Patient Price Information List

Disclaimer: Sidney Regional Medical Center 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, Sidney Regional Medical Center has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 9/30/2019. Sidney Regional Medical Center's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Box Butte General Hospital

Alliance

NE

Cheyenne Regional Medical Center

Cheyenne

WY

Great Plains Regional Med Ctr

North Platte

NE

Kimball Health Services

Kimball

NE

Medical Center of the Rockies

Loveland

CO

Morrill County Community Hosp

Bridgeport

NE

Ogallala Community Hospital

Ogallala

NE

Perkins County Health Services

Grant

NE

Phelps Memorial Health Center

Holdrege

NE

Regional West Garden County Hospital

Oshkosh

NE

Regional West Medical Center

Scottsbluff

NE

Sterling Regional MedCenter

Sterling

CO

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,721
$1,487

16% higher than market

Intensive Care Unit

$2,840
$2,891

2% lower than market

Coronary Care Unit

$2,840
$2,993

5% 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

hes

$203
$205

1% lower than market

Emergency Department Visit - Level 5

$1,653
$1,653

Approximately equal to 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

$92
$92

Approximately equal to market

PT Evaluation - Moderate Complexity

$185
$186

1% lower than market

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

$91
$91

Approximately equal to market

Physical Therapy 1 or More Regions (15 min)

$99
$99

Approximately equal to market

Physical Therapy Exercise, 15 Minutes

$100
$99

1% higher than market

Physical Therapy, complex evaluation

$255
$257

1% lower than market

Physical Therapy, re-evaluation

$130
$130

Approximately equal to market

Physical Therapy, standard evaluation - 20 minutes

$158
$159

1% lower than market

OUTPATIENT CLINIC CHARGES

Description

Our Charge
Market Charge

Variance

Established patient office or other outpatient visit, typically 10 minutes

$82
$83

1% lower than market

Established patient office visit, standard

$58
$58

Approximately equal to market

New patient office or other outpatient visit, typically 45 min

$220
$277

21% 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 Evaluation - Moderate Complexity

$198
$200

1% lower than market

Occupational Therapy, re-evaluation

$136
$136

Approximately equal to market

Occupational Therapy, standard evaluation - 30 minutes

$172
$174

1% 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

$480
$464

3% higher than market

Spirometry - breathing test

$323
$326

1% lower than market

Spirometry - medicated breathing procedure

$660
$666

1% lower than market

Stress Test with EKG tracing

$1,104
$1,115

1% 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

Ammonia level

$158
$159

1% lower than market

Analysis for antibody to HIV-1 and HIV-2 virus

$121
$149

19% lower than market

Antibody Screen

$280
$282

1% lower than market

Arterial Blood Gases Measurement

$252
$254

1% lower than market

Bacterial Blood Culture

$190
$191

1% lower than market

Bacterial Culture, Any Source Blood

$128
$128

Approximately equal to market

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

$142
$143

1% lower than market

Bilirubin level (Direct)

$64
$64

Approximately equal to market

Blood Typing, ABO

$84
$90

6% lower than market

Blood glucose (sugar) level

$52
$52

1% lower than market

Blood osmolality (concentration) measurement

$108
$109

1% lower than market

Blood potassium level

$59
$59

Approximately equal to market

Blood test, basic group of blood chemicals

$115
$157

27% lower than market

Blood test, basic group of blood chemicals

$114
$105

8% higher than market

Blood test, clotting time

$51
$51

Approximately equal to market

Blood test, comprehensive group of blood chemicals

$143
$144

1% lower than market

Blood test, lipids (cholesterol and triglycerides)

$123
$123

Approximately equal to market

Blood test, thyroid stimulating hormone (TSH)

$111
$112

1% lower than market

Body fluid cell count with cell identification

$125
$159

21% lower than market

Clotting factor II prothrombin, measurement

$102
$180

43% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$182
$183

1% lower than market

Complete blood cell count - automated differential WBC count

$82
$83

1% lower than market

Complete blood cell count - automated test with out Differential

$64
$64

Approximately equal to market

Concentration of specimen for infectious agents

$68
$69

1% lower than market

Crystal identification from tissue or body fluid

$71
$71

Approximately equal to market

Cyclosporine level

$120
$163

26% lower than market

Detection Test for Chlamydia; Amplified Probe Technique

$129
$130

1% lower than market

Detection Test for Hepatitis B

$107
$107

Approximately equal to market

Detection Test for Hepatitis C Virus; Includes Reverse Transcription

$275
$277

1% lower than market

Detection Test for Neisseria Gonorrhoeae

$138
$139

1% lower than market

Detection test for candida species (yeast); direct probe technique

$54
$86

37% lower than market

Detection test for gardnerella vaginalis (bacteria); direct probe technique

$54
$86

37% lower than market

Detection test for multiple types influenza virus

$243
$245

1% lower than market

Detection test for organism; amplified probe technique

$191
$240

20% lower than market

Detection test for trichomonas vaginalis (genital parasite); direct probe technique

$54
$86

37% lower than market

Digoxin level

$128
$128

Approximately equal to market

Folic acid; serum

$141
$142

1% lower than market

Fresh frozen plasma (single donor), frozen within 8 hours of collection, each unit

$272
$301

10% lower than market

Gene analysis (prothrombin, coagulation factor II) A variant

$251
$365

31% lower than market

Glucose Level on Body Fluid

$82
$83

1% lower than market

Gonadotropin (reproductive hormone) analysis

$125
$126

1% lower than market

Gonadotropin, chorionic (reproductive hormone) level

$137
$138

1% lower than market

Hemoglobin A1C level

$84
$85

1% lower than market

Hemoglobin Measurement

$40
$40

Approximately equal to market

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

$196
$197

1% lower than market

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

$126
$213

41% lower than market

Immunoassay for analyte other than infectious agent antibody or infectious agent antigen; quantitative, not otherwise specified

$72
$159

55% lower than market

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

$132
$133

1% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); 12-25 targets

$833
$841

1% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (3-5 targets)

$320
$322

1% lower than market

Infectious agent detection by nucleic acid (DNA or RNA); respiratory virus (6-11 targets)

$670
$739

9% lower than market

Kidney Function Blood Test Panel

$130
$131

1% lower than market

Lactic acid level

$178
$180

1% lower than market

Lipase (fat enzyme) level

$138
$139

1% lower than market

Liver function blood test panel

$122
$122

Approximately equal to market

Mass spectrometry and tandem mass spectrometry (eg, MS, MS/ MS, MALDI, MS-TOF, QTOF), non-drug analyte(s) not elsewhere specified, qualitative or quantitative, each specimen

$136
$156

13% lower than market

Measurement for Strep antibody (strep throat)

$63
$63

Approximately equal to market

Measurement of Complement (Immune System Proteins)

$110
$110

Approximately equal to market

Measurement of antibody for rheumatoid arthritis assessment

$121
$122

1% lower than market

Microscopic Examination of White Blood Cells with Manual Count

$65
$65

Approximately equal to market

Microscopic genetic analysis of tumor; each single antibody stain procedure

$382
$385

1% lower than market

Other closed skull fracture without mention of intracranial injury, with loss of consciousness of unspecified duration

$297
$338

12% lower than market

Oxcarbazepine level

$109
$149

27% lower than market

PSA (prostate specific antigen) measurement

$136
$136

Approximately equal to market

PSA Measurement; Free

$122
$123

1% lower than market

Coagulation assessment blood test

$86
$86

Approximately equal to market

Pathology examination of tissue using a microscope

$123
$152

19% lower than market

Pathology examination of tissue using a microscope, intermediate complexity

$220
$222

1% lower than market

Pathology examination of tissue using a microscope, moderately high complexity

$463
$467

1% lower than market

Pathology examination of tissue using a microscope, moderately low complexity

$186
$187

1% lower than market

Platelets, pheresis, leukocytes reduced, each unit

$1,529
$1,645

7% lower than market

Preparation of tissue for examination by removing any calcium present

$57
$57

Approximately equal to market

Procalcitonin (hormone) level

$199
$200

1% lower than market

Protein measurement, body fluid

$131
$159

17% lower than market

Red Blood Cell Concentration Measurement

$47
$47

Approximately equal to market

Red blood cell sedimentation rate, to detect inflammation

$38
$38

1% lower than market

Screening Test for Red Blood Cell Antibodies

$117
$117

Approximately equal to market

Screening test for Pathogenic Organisms

$80
$79

1% higher than market

Special Stain for Microorganism; Gram or Glemsa Stain

$64
$64

Approximately equal to market

Special stain for parasites

$105
$105

Approximately equal to market

Special stained specimen slides to examine tissue including interpretation and report

$146
$147

1% lower than market

Special stained specimen slides to identify organisms including interpretation and report

$126
$127

1% lower than market

Stool fat analysis

$90
$90

Approximately equal to market

Strep Test

$66
$67

1% lower than market

Tacrolimus Level

$177
$210

16% lower than market

Thyroxine (thyroid chemical) measurement - Total

$86
$87

1% lower than market

Tissue culture for virus isolation

$62
$63

1% lower than market

Tissue or Cell Analysis by Immunologic Technique

$288
$290

1% lower than market

Total Protein Level, Body Fluid

$61
$90

32% lower than market

Total protein level, blood

$59
$60

1% lower than market

Triglycerides level

$44
$44

Approximately equal to market

Troponin (protein) analysis

$215
$216

1% lower than market

Urinalysis with Examination, using Microscope

$54
$54

Approximately equal to market

Urinalysis with Microscopy

$35
$35

Approximately equal to market

Urinalysis, Automated Test

$39
$39

Approximately equal to market

Urine Pregnancy Test

$92
$101

9% lower than market

Urine Volume Measurement

$32
$32

Approximately equal to market

Urine calcium level

$79
$79

Approximately equal to market

Urine microalbumin (protein) level

$95
$96

1% lower than market

Urine sodium level

$73
$74

1% lower than market

Zinc level

$79
$80

1% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Administration of vaccine

$50
$50

Approximately equal to market

Application of mechanical traction to 1 or more areas

$84
$84

Approximately equal to market

Debridement, open wound; first 20 cm2 or less

$285
$860

67% lower than market

Debridement, open wound; each additional 20 cm2 or part thereof

$288
$291

1% lower than market

Evaluation of parameters of single, dual, or multiple lead pacemaker including device connection, re

$103
$104

1% lower than market

Fluoroscopic and video recorded motion evaluation of swallowing function

$378
$381

1% lower than market

Heart rhythm analysis, interpretation and report of 48-hour EKG

$507
$512

1% lower than market

Heart rhythm symptom-related tracing of 24-hour EKG monitoring up to 30 days

$310
$312

1% lower than market

Hormonal anti-neoplastic chemotherapy administration beneath the skin or into muscle

$210
$212

1% lower than market

Hydration Infusion into a Vein

$151
$152

1% lower than market

Hydration Infusion into a Vein - 31 Minutes to 1 Hour

$384
$387

1% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$168
$169

1% lower than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$144
$145

1% lower than market

Infusion of Drug or Substance into Vein for Therapy or Diagnosis

$386
$389

1% lower than market

Infusion of chemotherapy into a vein

$200
$202

1% lower than market

Infusion of different chemotherapy drug or substance into a vein

$214
$216

1% lower than market

Infusion of different chemotherapy drug or substance into a vein up to 1 hour

$232
$234

1% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$135
$136

1% lower than market

Irrigation of implanted venous access drug delivery device

$166
$167

1% lower than market

Needle measurement and recording of electrical activity of muscles of arms or legs

$726
$733

1% lower than market

Negative pressure wound therapy, surface area less than or equal to 50 square centimeters, per sessi

$246
$636

61% lower than market

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

$496
$501

1% lower than market

Non-hormonal anti-neoplastic chemotherapy beneath the skin or into muscle

$243
$243

Approximately equal to market

Orthotic(s)/prosthetic(s) management and/or training, upper extremity(ies), lower extremity(ies), and/or trunk, subsequent orthotic(s)/prosthetic(s) encounter, each 15 minutes

$102
$103

1% lower than market

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

$487
$555

12% lower than market

Pulmonary stress testing, including measurement of heart rate, oximetry and oxygen titration

$455
$459

1% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab

$3,736
$3,889

4% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$165
$171

4% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Analysis and report of external EKG recording for more than 48 hours up to 21 days

$262
$265

1% lower than market

Destruction of peripheral nerve or branch

$1,802
$1,819

1% lower than market

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

$113
$114

1% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$90
$90

Approximately equal to 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

Arterial Puncture

$195
$196

1% lower than market

Nebulizer Treatment

$185
$186

1% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

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

$854
$612

40% higher than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Alignment of knee joint under anesthesia

$2,311
$2,334

1% lower than market

Application of Short Arm Splint

$241
$243

1% lower than market

Application of cast, elbow to finger (short arm)

$295
$298

1% lower than market

Application of chemical agent to excessive wound tissue

$285
$287

1% lower than market

Application of vein wound compression system lower leg below knee including ankle and foot

$279
$281

1% lower than market

Aspiration and/or injection: large joint/bursa

$577
$582

1% lower than market

Aspiration and/or injection: small joint/bursa

$725
$1,054

31% lower than market

Avulsion of nail plate, partial or complete, simple; single

$373
$377

1% lower than market

Biopsy of Large Bowel, Using an Endoscope

$2,413
$2,437

1% lower than market

Biopsy of prostate gland

$1,722
$3,050

44% lower than market

Bladder irrigation and/or instillation

$276
$278

1% lower than market

Collection of blood specimen from a completely implantable venous access device

$163
$164

1% lower than market

Colonscopy

$2,295
$2,317

1% lower than market

Control Nose Bleed - Simple Case

$341
$344

1% lower than market

Control of nose bleed and insertion of packing

$392
$395

1% lower than market

Destruction of skin growth

$139
$140

1% lower than market

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

$2,074
$2,094

1% lower than market

Diagnostic examination of the bladder and bladder canal (urethra) using an endoscope

$1,988
$2,720

27% lower than market

Diagnostic examination of voice box using flexible endoscope

$330
$333

1% lower than market

Dilation of esophagus, by unguided sound or bougie, single or multiple passes

$1,770
$1,787

1% lower than market

Drainage of finger abscess; simple

$426
$430

1% lower than market

Drainage of fluid from abdominal cavity using imaging guidance

$1,177
$1,415

17% lower than market

Epidural Injection Lumbar

$1,492
$2,021

26% lower than market

Epidural Injection Thoracic

$1,702
$1,906

11% lower than market

Removal of cataract with insertion of lens

$2,950
$3,529

16% lower than market

Gallbladder Removal Using an Endoscope

$7,482
$9,237

19% lower than market

Injection of anesthetic and/or steroid into lower spine nerve root using imaging

$2,340
$2,355

1% lower than market

Injections of tendon attachment to bone

$570
$2,139

73% lower than market

Injections of trigger points in 1 or 2 muscles

$309
$495

38% lower than market

Insertion of Central Venous Catheter for Infusion

$1,958
$1,978

1% lower than market

Insertion of Indwelling Bladder Catheter

$189
$191

1% lower than market

Insertion of Needle into Vein to Collect Blood

$29
$29

Approximately equal to market

Removal of one knee cartilage using an endoscope

$5,596
$6,487

14% lower than market

Needle biopsy of kidney, accessed through the skin

$2,534
$2,781

9% lower than market

Removal of 1 or more breast growth, open procedure

$4,304
$5,984

28% lower than market

Colonoscopy with removal of polyp(s)

$2,484
$2,317

7% higher than market

Removal of fluid from chest cavity with imaging guidance

$1,602
$1,818

12% lower than market

Removal of foreign body from ear canal

$223
$225

1% lower than market

Removal of growth (0.5 centimeters or less) of the trunk, arms or legs

$3,107
$6,299

51% lower than market

Removal of growth (3.1 to 4.0 centimeters) of the trunk, arms, or legs

$1,971
$3,484

43% lower than market

Removal of impact ear wax, one ear

$414
$418

1% lower than market

Removal of malignant growth (over 4.0 centimeters) of the face, ears, eyelids, nose, or lips

$1,981
$3,862

49% lower than market

Removal of peripheral venous catheter for infusion

$2,574
$3,212

20% lower than market

Removal of skin and tissue first 20 sq cm or less

$1,425
$1,779

20% lower than market

Repair of Wound (2.6 to 7.5 centimeters)

$421
$424

1% lower than market

Repair of Wound (7.6 to 12.5 cm)

$483
$488

1% lower than market

Repair of groin hernia patient age 5 years or older

$4,356
$7,825

44% lower than market

Repair of wound (12.6 to 20.0 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/

$450
$454

1% lower than market

Shaving of shoulder bone using an endoscope

$1,441
$6,373

77% lower than market

Simple wound repair of face, including ears; 2.5 cm or less

$406
$409

1% lower than market

Simple wound repair of face, including ears; 2.6 cm to 5.0 cm

$437
$441

1% lower than market

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

$394
$397

1% lower than market

Strapping, Unna boot

$272
$274

1% lower than market

Transfusion of Blood or Blood Products

$748
$914

18% lower than market

Ultrasound measurement of bladder capacity after voiding

$221
$223

1% 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

Breast Ultrasound - Limited

$428
$432

1% lower than market

CT Abdomen & Pelvis with Contrast

$4,382
$4,426

1% lower than market

CT Abdomen & Pelvis with and without Contrast

$4,923
$4,973

1% lower than market

CT Abdomen with Contrast

$2,729
$2,756

1% lower than market

CT Abdomen with and without Contrast

$3,132
$3,164

1% lower than market

CT Abdomen without Contrast

$2,246
$2,268

1% lower than market

CT Angiogram Chest with and without Contrast

$3,077
$3,108

1% lower than market

CT Angiogram Head with and without Contrast

$2,939
$2,969

1% lower than market

CT Angiogram Neck with and without Contrast

$2,852
$2,881

1% lower than market

CT Arm with Contrast

$2,497
$2,521

1% lower than market

CT Arm without Contrast

$1,914
$1,933

1% lower than market

CT Chest with Contrast

$2,561
$2,586

1% lower than market

CT Head Brain with and without Contrast

$2,740
$2,767

1% lower than market

CT Head Brain without Contrast

$1,926
$1,945

1% lower than market

CT Leg without Contrast

$1,943
$1,962

1% lower than market

CT Neck with Contrast

$2,603
$2,628

1% lower than market

CT Pelvis with Contrast

$2,711
$2,733

1% lower than market

CT Scan of Abdominal Aorta and Both Leg Arteries with Contrast

$2,931
$2,960

1% lower than market

CT Spine Cervical with Contrast

$2,654
$2,758

4% lower than market

Cardiac testing - doppler color flow, add on

$414
$542

24% lower than market

Cardiac testing - electrocardiogram, doppler

$473
$595

20% lower than market

Chest X-Ray; 2 Views

$337
$340

1% lower than market

Chest X-Ray; Single View

$275
$278

1% lower than market

Diagnostic mammography, bilateral

$414
$418

1% lower than market

Diagnostic mammography, unilateral

$330
$333

1% lower than market

Fluoroscopic guidance for spine or spinal canal injection

$875
$884

1% lower than market

Follow-up or limited heart doppler ultrasound study of heart blood flow, valves, and chambers

$278
$427

35% lower than market

Follow-up or limited ultrasound examination of heart

$758
$765

1% lower than market

Imaging for Evaluation of Swalling Function

$603
$608

1% lower than market

Imaging guidance for procedure, up to 1 hour

$611
$617

1% lower than market

Imaging of Abdomen and Chest

$574
$580

1% lower than market

Imaging of Abdomen; 2 Views

$388
$392

1% lower than market

Imaging of Abdomen; Single View

$306
$309

1% lower than market

Insertion of probe in esophagus for heart ultrasound examination including interpretation and report

$2,312
$2,335

1% lower than market

MRA Neck with and without Contrast

$4,335
$4,659

7% lower than market

MRI Brain with and without Conrast

$4,078
$4,181

2% lower than market

MRI Leg Joint without Contrast

$2,680
$2,707

1% lower than market

MRI Orbit, Face, Neck with and without Contrast

$4,274
$4,412

3% lower than market

MRI Pelvis with and without Contrast

$3,891
$4,118

6% lower than market

MRI Spine Lumbar without Contrast

$3,188
$3,219

1% lower than market

MRI scan of lower spinal canal with contrast

$4,045
$4,085

1% lower than market

Nuclear Medicine Study of Lung Ventilation and Blood Circulation in the Lungs

$2,294
$2,317

1% lower than market

Parathyroid Planar Imaging

$1,446
$1,460

1% lower than market

Physical Therapy, ultrasound therapy - 15 minutes

$80
$80

Approximately equal to market

Radiologic examination, abdomen; 3 or more views

$384
$387

1% lower than market

Radiological supervision and interpretation of CT guidance for needle insertion

$2,077
$2,253

8% lower than market

Screening Mammography, Bilateral, with CAD

$356
$359

1% lower than market

Ultrasound Abdomen - Complete

$866
$875

1% lower than market

Ultrasound Abdomen - Limited

$683
$689

1% lower than market

Ultrasound Behind Abdominal Cavity - Complete

$756
$763

1% lower than market

Ultrasound Guidance for Insertion of Needle

$668
$674

1% lower than market

Ultrasound Head Neck

$657
$663

1% lower than market

Ultrasound Joint Soft Tissue - Complete

$731
$738

1% lower than market

Ultrasound Pelvis NonOB

$784
$791

1% lower than market

Ultrasound Pregnant Uterus > 14 Weeks Pregnant

$790
$790

Approximately equal to market

Ultrasound Scrotum

$675
$681

1% lower than market

Ultrasound Veins of Both Arms or Legs

$1,462
$1,477

1% lower than market

Ultrasound Veins of One Arm or Leg

$960
$969

1% lower than market

Ultrasound limited scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow

$979
$989

1% lower than market

X-Ray Ankle, 2 Views

$279
$282

1% lower than market

X-Ray Ankle, 3 Views

$334
$336

1% lower than market

X-Ray Collar Bone

$310
$313

1% lower than market

X-Ray Elbow, 2 Views

$284
$287

1% lower than market

X-Ray Elbow, 3 Views

$335
$338

1% lower than market

X-Ray Esophagus

$713
$719

1% lower than market

X-Ray Fingers, 2 Views

$243
$245

1% lower than market

X-Ray Foot, 2 Views

$279
$281

1% lower than market

X-Ray Foot, 3 Views

$334
$337

1% lower than market

X-Ray Forearm, 2 Views

$287
$289

1% lower than market

X-Ray Hand, 2 Views

$309
$311

1% lower than market

X-Ray Hand, 3 Views

$330
$333

1% lower than market

X-Ray Hip and Pelvis, 2 Views

$318
$321

1% lower than market

X-Ray Knee, 1-2 Views

$312
$315

1% lower than market

X-Ray Knee, 3 Views

$376
$379

1% lower than market

X-Ray Knee, 4 or More Views

$425
$429

1% lower than market

X-Ray Lower Leg, 2 Views

$315
$317

1% lower than market

X-Ray Lower Sacral Spine, 2-3 Views

$405
$409

1% lower than market

X-Ray Lower Sacral Spine, 4 or More Views

$581
$586

1% lower than market

X-Ray Middle Spine, 3 Views

$357
$361

1% lower than market

X-Ray Neck Soft Tissue

$320
$323

1% lower than market

X-Ray Neck Spine, 2-3 Views

$357
$360

1% lower than market

X-Ray Pelvis, 1-2 Views

$334
$337

1% lower than market

X-Ray Pelvis, 2 Views

$329
$332

1% lower than market

X-Ray Ribs One Side, 2 Views

$337
$340

1% lower than market

X-Ray Shoulder, 1 View

$280
$282

1% lower than market

X-Ray Shoulder, 2 Views

$353
$356

1% lower than market

X-Ray Small Intestine without Contrast

$670
$731

8% lower than market

X-Ray Toes, 2 Views

$247
$249

1% lower than market

X-Ray Upper Arm, 2 Views

$316
$319

1% lower than market

X-Ray Upper Spine, 4-5 Views

$490
$495

1% lower than market

X-Ray Wrist, 2 Views

$280
$282

1% lower than market

X-Ray Wrist, 3 Views

$335
$338

1% lower than market

X-ray of both sides of the ribs, 3 views

$453
$457

1% lower than market

X-ray of breast bone, minimum of 2 views

$332
$335

1% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Cervical spinal fusion without complications

$59,822
$71,361

16% lower than market

Spinal fusion other than the neck without major complications

$92,475
$114,664

19% lower than market

Total Knee or Hip Replacement

$65,323
$52,379

25% higher than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Sidney Regional Medical Center 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 Sidney Regional Medical Center, 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 Sidney Regional Medical Center 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 Sidney Regional Medical Center 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 308-254-8778.

If you need more information about the price of a future service, please contact our Customer Service at 308-254-8778. 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.