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 3/31/2019. 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

$1,417
$1,487

5% lower than market

Semi-Private Room

$1,417
$1,476

4% lower than market

Coronary Care Unit

$2,415
$2,993

19% lower than market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with Level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Description

Our Charge
Market Charge

Variance

Emergency Department Visit - Level 1

$268
$199

35% higher than market

Emergency Department Visit - Level 2

$446
$347

29% higher than market

Emergency Department Visit - Level 3

$120
$518

77% lower than market

Emergency Department Visit - Level 4

$1,289
$841

53% higher than market

Emergency Department Visit - Level 5

$334
$1,598

79% lower than market

Emergency Critical Care, First 30 Minutes

$3,148
$2,949

7% higher than market

OUTPATIENT PHYSICAL THERAPY CHARGES

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Application of Electrical Stimulation - 15 Minutes

$82
$93

12% lower than market

Electric Stimulation for Therapy

$73
$78

7% lower than market

Gait Training - 15 Minutes

$95
$87

9% higher than market

Physical Therapy 1 or More Regions (15 min)

$115
$99

16% higher than market

Physical Therapy Exercise, 15 Minutes

$115
$99

16% higher than market

Physical Therapy, re-evaluation

$111
$127

12% lower than market

OUTPATIENT CLINIC CHARGES

Description

Our Charge
Market Charge

Variance

Established patient office or other outpatient visit, typically 10 minutes

$70
$70

Approximately equal to market

Established patient office or other outpatient, visit typically 25 minutes

$152
$293

48% lower than market

Established patient office visit, complex

$99
$136

27% lower than market

Established patient office visit, comprehensive visit

$214
$230

7% lower than market

New patient office or other outpatient visit, typically 20 minutes

$101
$98

3% higher than market

New patient office or other outpatient visit, typically 45 min

$220
$263

16% lower than market

New patient ofice visit, complex

$146
$165

12% lower than market

New patient ofice visit, comprehensive visit

$287
$531

46% lower than market

OUTPATIENT OCCUPATIONAL THERAPY CHARGES

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Occupational Therapy, re-evaluation

$111
$140

21% 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

$538
$521

3% higher than market

Routine EKG - Minimum 12 Leads

$328
$273

20% higher than market

Spirometry - medicated breathing procedure

$620
$663

6% lower than market

Stress Test with EKG tracing

$1,134
$1,111

2% higher 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

Amylase (enzyme) level

$96
$84

15% higher than market

Arterial Blood Gases Measurement

$272
$236

15% higher than market

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

$141
$143

1% lower than market

Bacterial urine culture

$83
$86

3% lower than market

Blood Typing, ABO

$79
$86

8% lower than market

Blood Typing, Rh (D)

$79
$66

20% higher than market

Blood Unit Compatibility Test; Antiglobulin Technique

$204
$259

21% lower than market

Blood Unit Compatibility Test; Immediate Spin Technique

$199
$203

2% lower than market

Blood potassium level

$61
$58

5% higher than market

Blood test, basic group of blood chemicals

$55
$105

47% lower than market

Blood test, clotting time

$35
$51

31% lower than market

Blood test, comprehensive group of blood chemicals

$66
$143

54% lower than market

Blood test, lipids (cholesterol and triglycerides)

$114
$123

7% lower than market

Blood test, thyroid stimulating hormone (TSH)

$77
$111

31% lower than market

Carbamazepine level

$162
$154

5% higher than market

Carcinoembryonic antigen (CEA) protein level

$171
$180

5% lower than market

Coagulation Function Measurement; D-dimer; quantitative

$194
$182

7% higher than market

Complete blood cell count - automated differential WBC count

$54
$82

34% lower than market

Complete blood cell count - automated test with out Differential

$35
$63

45% lower than market

Creatine kinase Level (cardiac enzyme) - Total

$105
$90

17% higher than market

Cyanocobalamin (vitamin B-12) level

$171
$143

20% higher than market

Detection test for multiple types influenza virus

$147
$268

45% lower than market

Digoxin level

$136
$129

5% higher than market

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

$225
$215

5% higher than market

Ferritin (blood protein) level

$127
$125

1% higher than market

Folic acid; serum

$161
$141

14% higher than market

Hemoglobin A1C level

$95
$84

12% higher than market

Hemoglobin Measurement

$45
$40

14% higher than market

Hepatitis C Antibody Measurement

$126
$135

6% lower than market

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

$715
$726

2% lower than market

Iron Binding Capacity

$91
$78

16% higher than market

Iron level

$72
$69

5% higher than market

Kidney Function Blood Test Panel

$197
$133

49% higher than market

Lactic acid level

$137
$180

24% lower than market

Lipase (fat enzyme) level

$137
$128

7% higher than market

Liver function blood test panel

$156
$133

18% higher than market

Magnesium Level

$40
$77

48% lower than market

Natriuretic peptide (heart and blood vessel protein) level

$339
$302

12% higher than market

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

$216
$334

35% lower than market

PSA (prostate specific antigen) measurement

$123
$130

5% lower than market

PSA Measurement; Free

$149
$125

19% higher than market

Parathormone

$269
$243

10% higher than market

Coagulation assessment blood test

$94
$86

10% higher than market

Pathology examination of tissue using a microscope, moderately high complexity

$447
$457

2% lower than market

Phosphate level

$62
$67

7% lower than market

Procalcitonin (hormone) level

$104
$205

49% lower than market

Prostate Cancer Screening Test

$123
$134

8% lower than market

Protein Measurement, Serum

$52
$106

51% lower than market

Protein test for diagnosis and monitoring of bladder cancer

$135
$113

20% higher than market

Red Blood Cell Concentration Measurement

$45
$46

3% lower than market

Red Blood Cells, Leukocytes Reduced, Each Unit

$483
$526

8% lower than market

Rheumatoid factor analysis

$94
$96

2% lower than market

Screening Test for Autoimmune Disorder

$109
$109

Approximately equal to market

Screening Test for Red Blood Cell Antibodies

$125
$116

8% higher than market

Screening test for Pathogenic Organisms

$92
$78

17% higher than market

Screening test for compatible blood unit

$98
$470

79% lower than market

Strep Test

$53
$57

8% lower than market

Testosterone (hormone) level

$177
$167

6% higher than market

Thyroid Hormone, T3 Measurement, Free

$227
$188

21% higher than market

Thyroxine (thyroid chemical) measurement - Free Thyroxine

$118
$108

9% higher than market

Tissue or Cell Analysis by Immunologic Technique

$257
$307

16% lower than market

Total protein level, blood

$52
$60

13% lower than market

Troponin (protein) analysis

$264
$223

19% higher than market

Urinalysis with Examination, using Microscope

$30
$56

47% lower than market

Urinalysis, Automated Test

$22
$36

38% lower than market

Vitamin D-3 Level

$182
$185

2% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Application of mechanical traction to 1 or more areas

$91
$88

4% higher than market

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

$108
$100

8% higher than market

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

$429
$786

45% lower than market

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

$297
$262

13% higher than market

Electronic analysis of implanted brain spinal cord or peripheral neurostimulator generator system

$62
$278

78% lower than market

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

$721
$617

17% higher than market

Hydration Infusion into a Vein

$130
$152

14% lower than market

Infusion (Additional) for Therapy, Diagnosis or Prevention

$185
$169

9% higher than market

Infusion into a Vein for Therapy, Diagnosis, or Prevention

$122
$143

15% lower than market

Infusion of chemotherapy into a vein

$191
$201

5% lower than market

Injection of Same Drug into Vein for Therapy or Diagnosis

$158
$135

17% higher than market

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

$62
$247

75% lower than market

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

$276
$683

60% lower than market

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

$246
$242

2% higher than market

Pneumococcal vaccine for injection into muscle; 13 valent (PCV13), for intramuscular use

$462
$1,021

55% lower than market

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

$181
$187

3% lower than market

Repositioning maneuvers for treatment of vertigo, per day

$107
$132

19% lower than market

Sleep Monitoring with CPAP

$4,715
$4,354

8% higher than market

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

$3,339
$3,889

14% lower than market

Therapeutic removal of whole blood to correct blood level imbalance

$144
$178

19% lower than market

Vaccine Injection for Pneumococcal Polysaccharide

$294
$395

25% lower than market

Vaccine for influenza administered into muscle, quadrivalent (IIV4) split virus, preservative free, 0.5 mL dosage

$69
$59

18% higher than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital Observation per Hour

$68
$63

8% higher than market

Hospital observation care discharge

$141
$161

13% lower than market

Hospital observation care typically 30 minutes

$193
$177

9% higher than market

Hospital observation care typically 50 minutes

$263
$249

5% higher than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Anesthesia for X-ray or radiation therapy

$43
$72

41% lower than market

Anesthesia for closed procedure on bones of forearm, wrist, or hand

$17
$75

77% lower than market

Anesthesia for closed procedure on knee joint

$59
$137

57% lower than market

Anesthesia for closed procedure on lower leg, ankle, and foot

$42
$159

74% lower than market

Anesthesia for fragmenting, manipulation and/or removal of kidney stone including use of an endoscop

$36
$137

74% lower than market

Anesthesia for insertion of permanent heart pacemaker

$33
$59

44% lower than market

Anesthesia for lens surgery

$49
$59

18% lower than market

Anesthesia for lithotripsy, extracorporeal shock wave; without water bath

$33
$137

76% lower than market

Anesthesia for lower abdominal hernia repair

$27
$102

73% lower than market

Anesthesia for middle or incisional abdominal hernia repair

$24
$83

71% lower than market

Anesthesia for open or endoscopic procedure at upper arm and shoulder joint including

$23
$103

77% lower than market

Anesthesia for open or endoscopic procedure on knee including

$27
$75

64% lower than market

Anesthesia for open procedure on bones of lower leg, ankle and foot

$27
$79

66% lower than market

Anesthesia for procedure in lower abdominal cavity including use of an endoscope

$24
$59

59% lower than market

Anesthesia for procedure on anus and rectum

$39
$72

45% lower than market

Anesthesia for procedure on lower front abdominal wall

$35
$83

58% lower than market

Anesthesia for procedure on male genitalia

$29
$52

44% lower than market

Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of forearm, wrist, and hand

$36
$79

54% lower than market

Anesthesia for procedure on nerves, muscles, tendons, fascia, and bursae of upper leg

$20
$79

74% lower than market

Anesthesia for procedure on urinary system including use of an endoscope

$19
$52

63% lower than market

Anesthesia for removal of prostate including use of an endoscope

$29
$137

79% lower than market

Anesthesia for removal of urinary bladder tumors including use of an endoscope

$28
$137

80% lower than market

Anesthesia for upper gastrointestinal endoscopic procedures, endoscope introduced proximal to duodenum; not otherwise specified

$68
$335

80% lower than market

Destruction of upper or middle spinal facet joint nerves using imaging guidance

$3,690
$3,242

14% higher than market

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

$94
$105

10% lower than market

Hepatitis c antibody screening, for individual at high risk and other covered indication(s)

$126
$148

15% lower than market

Injection, fosphenytoin, 50 mg phenytoin equivalent

$28
$33

16% lower than market

Non-covered item or service

$6
$23

73% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Administration of 1 Vaccine

$78
$90

13% lower than market

Administration of Influenza Virus Vaccine

$78
$67

17% higher than market

Administration of Pneumococcal Vaccine

$78
$80

2% lower than market

Atezolizumab - 1200 mg

$13
$25

47% lower than market

Chemotherapy Infustion - Up to 1 Hour

$627
$631

1% lower than market

Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg

$28
$50

43% lower than market

Injection, Adrenalin, Epinephrine, 0.1 mg

$7
$12

45% lower than market

Injection, Azithromycin, 500 mg

$28
$115

76% lower than market

Injection, Cefazolin Sodium, 500 mg

$11
$48

77% lower than market

Injection, Dexamethasone Sodium Phosphate, 1 mg

$7
$12

45% lower than market

Injection, Diphenhydramine HCL, up to 50 mg

$26
$34

23% lower than market

Injection, Enoxaparin Sodium, 10 mg

$10
$28

64% lower than market

Injection, Fentanyl Citrate, 0.1 mg

$26
$32

19% lower than market

Injection, Furosemide, up to 20 mg

$27
$27

Approximately equal to market

Injection, Heparin Sodium, per 1000 Units

$5
$26

79% lower than market

Injection, Hydromorphone, Up to 4 mg

$28
$33

15% lower than market

Injection, Ketorolac Tromethamine, per 15 mg

$14
$27

50% lower than market

Injection, Lorazepam, 2 mg

$26
$31

17% lower than market

Injection, Magnesium Sulfate, per 500 mg

$14
$33

58% lower than market

Injection, Methylprednisolone Sodium Succinate, up to 125 mg

$45
$56

20% lower than market

Injection, Metoclopramide HCL, Up to 10mg

$26
$35

27% lower than market

Injection, Midazolam Hydrochloride, per 1 mg

$13
$15

13% lower than market

Injection, Morphine Sulfate, up to 10 mg

$27
$36

25% lower than market

Injection, Ondansetron Hydrochloride, per 1 mg

$7
$11

40% lower than market

Injection, Vancomycin HCL, 500 mg

$28
$64

56% lower than market

Injection, adenosine, 1 mg (not to be used to report any adenosine phosphate compounds)

$5
$13

64% lower than market

Injection, alteplase recombinant, 1 mg

$193
$286

33% lower than market

Injection, bortezomib, 0.1 mg

$93
$149

37% lower than market

Injection, ceftazidime, per 500 mg

$10
$43

77% lower than market

Injection, daptomycin, 1 mg

$1
$2

42% lower than market

Injection, diazepam, up to 5 mg

$46
$43

7% higher than market

Injection, doxorubicin hydrochloride, liposomal, not otherwise specified, 10 mg

$764
$2,391

68% lower than market

Injection, ertapenem sodium, 500 mg

$142
$214

34% lower than market

Injection, golimumab, 1 mg, for intravenous use

$70
$79

11% lower than market

Injection, haloperidol, up to 5 mg

$42
$55

24% lower than market

Injection, infliximab, excludes biosimilar, 10 mg

$203
$525

61% lower than market

Injection, methylprednisolone acetate, 40 mg

$43
$47

8% lower than market

Injection, methylprednisolone acetate, 80 mg

$60
$70

14% lower than market

Injection, methylprednisolone sodium succinate, up to 40 mg

$41
$39

6% higher than market

Injection, mitomycin, 5 mg

$315
$316

Approximately equal to market

Injection, neostigmine methylsulfate, up to 0.5 mg

$15
$49

70% lower than market

Injection, pemetrexed, 10 mg

$144
$187

23% lower than market

Injection, phenylephrine hcl, up to 1 ml

$39
$35

12% higher than market

Injection, phytonadione (vitamin k), per 1 mg

$15
$38

60% lower than market

Injection, prochlorperazine, up to 10 mg

$48
$67

28% lower than market

Injection, regadenoson, 0.1 mg

$121
$339

64% lower than market

Injection, rituximab, 100 mg

$1,949
$3,685

47% lower than market

Injection, succinylcholine chloride, up to 20 mg

$18
$43

58% lower than market

Injection, trastuzumab, 10 mg

$216
$717

70% lower than market

Injection, triamcinolone acetonide, not otherwise specified, 10 mg

$11
$22

49% lower than market

Tetanus Vaccine

$129
$149

14% lower than market

OUTPATIENT RESPIRATORY THERAPY CHARGES

The following charges reflect the most common services offered by our Respiratory Therapy department. Patients may have additional charges, depending on the services performed.

Description

Our Charge
Market Charge

Variance

Arterial Puncture

$98
$105

7% lower than market

Nebulizer Treatment

$233
$204

14% higher than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Anchor/screw for opposing bone-to-bone or soft tissue-to-bone (implantable)

$1,653
$1,399

18% higher than market

Joint device (implantable)

$8,949
$14,067

36% lower than market

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

$586
$611

4% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Aspiration and/or injection: large joint/bursa

$316
$538

41% lower than market

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

$128
$367

65% lower than market

Biopsy of Large Bowel, Using an Endoscope

$780
$2,334

67% lower than market

Biopsy of prostate gland

$1,354
$3,366

60% lower than market

Biopsy of the Esophagus, Stomach, Using an Endoscope

$660
$2,434

73% lower than market

Bladder instillation of cancer preventive, inhibiting, or suppressive agent

$881
$816

8% higher than market

Carpal Tunnel Release

$3,283
$3,426

4% lower than market

Collection of blood specimen from a completely implantable venous access device

$150
$163

8% lower than market

Colonoscopy on High Cancer Risk Patient

$2,111
$2,295

8% lower than market

Colonscopy

$610
$2,377

74% lower than market

Colorectal Cancer Screening; Colonoscopy on Non-High Risk Patient

$2,111
$2,312

9% lower than market

Control Nose Bleed - Simple Case

$125
$344

64% lower than market

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

$2,111
$2,009

5% higher than market

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

$1,383
$3,152

56% lower than market

Diagnostic examination of voice box using flexible endoscope

$270
$900

70% lower than market

Drainage of fluid from abdominal cavity using imaging guidance

$492
$1,564

69% lower than market

Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endosc

$8,097
$7,412

9% higher than market

Epidural Injection Lumbar

$926
$2,005

54% lower than market

Epidural Injection Thoracic

$2,802
$1,884

49% higher than market

Removal of cataract with insertion of lens

$3,283
$3,441

5% lower than market

Gallbladder Removal Using an Endoscope

$7,482
$9,269

19% lower than market

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

$1,058
$2,153

51% lower than market

Injections of large bowel using an endoscope

$746
$2,236

67% lower than market

Insertion of Needle into Vein to Collect Blood

$34
$29

17% higher than market

Removal of one knee cartilage using an endoscope

$5,227
$6,669

22% lower than market

Laser vaporization of prostate including control of bleeding using an endoscope

$7,605
$10,723

29% lower than market

Partial removal of collar bone at shoulder using an endoscope

$1,413
$5,318

73% lower than market

Removal of 1 or more breast growth, open procedure

$4,304
$4,690

8% lower than market

Removal of Polyps in Large Bowel, Using an Endoscope

$822
$2,461

67% lower than market

Removal of both knee cartilages using an endoscope

$5,596
$6,102

8% lower than market

Removal of gallbladder with X-ray study of bile ducts using endoscope

$7,277
$10,313

29% lower than market

Removal of impact ear wax, one ear

$101
$492

79% lower than market

Removal of skin and tissue first 20 sq cm or less

$1,015
$2,165

53% lower than market

Removal of tissue from 6 or more finger or toe nails

$62
$82

24% lower than market

Repair of Wound (2.6 to 7.5 centimeters)

$223
$471

53% lower than market

Repair of groin hernia patient age 5 years or older

$4,467
$8,662

48% lower than market

Rotator Cuff Repair

$2,280
$8,350

73% lower than market

Shaving of shoulder bone using an endoscope

$1,441
$6,181

77% lower than market

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

$205
$421

51% lower than market

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

$200
$401

50% lower than market

Transfusion of Blood or Blood Products

$896
$834

7% higher than market

Ultrasound measurement of bladder capacity after voiding

$230
$221

4% higher than market

OUTPATIENT VISION CHARGES

Description

Our Charge
Market Charge

Variance

Posterior chamber intraocular lens

$881
$1,765

50% 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

Bone Density Scan (DEXA Scan)

$684
$655

4% higher than market

Breast Ultrasound - Limited

$403
$380

6% higher than market

CT Abdomen & Pelvis with Contrast

$4,559
$4,437

3% higher than market

CT Abdomen & Pelvis with and without Contrast

$5,294
$5,104

4% higher than market

CT Abdomen & Pelvis without Contrast

$4,255
$4,031

6% higher than market

CT Angiogram Chest with and without Contrast

$3,220
$3,075

5% higher than market

CT Chest with Contrast

$2,592
$2,583

Approximately equal to market

CT Chest without Contrast

$2,373
$2,107

13% higher than market

CT Head Brain without Contrast

$2,022
$1,948

4% higher than market

CT Pelvis with Contrast

$2,607
$2,714

4% lower than market

CT Pelvis without Contrast

$2,143
$2,216

3% lower than market

CT Spine Cervical without Contrast

$2,373
$2,332

2% higher than market

CT Spine Lumbar without Contrast

$2,373
$2,348

1% higher than market

Cardiac testing - doppler color flow, add on

$457
$546

16% lower than market

Cardiac testing - electrocardiogram, doppler

$472
$595

21% lower than market

Chest X-Ray; 2 Views

$343
$338

2% higher than market

Diagnostic mammography, bilateral

$376
$410

8% lower than market

Diagnostic mammography, unilateral

$298
$331

10% lower than market

Fluoroscopic guidance for insertion of needle

$199
$735

73% lower than market

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

$280
$427

34% lower than market

Follow-up or limited ultrasound examination of heart

$822
$763

8% higher than market

Imaging of Abdomen; 2 Views

$420
$389

8% higher than market

Imaging of Abdomen; Single View

$364
$310

17% higher than market

MRI Arm Joint without Contrast

$2,801
$2,614

7% higher than market

MRI Brain with and without Conrast

$4,414
$4,222

5% higher than market

MRI Brain without Contrast

$3,464
$3,138

10% higher than market

MRI Leg Joint without Contrast

$2,816
$2,729

3% higher than market

MRI Spine Cervical without Contrast

$3,401
$3,107

9% higher than market

MRI Spine Lumbar without Contrast

$3,521
$3,222

9% higher than market

Myocardial Perfusion, Tomographic

$4,745
$4,338

9% higher than market

Physical Therapy, ultrasound therapy - 15 minutes

$95
$80

18% higher than market

Screening Mammography, Bilateral, with CAD

$412
$357

15% higher than market

Ultrasound Abdomen - Complete

$1,057
$885

19% higher than market

Ultrasound Behind Abdominal Cavity - Complete

$876
$771

14% higher than market

Ultrasound Blood Flow Outside the Brain

$1,424
$1,218

17% higher than market

Ultrasound Guidance for Insertion of Needle

$136
$680

80% lower than market

Ultrasound Head Neck

$715
$663

8% higher than market

Ultrasound Pelvis NonOB

$916
$794

15% higher than market

Ultrasound Pregnant Uterus > 14 Weeks Pregnant

$936
$807

16% higher than market

Ultrasound Veins of Both Arms or Legs

$1,360
$1,444

6% lower than market

Ultrasound Veins of One Arm or Leg

$1,056
$943

12% higher than market

X-Ray Ankle, 3 Views

$356
$341

5% higher than market

X-Ray Both Hips and Pelvis, 2 Views

$293
$445

34% lower than market

X-Ray Elbow, 3 Views

$381
$316

21% higher than market

X-Ray Fingers, 2 Views

$285
$248

15% higher than market

X-Ray Foot, 2 Views

$297
$260

14% higher than market

X-Ray Foot, 3 Views

$371
$342

9% higher than market

X-Ray Hand, 3 Views

$354
$310

14% higher than market

X-Ray Hip and Pelvis, 2 Views

$356
$319

11% higher than market

X-Ray Knee, 3 Views

$415
$380

9% higher than market

X-Ray Lower Leg, 2 Views

$349
$322

8% higher than market

X-Ray Lower Sacral Spine, 2-3 Views

$470
$407

15% higher than market

X-Ray Lower Sacral Spine, 4 or More Views

$759
$553

37% higher than market

X-Ray Pelvis, 1-2 Views

$354
$337

5% higher than market

X-Ray Ribs One Side, 2 Views

$321
$315

2% higher than market

X-Ray Upper Spine, 4-5 Views

$524
$491

7% higher than market

X-Ray Wrist, 3 Views

$348
$342

2% higher 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

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$15,251
$19,388

21% lower 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.