Patient Price Information List

Disclaimer: Sparta Community Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, Sparta Community Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 6/30/2020. Sparta Community Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Marshall Browning Hospital

Du Quoin

IL

Memorial Hospital East

Shiloh

IL

Memorial Hospital-Belleville

Belleville

IL

Memorial Hospital-Carbondale

Carbondale

IL

Memorial Hospital-Chester

Chester

IL

Pinckneyville Community Hosp

Pinckneyville

IL

Red Bud Regional Hospital

Red Bud

IL

St Joseph Memorial Hospital-Murphysboro

Murphysboro

IL

St. Elizabeth's Hospital

Belleville

IL

Washington County Hospital

Nashville

IL

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Semi-Private Room

$707
$1,868

62% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]

$1,226
$1,233

1% lower than market

Automated urinalysis test [CPT 81003]

$66
$69

4% lower than market

Biopsy of prostate gland [CPT 55700]

$1,568
$15,795

90% lower than market

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43239]

$4,632
$7,073

35% lower than market

Biopsy of the large bowel using an endoscope (colonoscopy) [CPT 45380]

$5,616
$7,930

29% lower than market

Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]

$194
$278

30% lower than market

Blood test, clotting time [CPT 85610]

$81
$82

1% lower than market

Blood test, comprehensive group of blood chemicals [CPT 80053]

$259
$392

34% lower than market

Blood test, lipids (cholesterol and triglycerides) [CPT 80061]

$246
$331

26% lower than market

Blood test, thyroid stimulating hormone (TSH) [CPT 84443]

$265
$226

17% higher than market

CT scan head or brain [CPT 70450]

$2,327
$2,158

8% higher than market

CT scan of abdomen and pelvis with contrast [CPT 74177]

$5,044
$5,628

10% lower than market

Coagulation assessment blood test, plasma or whole blood [CPT 85730]

$85
$115

26% lower than market

Complete blood cell count (red cells, white blood cell, platelets), automated test [CPT 85027]

$52
$120

57% lower than market

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]

$122
$163

25% lower than market

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43235]

$6,889
$6,775

2% higher than market

Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk [CPT 45378]

$5,133
$5,912

13% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$492
$510

3% lower than market

Diagnostic mammography of one breast [CPT 77065]

$377
$401

6% lower than market

Injection of substance into spinal canal of lower back or sacrum using imaging guidance [CPT 62323]

$2,786
$4,372

36% lower than market

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level [CPT 64483]

$2,707
$3,986

32% lower than market

Kidney function blood test panel [CPT 80069]

$130
$270

52% lower than market

Liver function blood test panel [CPT 80076]

$291
$291

Approximately equal to market

MRI scan of brain before and after contrast [CPT 70553]

$4,098
$5,271

22% lower than market

MRI scan of leg joint [CPT 73721]

$2,933
$3,885

24% lower than market

MRI scan of lower spinal canal [CPT 72148]

$3,399
$3,771

10% lower than market

Manual urinalysis test with examination using microscope, automated [CPT 81001]

$117
$127

8% lower than market

New patient outpatient visit, total time 30-44 minutes [CPT 99203]

$178
$108

65% higher than market

PSA (prostate specific antigen) measurement, free [CPT 84154]

$202
$225

10% lower than market

PSA (prostate specific antigen) measurement, total [CPT 84153]

$130
$255

49% lower than market

Removal of 1 or more breast growth, open procedure [CPT 19120]

$4,903
$15,845

69% lower than market

Removal of cataract with insertion of lens, simple [CPT 66984]

$6,472
$9,115

29% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$16,432
$25,714

36% lower than market

Removal of one knee cartilage using an endoscope [CPT 29881]

$5,547
$17,597

68% lower than market

Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare [CPT 45385]

$5,833
$8,551

32% lower than market

Repair of groin hernia patient age 5 years or older [CPT 49505]

$9,832
$19,868

51% lower than market

Screening mammography of both breasts [CPT 77067]

$647
$418

55% higher than market

Shaving of shoulder bone using an endoscope [CPT 29826]

$12,107
$33,661

64% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab [CPT 95810]

$4,624
$4,678

1% lower than market

Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes [CPT 97110]

$191
$172

11% higher than market

Total Knee or Hip Replacement

$35,691
$51,536

31% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$1,167
$1,471

21% lower than market

Ultrasound pelvis through vagina [CPT 76830]

$1,047
$931

12% higher than market

Urinalysis, manual test [CPT 81002]

$6
$34

82% lower than market

X-ray of lower and sacral spine, minimum of 4 views [CPT 72110]

$460
$1,015

55% lower than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

Critical care delivery critically ill or injured patient, first 30-74 minutes [CPT 99291]

$1,910
$3,342

43% lower than market

Emergency department visit, low to moderately severe problem [CPT 99282]

$232
$569

59% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$406
$912

56% lower than market

Emergency department visit, problem of high severity [CPT 99284]

$811
$1,353

40% lower than market

Emergency department visit, problem with significant threat to life or function [CPT 99285]

$1,129
$1,860

39% lower than market

Emergency department visit, self limited or minor problem [CPT 99281]

$174
$392

56% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Albumin (protein) level [CPT 82040]

$96
$108

11% lower than market

Ammonia level [CPT 82140]

$192
$189

2% higher than market

Amylase (enzyme) level [CPT 82150]

$85
$223

62% lower than market

Analysis for antibody to Ehrlichia (bacteria transmitted by ticks) [CPT 86666]

$112
$372

70% lower than market

Analysis test by nucleic acid for Hepatitis C virus [CPT 87902]

$538
$775

31% lower than market

Bacterial culture and colony count [CPT 87071]

$122
$121

Approximately equal to market

Bacterial culture, any other source except urine, blood or stool, aerobic [CPT 87070]

$161
$224

28% lower than market

Bacterial culture, any source, except blood, anaerobic [CPT 87075]

$253
$264

4% lower than market

Bilirubin level, direct [CPT 82248]

$111
$111

Approximately equal to market

Blood count, hemoglobin [CPT 85018]

$24
$51

52% lower than market

Blood creatinine level [CPT 82565]

$81
$106

24% lower than market

Blood glucose (sugar) test performed by hand-held instrument [CPT 82962]

$17
$84

80% lower than market

Blood group typing (ABO) [CPT 86900]

$81
$99

19% lower than market

Blood typing for Rh (D) antigen [CPT 86901]

$81
$92

12% lower than market

Blood unit compatibility test, antiglobulin technique [CPT 86922]

$198
$200

1% lower than market

Calcium level, ionized [CPT 82330]

$179
$203

12% lower than market

Carcinoembryonic antigen (CEA) protein level [CPT 82378]

$271
$313

14% lower than market

Coagulation function measurement, D-dimer; quantitative [CPT 85379]

$206
$315

35% lower than market

Creatine kinase (cardiac enzyme) level, MB fraction only [CPT 82553]

$120
$194

38% lower than market

Creatine kinase (cardiac enzyme) level, total [CPT 82550]

$92
$131

30% lower than market

Creatinine level to test for kidney function or muscle injury [CPT 82570]

$63
$86

27% lower than market

Detection test by immunoassay technique for Influenza virus, A or B [CPT 87400]

$118
$234

50% lower than market

Detection test by immunoassay technique for bacteria toxin (shiga-like toxin) [CPT 87427]

$92
$286

68% lower than market

Digoxin level, total [CPT 80162]

$171
$158

8% higher than market

Drug test def 1-7 classes [HCPCS G0480]

$164
$322

49% lower than market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral) [CPT 87184]

$101
$122

17% lower than market

Ferritin (blood protein) level [CPT 82728]

$214
$235

9% lower than market

Hemoglobin A1C level [CPT 83036]

$136
$148

8% lower than market

Hepatitis C antibody measurement [CPT 86803]

$143
$162

12% lower than market

Hopd covid-19 spec collect [HCPCS C9803]

$42
$51

17% lower than market

Identification of organisms by immunologic analysis, other than immunofluorescence method [CPT 87147]

$44
$54

19% lower than market

Iron binding capacity [CPT 83550]

$84
$104

19% lower than market

Iron level [CPT 83540]

$80
$128

37% lower than market

LDL cholesterol level [CPT 83721]

$118
$129

9% lower than market

Lactate dehydrogenase (enzyme) level [CPT 83615]

$92
$108

15% lower than market

Lactic acid level [CPT 83605]

$107
$151

29% lower than market

Lipase (fat enzyme) level [CPT 83690]

$111
$155

28% lower than market

Liver enzyme (SGOT), level [CPT 84450]

$101
$133

24% lower than market

Liver enzyme (SGPT), level [CPT 84460]

$106
$126

16% lower than market

Magnesium level [CPT 83735]

$106
$126

16% lower than market

Measurement C-reactive protein for detection of infection or inflammation [CPT 86140]

$198
$200

1% lower than market

Measurement of antibody for assessment of autoimmune disorder, any method [CPT 86235]

$119
$318

63% lower than market

Measurement of antibody for rheumatoid arthritis assessment [CPT 86200]

$286
$283

1% higher than market

Measurement of complement (immune system proteins), antigen, [CPT 86160]

$187
$217

14% lower than market

Nephelometry, test method using light [CPT 83883]

$85
$203

58% lower than market

Pathology examination of tissue using a microscope, intermediate complexity [CPT 88305]

$395
$407

3% lower than market

Pathology examination of tissue using a microscope, moderately low complexity [CPT 88304]

$275
$252

9% higher than market

Phenytoin level, total [CPT 80185]

$176
$207

15% lower than market

Phosphate level [CPT 84100]

$84
$95

12% lower than market

Procalcitonin (hormone) level [CPT 84145]

$326
$338

3% lower than market

Protein measurement, serum [CPT 84165]

$174
$191

9% lower than market

Psa screening [HCPCS G0103]

$130
$220

41% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$590
$725

19% lower than market

Red blood cell concentration measurement [CPT 85014]

$24
$51

52% lower than market

Red blood cell sedimentation rate, to detect inflammation, automated [CPT 85652]

$81
$97

17% lower than market

Rheumatoid factor analysis [CPT 86430]

$96
$186

48% lower than market

Rheumatoid factor level [CPT 86431]

$98
$131

26% lower than market

Screening test for antibody to noninfectious agent [CPT 86255]

$64
$242

74% lower than market

Screening test for autoimmune disorder [CPT 86038]

$187
$192

3% lower than market

Screening test for pathogenic organisms [CPT 87081]

$70
$133

47% lower than market

Screening test for red blood cell antibodies [CPT 86850]

$165
$209

21% lower than market

Smear for parasites [CPT 87177]

$61
$171

65% lower than market

Special Gram or Giemsa stain for microorganism [CPT 87205]

$55
$84

35% lower than market

Special stain for parasites [CPT 87209]

$61
$126

52% lower than market

Stool culture [CPT 87045]

$92
$190

52% lower than market

Stool culture, additional pathogens [CPT 87046]

$92
$120

23% lower than market

Strep test by immunoassay for Streptococcus [CPT 87880]

$62
$73

14% lower than market

Tacrolimus level [CPT 80197]

$384
$472

19% lower than market

Testing for presence of drug, read by instrument assisted observation [CPT 80306]

$202
$207

2% lower than market

Testosterone (hormone) level, free [CPT 84402]

$118
$229

49% lower than market

Thyroxine (thyroid chemical), free [CPT 84439]

$162
$186

13% lower than market

Thyroxine (thyroid chemical), total [CPT 84436]

$155
$169

8% lower than market

Total protein level, urine [CPT 84156]

$77
$91

16% lower than market

Troponin (protein) analysis, quantitative [CPT 84484]

$181
$210

14% lower than market

Urea nitrogen level to assess kidney function, quantitative [CPT 84520]

$96
$98

2% lower than market

Uric acid level, blood [CPT 84550]

$92
$124

26% lower than market

Urine microalbumin (protein) level [CPT 82043]

$63
$189

67% lower than market

Urine pregnancy test [CPT 81025]

$96
$115

17% lower than market

Vancomycin (antibiotic) level [CPT 80202]

$185
$218

15% lower than market

Vitamin D-3 level [CPT 82306]

$61
$261

77% lower than market

White blood cell measure, stool specimen [CPT 89055]

$85
$89

5% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Application of blood vessel compression or decompression device to 1 or more areas [CPT 97016]

$130
$118

10% higher than market

Application of mechanical traction to 1 or more areas [CPT 97012]

$130
$175

26% lower than market

Heart rhythm analysis, interpretation and report of 48-hour EKG [CPT 93226]

$598
$961

38% lower than market

Hydration infusion into a vein 31 minutes to 1 hour [CPT 96360]

$264
$354

25% lower than market

Hydration infusion into a vein [CPT 96361]

$151
$200

25% lower than market

Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour [CPT 96367]

$151
$278

46% lower than market

Infusion into a vein for therapy, prevention, or diagnosis [CPT 96366]

$151
$233

35% lower than market

Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour [CPT 96365]

$264
$484

45% lower than market

Injection beneath the skin or into muscle for therapy, diagnosis, or prevention [CPT 96372]

$136
$186

27% lower than market

Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility [CPT 96376]

$136
$230

41% lower than market

Irrigation of implanted venous access drug delivery device [CPT 96523]

$94
$217

57% lower than market

Medical nutrition therapy, assessment and intervention, each 15 minutes [CPT 97802]

$63
$69

9% lower than market

Multiple measurements of oxygen saturation in blood using ear or finger device [CPT 94761]

$121
$119

1% higher than market

Physician services for outpatient heart rehabilitation with continuous EKG monitoring per session [CPT 93798]

$278
$305

9% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube [CPT 95811]

$4,624
$5,870

21% lower than market

Training in use of orthotics (supports, braces, or splints) for arms, legs and/or trunk, per 15 minutes [CPT 97760]

$131
$124

6% higher than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

Direct refer hospital observ [HCPCS G0379]

$240
$678

65% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Acetaminophen injection [HCPCS J0131]

$1
$2

44% lower than market

Administration of 1 vaccine [CPT 90471]

$53
$107

51% lower than market

Amiodarone hcl [HCPCS J0282]

$10
$34

71% lower than market

Cefazolin sodium injection [HCPCS J0690]

$5
$20

78% lower than market

Cefepime hcl for injection [HCPCS J0692]

$14
$29

51% lower than market

Ceftriaxone sodium injection [HCPCS J0696]

$10
$19

49% lower than market

Dexamethasone sodium phos [HCPCS J1100]

$2
$7

72% lower than market

Dicyclomine injection [HCPCS J0500]

$192
$217

12% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$8
$18

54% lower than market

Ertapenem injection [HCPCS J1335]

$142
$285

50% lower than market

Fentanyl citrate injection [HCPCS J3010]

$9
$19

53% lower than market

Furosemide injection [HCPCS J1940]

$8
$13

39% lower than market

Hydromorphone injection [HCPCS J1170]

$9
$21

59% lower than market

Infliximab not biosimil 10mg [HCPCS J1745]

$306
$1,011

70% lower than market

Inj heparin sodium per 1000u [HCPCS J1644]

$8
$23

64% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$4
$10

55% lower than market

Inj perflutren lip micros,ml [HCPCS Q9957]

$160
$370

57% lower than market

Injection of different drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96375]

$136
$268

49% lower than market

Injection of drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96374]

$136
$301

55% lower than market

Injection, mepolizumab, 1mg [HCPCS J2182]

$78
$274

72% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$4
$15

72% lower than market

Leuprolide acetate suspnsion [HCPCS J9217]

$1,186
$5,354

78% lower than market

Lidocaine injection [HCPCS J2001]

$2
$8

80% lower than market

Lorazepam injection [HCPCS J2060]

$9
$16

47% lower than market

Meropenem [HCPCS J2185]

$7
$20

64% lower than market

Methylprednisolone 80 mg inj [HCPCS J1040]

$28
$69

59% lower than market

Methylprednisolone injection [HCPCS J2930]

$19
$80

77% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$8
$20

60% lower than market

Normal saline solution infus [HCPCS J7030]

$14
$37

62% lower than market

Octreotide injection, depot [HCPCS J2353]

$373
$798

53% lower than market

Omalizumab injection [HCPCS J2357]

$47
$120

61% lower than market

Ondansetron hcl injection [HCPCS J2405]

$2
$4

49% lower than market

Orphenadrine injection [HCPCS J2360]

$11
$55

81% lower than market

Penicillin g benzathine inj [HCPCS J0561]

$29
$139

79% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$10
$45

79% lower than market

Regadenoson injection [HCPCS J2785]

$141
$375

62% lower than market

Tocilizumab injection [HCPCS J3262]

$12
$21

39% lower than market

Triamcinolone acet inj nos [HCPCS J3301]

$9
$11

18% lower than market

Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older [CPT 90715]

$108
$225

52% lower than market

Vancomycin hcl injection [HCPCS J3370]

$12
$44

72% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$150
$314

52% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Elec stim other than wound [HCPCS G0283]

$130
$164

21% lower than market

Evaluation of physical therapy, typically 20 minutes [CPT 97161]

$241
$292

17% lower than market

Evaluation of physical therapy, typically 30 minutes [CPT 97162]

$322
$332

3% lower than market

Manual (physical) therapy techniques to 1 or more regions, each 15 minutes [CPT 97140]

$130
$172

25% lower than market

Therapeutic activities to improve function, with one-on-one contact between patient and provider, each 15 minutes [CPT 97530]

$111
$134

17% lower than market

Treatment of speech, language, voice, communication, and/or hearing processing disorder [CPT 92507]

$225
$279

19% lower than market

Treatment of swallowing and/or oral feeding function [CPT 92526]

$236
$286

18% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Heart rhythm tracing of 48-hour EKG [CPT 93225]

$540
$923

41% lower than market

Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration [CPT 94060]

$762
$743

3% higher than market

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$199
$366

46% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Determination of lung volumes using plethysmography [CPT 94726]

$389
$479

19% lower than market

Measurement of lung diffusing capacity [CPT 94729]

$207
$394

48% lower than market

Measurement of oxygen saturation in blood using ear or finger device [CPT 94760]

$82
$115

29% lower than market

Respiratory inhaled pressure or nonpressure treatment to relieve airway obstruction or for sputum specimen [CPT 94640]

$63
$217

71% lower than market

OUTPATIENT SUPPLIES

Description

Our Charge
Market Charge

Variance

Tc99m sestamibi [HCPCS A9500]

$437
$669

35% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Colorectal cancer screening; colonoscopy on invididual not meeting high risk [HCPCS G0121]

$5,011
$9,225

46% lower than market

Injection procedure into sacroiliac joint for anesthetic or steroid [CPT 27096]

$2,718
$4,751

43% lower than market

Insertion of guide wire with dilation of esophagus using an endoscope [CPT 43248]

$4,587
$9,189

50% lower than market

Insertion of needle into vein for collection of blood sample [CPT 36415]

$35
$35

Approximately equal to market

Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs [CPT 12001]

$2,850
$3,391

16% lower than market

Transfusion of blood or blood products [CPT 36430]

$3,361
$3,740

10% lower than market

Ultrasound measurement of bladder capacity after voiding [CPT 51798]

$1,235
$4,032

69% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]

$505
$538

6% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$3,661
$4,580

20% lower than market

CT scan of abdomen and pelvis before and after contrast [CPT 74178]

$6,444
$6,405

1% higher than market

CT scan of abdominal and pelvic blood vessels with contrast [CPT 74174]

$5,366
$4,847

11% higher than market

CT scan of blood vessels in chest with contrast [CPT 71275]

$3,418
$3,587

5% lower than market

CT scan of lower spine [CPT 72131]

$2,916
$2,796

4% higher than market

MRI scan brain [CPT 70551]

$3,368
$3,853

13% lower than market

MRI scan of abdomen before and after contrast [CPT 74183]

$4,169
$4,798

13% lower than market

MRI scan of arm joint [CPT 73221]

$2,874
$3,779

24% lower than market

MRI scan of upper spinal canal [CPT 72141]

$3,222
$3,753

14% lower than market

Nuclear medicine study of vessels of heart using drugs or exercise multiple studies [CPT 78452]

$4,356
$5,975

27% lower than market

Tte w or wo fol wcon,doppler [HCPCS C8929]

$3,589
$4,183

14% lower than market

Ultrasound behind abdominal cavity [CPT 76770]

$1,114
$1,309

15% lower than market

Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]

$2,583
$4,629

44% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$896
$1,264

29% lower than market

Ultrasound of head and neck [CPT 76536]

$975
$1,213

20% lower than market

Ultrasound of one breast, limited [CPT 76642]

$838
$931

10% lower than market

Ultrasound of pelvis, complete, not pregnancy related [CPT 76856]

$1,058
$1,283

18% lower than market

Ultrasound scan of veins of both arms or legs including assessment of compression and functional maneuvers [CPT 93970]

$2,133
$1,945

10% higher than market

Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers [CPT 93971]

$1,400
$1,307

7% higher than market

Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck [CPT 93880]

$2,057
$2,160

5% lower than market

X-ray of abdomen, 1 view [CPT 74018]

$207
$390

47% lower than market

X-ray of ankle, minimum of 3 views [CPT 73610]

$260
$497

48% lower than market

X-ray of both hips with pelvis, 2 views [CPT 73521]

$326
$399

18% lower than market

X-ray of chest, 1 view [CPT 71045]

$197
$311

37% lower than market

X-ray of chest, 2 views [CPT 71046]

$268
$497

46% lower than market

X-ray of elbow, minimum of 3 views [CPT 73080]

$293
$467

37% lower than market

X-ray of femur, minimum 2 views [CPT 73552]

$231
$552

58% lower than market

X-ray of fingers, minimum of 2 views [CPT 73140]

$252
$406

38% lower than market

X-ray of foot, minimum of 3 views [CPT 73630]

$256
$463

45% lower than market

X-ray of forearm, 2 views [CPT 73090]

$224
$391

43% lower than market

X-ray of hand, minimum of 3 views [CPT 73130]

$257
$499

48% lower than market

X-ray of hip with pelvis, 2-3 views [CPT 73502]

$313
$402

22% lower than market

X-ray of knee, 1 or 2 views [CPT 73560]

$233
$468

50% lower than market

X-ray of knee, 3 views [CPT 73562]

$288
$575

50% lower than market

X-ray of knee, 4 or more views [CPT 73564]

$338
$673

50% lower than market

X-ray of lower and sacral spine, 2 or 3 views [CPT 72100]

$324
$786

59% lower than market

X-ray of lower leg, 2 views [CPT 73590]

$221
$515

57% lower than market

X-ray of middle spine, 3 views [CPT 72072]

$317
$866

63% lower than market

X-ray of pelvis, 1 or 2 views [CPT 72170]

$213
$379

44% lower than market

X-ray of ribs on one side of body including the chest, minimum of 3 views [CPT 71101]

$326
$699

53% lower than market

X-ray of shoulder, minimum of 2 views [CPT 73030]

$244
$471

48% lower than market

X-ray of upper spine, 4 or 5 views [CPT 72050]

$549
$923

41% lower than market

X-ray of wrist, minimum of 3 views [CPT 73110]

$291
$454

36% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Pneumonia with complications

$7,528
$17,861

58% lower than market

Respiratory infections and inflammations with major complications

$11,079
$33,495

67% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Sparta Community 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 Sparta Community 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 Sparta Community 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 Sparta Community 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 618-443-1338.

If you need more information about the price of a future service, please contact our Customer Service at 618-443-1400. 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.