immunoassay.
73% lower than market
Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]
Lab analysis to measure the total creatine kinase (cardiac enzyme) level in blood specimen [HCPCS 82550]
Creatine kinase (CK) also known as, creatine phosphokinase (CPK), is an enzyme found in the heart, brain, skeletal muscle and certain other tissue. The subtypes are known as CK-MM found primarily in skeletal and heart muscle, CK-MB found in heart muscle and CK-BB located in the brain. CK circulating in blood rarely contains CK-BB but is largely comprised of CK-MM or CK-MB. Levels may be elevated following heart muscle damage (heart attack/myocardial infarction) and skeletal muscle injury (trauma, vigorous exercise). Statin drugs that lower cholesterol level and alcohol intake may cause elevated CK blood levels. A blood test is performed to measure total creatine kinase (CK) levels. A blood specimen is obtained by separately reportable venipuncture. Serum or plasma is tested using quantitative enzymatic methodology.
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]
Lab analysis to evaluate an antimicrobial drug (antibiotic, antifungal, antiviral) by microdilution or agar dilution (each multi-antimicrobial, per plate) [HCPCS 87186]
A study is performed to determine the effectiveness of a specific antibiotic agent to a specific bacteria. The test is performed in an agar solution.
70% lower than market
Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]
Lab analysis to measure the lactic acid level in blood, plasma, or cerbrospinal fluid specimen [HCPCS 83605]
A blood or body fluid test is performed to measure lactate (lactic acid) levels. Lactic acid is produced primarily by muscle tissue and red blood cells in the body. Elevated levels may be caused by strenuous exercise, heart failure, severe infection (sepsis), shock states (cardiogenic, hypovolemic) and liver disease. A blood sample is obtained by separately reportable venipuncture. Cerebral spinal fluid (CSF) is obtained by lumbar puncture (spinal tap). Other body fluids may also be collected and tested. Plasma, CSF, and other body fluids are tested using enzymatic methodology.
39% lower than market
Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]
Lab analysis to measure the magnesium level in body fluids and cells [HCPCS 83735]
A blood, urine, or fecal test is performed to measure magnesium levels. Magnesium is an essential dietary mineral responsible for enzyme function, energy production, and contraction and relaxation of muscle fibers. Decreased levels may result from severe burns, metabolic disorders, certain medications, and low blood calcium levels. A blood sample is obtained by separately reportable venipuncture. Red blood cells (RBCs) are tested using quantitative inductively coupled plasma-mass spectrometry. Serum/plasma is tested using quantitative spectrophotometry. A 24-hour voided urine specimen is tested using quantitative spectrophotometry. A random or 24-hour fecal sample is tested using quantitative spectrophotometry.
84% lower than market
Lab analysis to measure the amount of C-reactive protein in serum to identify infection or inflammation [HCPCS 86140]
Lab analysis to measure the amount of C-reactive protein in serum to identify infection or inflammation [HCPCS 86140]
A blood test is performed to measure C-reactive protein (CRP) levels. This standard test has a wide value range. CRP is an acute phase protein, synthesized by the liver and released in response to inflammation and infection. The test is not diagnostic for any specific disease or condition but can be used as a marker to monitor the body's response to treatment(s) or to evaluate the need for further testing. Elevation of CRP levels may be found during pregnancy, with the use of oral contraceptives, or hormone replacement therapy. Diseases/conditions that cause an elevation of CRP include: lymphoma, arteritis/vasculitis, osteomyelitis, inflammatory bowel disease, rheumatoid arthritis, pelvic inflammatory disease (PID), systemic lupus erythematosus (SLE), acute infections, burns, surgical procedures, and organ transplants. A blood sample is obtained by separately reportable venipuncture. Serum in neonates is tested using immunoassay. Serum/plasma in all other patients is tested using quantitative immunoturbidimetric method.
79% lower than market
Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]
Lab analysis to measure the parathormone (parathyroid hormone) level [HCPCS 83970]
A blood or tissue test is performed to measure parathormone (parathyroid hormone, parathyrin) levels. Parathyroid hormone (PTH) is produced by chief cells in the parathyroid gland. The hormone helps to regulate blood calcium levels, absorption/excretion of phosphate by the kidneys and in Vitamin D synthesis in the body. Elevated levels (hyperparathyroidism) may be caused by parathyroid gland tumors or chronic renal failure. Decreased levels (hypoparathyroidism) may result from inadvertent removal (during thyroid gland surgery), autoimmune disorders or genetic inborn errors of metabolism. A blood sample is obtained by separately reportable venipuncture. Parathyroid gland tissue is obtained by separately reportable fine needle aspirate. Serum/plasma or tissue sample are tested using quantitative electrochemiluminescent immunoassay. Plasma is tested for parathyroid hormone, CAP (Cyclase Activating Parathyroid Hormone) using immunoradiometric assay.
2% higher than market
Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]
Lab analysis to measure the amount of total PSA (prostate specific antigen) in serum specimen [HCPCS 84153]
Prostate specific antigen (PSA) is measured. PSA is a protein produced by normal prostate cells found in serum and exists in both free form and complexed with other proteins. Total PSA is measured ad the total amount of both free and complexed forms. Total PSA levels are higher in men with benign prostatic hyperplasia (BPH), acute bacterial prostatitis, or prostate cancer. Total PSA is used to screen for prostate cancer and evaluate the response to treatment in those with prostate cancer, but cannot be used by itself to definitively diagnose prostate cancer.
72% lower than market
Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]
Lab analysis to measure the amount of troponin (protein) in serum specimen [HCPCS 84484]
A blood test is performed to measure troponin levels. Troponins are regulatory proteins that facilitate contraction of skeletal and smooth muscle by forming calcium bonds. Troponin T binds to tropomyosin to form a complex. Troponin I binds to actin and holds the Troponin T-tropomyosin complex together. Elevation of troponins, coupled with cardiac symptoms such as chest pain are considered diagnostic for cardiac injury. This test is commonly ordered in the Emergency Department when a patient presents with possible myocardial infarction, and is then repeated at 6 hour intervals. It may be ordered with other tests that assess cardiac biomarkers such as CK, CK-MB, and myoglobin. A blood sample is obtained by separately reportable venipuncture. Serum/plasma is tested for Troponin T using quantitative electrochemiluminescent immunoassay. Serum is tested for Troponin I using chemiluminescent immunoassay.
69% lower than market
Salina Surgical Hospital Patient Information Price List
ORTHOPEDIC SURGERY (INPATIENT)
ORTHOPEDIC SURGERY (INPATIENT)
Description
Variance
Total Knee or Hip Replacement
Total Knee or Hip Replacement
43% lower than market
Total Shoulder Replacement
Total Shoulder Replacement
40% lower than market
Salina Surgical Hospital Patient Information Price List
RADIOLOGY (OUTPATIENT)
RADIOLOGY (OUTPATIENT)
Description
Variance
Chest x-ray (single view) [HCPCS 71045]
Chest x-ray (single view) [HCPCS 71045]
A radiologic examination of the chest is performed. Chest radiographs (X-rays) provide images of the heart, lungs, bronchi, major blood vessels (aorta, vena cava, pulmonary vessels), and bones, (sternum, ribs, clavicle, scapula, spine). The most common views are frontal (also referred to as anteroposterior or AP), posteroanterior (PA), and lateral. To obtain a frontal view, the patient is positioned facing the x-ray machine. A PA view is obtained with the patient's back toward the x-ray machine. For a lateral view, the patient is positioned with side of the chest toward the machine. Other views that may be obtained include apical lordotic, oblique, and lateral decubitus. An apical lordotic image provides better visualization of the apical (top) regions of the lungs. The patient is positioned with the back arched so that the tops of the lungs can be x-rayed. Oblique views may be obtained to evaluate a pulmonary or mediastinal mass or opacity or to provide additional images of the heart and great vessels. There are four positions used for oblique views including right and left anterior oblique, and right and left posterior oblique. Anterior oblique views are obtained with the patient standing and the chest rotated 45 degrees. The arm closest to the x-ray cassette is flexed with the hand resting on the hip. The opposite arm is raised as high as possible. The part of the chest farthest away from the x-ray cassette is the area being studied. Posterior oblique views are typically obtained only when the patient is too ill to stand or lay prone for anterior oblique views. A lateral decubitus view is obtained with the patient lying on the side; the patient's head rests on one arm, and the other arm is raised over the head with the elbow bent. Images are recorded on hard copy film or stored electronically as digital images. The physician reviews the images, notes any abnormalities, and provides a written interpretation of the findings.
72% lower than market
Salina Surgical Hospital Patient Information Price List
SURGERY (OUTPATIENT)
SURGERY (OUTPATIENT)
Description
Variance
Esophagus, stomach, and/or upper small bowel examination and widening by balloon with endoscope (less than 30 mm) [HCPCS 43249]
Esophagus, stomach, and/or upper small bowel examination and widening by balloon with endoscope (less than 30 mm) [HCPCS 43249]
45% lower than market
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]
An upper gastrointestinal (UGI) endoscopic examination, also referred to as an esophagogastroduodenoscopy (EGD), is performed on the esophagus, stomach, duodenum and/or jejunum with biopsy(s). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum where mucosal surfaces are inspected for any abnormalities. Single or multiple samples of suspect tissue are taken through the scope. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities.
64% lower than market
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]
A flexible colonoscopy is performed with single or multiple biopsies. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Any suspect site(s) to be biopsied is identified and biopsy forceps are placed through the biopsy channel in the endoscope. The forceps are opened, the tissue is spiked, and the forceps are closed. The biopsied tissue is then removed through the endoscope. One or more tissue samples may be obtained and are sent for separately reportable laboratory analysis.
64% lower than market
Uterus polyp biopsy and/or removal with endoscope [HCPCS 58558]
Uterus polyp biopsy and/or removal with endoscope [HCPCS 58558]
36% lower than market
Colon (lower large bowel) examination and biopsy with endoscope [HCPCS 45331]
Colon (lower large bowel) examination and biopsy with endoscope [HCPCS 45331]
76% lower than market
Complex cataract removal with lens insertion [HCPCS 66982]
Complex cataract removal with lens insertion [HCPCS 66982]
47% lower than market
Sling around bladder canal (urethra) creation to control leakage [HCPCS 57288]
Sling around bladder canal (urethra) creation to control leakage [HCPCS 57288]
52% lower than market
Crushing of ureter (urinary duct) stone with endoscope [HCPCS 52353]
Crushing of ureter (urinary duct) stone with endoscope [HCPCS 52353]
15% lower than market
Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]
Ureter (urinary duct) stone crushing with stent with endoscope [HCPCS 52356]
47% lower than market
Small bladder tumor (0.5 to 2.0 cm) destruction and/or removal with endoscope [HCPCS 52234]
Small bladder tumor (0.5 to 2.0 cm) destruction and/or removal with endoscope [HCPCS 52234]
40% lower than market
Bladder, urethra (bladder canal), and ureter (urinary duct) or kidney examination with endoscope for diagnosis [HCPCS 52351]
Bladder, urethra (bladder canal), and ureter (urinary duct) or kidney examination with endoscope for diagnosis [HCPCS 52351]
74% lower than market
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
Esophagus, stomach, and/or upper small bowel examination with endoscope for diagnosis [HCPCS 43235]
A diagnostic upper gastrointestinal (UGI) endoscopic examination is performed of the esophagus, stomach, duodenum and/or jejunum with or without collection of specimens by brushing or washing. This procedure may also be referred to as an esophagogastroduodenoscopy (EGD). The mouth and throat are numbed using an anesthetic spray. A hollow mouthpiece is placed in the mouth. The flexible fiberoptic endoscope is then inserted and advanced as it is swallowed by the patient. Once the endoscope has been advanced beyond the cricopharyngeal region, it is guided using direct visualization. The esophagus is inspected and any abnormalities are noted. The endoscope is then advanced beyond the gastroesophageal junction into the stomach and the stomach is insufflated with air. The cardia, fundus, greater and lesser curvature, and antrum of the stomach are inspected and any abnormalities are noted. The tip of the endoscope is then advanced through the pylorus and into the duodenum and/or jejunum. Mucosal surfaces of the duodenum and/or jejunum are inspected and any abnormalities are noted. The endoscope is then withdrawn and mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology samples may be obtained by cell brushing or washing.
58% lower than market
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
Colon (large bowel) examination with endoscope for diagnosis (high risk) [HCPCS 45378]
A flexible colonoscopy is performed with or without collection of specimens by brushing or washing. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The endoscope is then withdrawn as mucosal surfaces are again inspected for ulcerations, varices, bleeding sites, lesions, strictures, or other abnormalities. Cytology (cell) samples may be obtained using a brush introduced through the endoscope. Alternatively, sterile water may be introduced to wash the mucosal lining and the fluid aspirated to obtain cell samples. Cytology samples are sent for separately reportable laboratory analysis.
74% lower than market
Colon (lower large bowel) examination with endoscope for diagnosis [HCPCS 45330]
Colon (lower large bowel) examination with endoscope for diagnosis [HCPCS 45330]
63% lower than market
Esophagus widening (unguided) [HCPCS 43450]
Esophagus widening (unguided) [HCPCS 43450]
63% lower than market
Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]
Bladder examination with chemical injections for destruction of bladder with endoscope [HCPCS 52287]
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
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
43% lower than market
Tendon covering incision [HCPCS 26055]
Tendon covering incision [HCPCS 26055]
64% lower than market
Anesthetic agent and/or steroid injection into brachial nerve bundle of arm [HCPCS 64415]
Anesthetic agent and/or steroid injection into brachial nerve bundle of arm [HCPCS 64415]
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]
Tunneled central venous catheter insertion for infusion with implanted port beneath the skin (5 years of age or older) [HCPCS 36561]
A tunneled centrally inserted central venous catheter (CVC) with a subcutaneous port is placed. A CVC must terminate in the subclavian, brachiocephalic, or iliac veins, the superior or inferior vena cava, or right atrium. A tunneled CVC is placed through a subcutaneous tunnel into the jugular, subclavian, or femoral vein or the inferior vena cava with the most common venous access site for tunneled devices being the jugular vein. Separately reportable imaging guidance may be used to access the venous entry site and/or to manipulate the catheter tip to the final central position. Local anesthesia is administered at the planned puncture site. Using a Seldinger technique to access the jugular vein, the skin and vein are punctured with a needle. A guidewire is inserted through the needle and advanced several centimeters. A subcutaneous pocket is then created for placement of the port. A subcutaneous tunnel is created from the venous access site to the subcutaneous pocket. An introducer sheath and dilator are advanced over the guidewire and the guidewire and dilator removed. The catheter is then advanced through the tunnel to the introducer sheath in the jugular vein and into the brachiocephalic vein, subclavian vein, superior vena cava or right atrium. Placement is checked by separately reportable radiographs. The catheter and port are connected and the port is placed in the subcutaneous pocket. The incision over the venous access site is closed. The port is sutured into place and the pocket is closed.
51% lower than market
Eye fluid drainage device insertion (external approach) [HCPCS 66183]
Eye fluid drainage device insertion (external approach) [HCPCS 66183]
22% lower than market
Peripheral or gastric neurostimulator generator insertion or replacement [HCPCS 64590]
Peripheral or gastric neurostimulator generator insertion or replacement [HCPCS 64590]
28% lower than market
Sacral nerve neurostimulator electrodes implantation [HCPCS 64561]
Sacral nerve neurostimulator electrodes implantation [HCPCS 64561]
28% lower than market
Ureter (urinary duct) stent insertion with endoscope [HCPCS 52332]
Ureter (urinary duct) stent insertion with endoscope [HCPCS 52332]
26% lower than market
Unlisted front (anterior) eye procedure [HCPCS 66999]
Unlisted front (anterior) eye procedure [HCPCS 66999]
54% lower than market
Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]
Prosthetic repair of shoulder joint (total shoulder) [HCPCS 23472]
14% lower than market
Ulnar nerve at elbow release and/or relocation [HCPCS 64718]
Ulnar nerve at elbow release and/or relocation [HCPCS 64718]
66% lower than market
Median nerve of hand release and/or relocation (Carpal Tunnel Release) [HCPCS 64721]
Median nerve of hand release and/or relocation (Carpal Tunnel Release) [HCPCS 64721]
63% lower than market
Shoulder examination and release of shoulder biceps tendon with endoscope [HCPCS 29828]
Shoulder examination and release of shoulder biceps tendon with endoscope [HCPCS 29828]
4% lower than market
Wrist ligament release with endoscope [HCPCS 29848]
Wrist ligament release with endoscope [HCPCS 29848]
74% lower than market
Knee cartilage removal with endoscope (both knees) [HCPCS 29880]
Knee cartilage removal with endoscope (both knees) [HCPCS 29880]
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]
Cataract removal involving removal of the front part of the capsule and the central part of the lens with lens prosthesis insertion [HCPCS 66984]
47% lower than market
Excessive skin removal of upper eyelid and fat around eye [HCPCS 15823]
Excessive skin removal of upper eyelid and fat around eye [HCPCS 15823]
77% lower than market
Shoulder examination and removal of abnormal shoulder joint tissue with endoscope (extensive) [HCPCS 29823]
Shoulder examination and removal of abnormal shoulder joint tissue with endoscope (extensive) [HCPCS 29823]
69% lower than market
Tendon lesion removal from finger or hand [HCPCS 26160]
Tendon lesion removal from finger or hand [HCPCS 26160]
60% lower than market
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
Knee cartilage removal with endoscope (one knee) [HCPCS 29881]
44% lower than market
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]
A flexible colonoscopy is performed with removal of tumors, polyps, or other lesions by hot biopsy forceps or snare technique. The colonoscope is inserted into the rectum and advanced through the colon to the cecum or a point within the terminal ileum, using air insufflation to separate the mucosal folds for better visualization. Mucosal surfaces of the colon are inspected and any abnormalities are noted. The tumor, polyp, or other lesion is identified. Hot biopsy method uses insulated monopolar forceps to remove and electrocoagulate (cauterize) tissue simultaneously. Hot biopsy forceps are used primarily for removal of small polyps and treatment of vascular ectasias. A wire snare loop is placed around the lesion. The loop is heated to shave off and cauterize the lesion. Lesions may be removed en bloc with one placement of the snare or in a piecemeal fashion which requires multiple applications of the snare. The endoscope is withdrawn and mucosal surfaces are again inspected for ulcerations, bleeding sites, lesions, strictures, or other abnormalities.
73% lower than market
Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]
Prostate removal through urethra (bladder canal) by electrosurgery including control of bleeding with endoscope [HCPCS 52601]
59% lower than market
Gallbladder and pancreatic, liver, and bile ducts examination and pancreatic or bile duct stone removal with endoscope [HCPCS 43264]
Gallbladder and pancreatic, liver, and bile ducts examination and pancreatic or bile duct stone removal with endoscope [HCPCS 43264]
27% lower than market
Parathyroid glands removal or inspection [HCPCS 60500]
Parathyroid glands removal or inspection [HCPCS 60500]
51% lower than market
Shoulder examination and shoulder rotator cuff repair with endoscope [HCPCS 29827]
Shoulder examination and shoulder rotator cuff repair with endoscope [HCPCS 29827]
31% lower than market
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
Shoulder examination and shoulder bone shaving with endoscope [HCPCS 29826]
16% lower than market
Kidney stones crushing by shock wave [HCPCS 50590]
Kidney stones crushing by shock wave [HCPCS 50590]
43% lower than market
Salina Surgical Hospital Patient Information Price List
HCPCS - J CODES (OUTPATIENT)
HCPCS - J CODES (OUTPATIENT)
Description
Variance
Adrenalin epinephrine inject [HCPCS J0171]
Adrenalin epinephrine inject [HCPCS J0171]
Injection, adrenalin, epinephrine, 0.1 mg
38% lower than market
Ceftriaxone sodium injection [HCPCS J0696]
Ceftriaxone sodium injection [HCPCS J0696]
Injection, ceftriaxone sodium, per 250 mg
24% higher than market
Dexamethasone sodium phos [HCPCS J1100]
Dexamethasone sodium phos [HCPCS J1100]
Injection, dexamethasone sodium phosphate, 1mg
67% lower than market
Inj enoxaparin sodium [HCPCS J1650]
Inj enoxaparin sodium [HCPCS J1650]
Injection, enoxaparin sodium, 10 mg
60% lower than market
Ketorolac tromethamine inj [HCPCS J1885]
Ketorolac tromethamine inj [HCPCS J1885]
Injection, ketorolac tromethamine, per 15 mg
84% lower than market
Levofloxacin injection [HCPCS J1956]
Levofloxacin injection [HCPCS J1956]
Injection, levofloxacin, 250 mg
6% lower than market
Morphine sulfate injection [HCPCS J2270]
Morphine sulfate injection [HCPCS J2270]
Injection, morphine sulfate, up to 10 mg
58% lower than market
Piperacillin/tazobactam [HCPCS J2543]
Piperacillin/tazobactam [HCPCS J2543]
Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams)
171% higher than market
Salina Surgical Hospital Patient Information Price List
BILLING PROCESS AND INFORMATION
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.
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