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 9/30/24. Sparta Community Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

HSHS Saint Elizabeth's Hospital

O'Fallon

IL

Marshall Browning Hospital

DuQuoin

IL

Memorial Hospital

Chester

IL

Memorial Hospital Belleville

Belleville

IL

Memorial Hospital East

Shiloh

IL

Memorial Hospital of Carbondale

Carbondale

IL

Pinckneyville Community Hospital

Pinckneyville

IL

Red Bud Regional Hospital

Red Bud

IL

SIH Saint Joseph Memorial Hospital

Murphysboro

IL

Washington County Hospital

Nashville

IL

LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

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

$286
$244

17% higher than market

Lab analysis of complex special stain to identify parasites [HCPCS 87209]

$74
$146

49% lower than market

Lab analysis of rheumatoid factor [HCPCS 86430]

$117
$95

23% higher than market

Lab analysis of smear to identify and measre the amount of parasites in culture [HCPCS 87177]

$74
$223

67% lower than market

Lab analysis of special gram or Giemsa stain to idenitfy microorganisms [HCPCS 87205]

$64
$103

38% lower than market

Lab analysis of specimen from fine needle aspirate with interpretation and report [HCPCS 88173]

$325
$309

5% higher than market

Lab analysis of stool culture to identify bacteria [HCPCS 87045]

$113
$137

18% lower than market

Lab analysis of urine culture to measure the amount of bacteria [HCPCS 87086]

$229
$186

23% higher than market

Lab analysis of urine specimen by dipstick with microscope (automated) [HCPCS 81001]

$143
$176

19% lower than market

Lab analysis of urine specimen by dipstick without microscope (automated) [HCPCS 81003]

$81
$73

11% higher than market

Lab analysis of urine specimen by dipstick without microscope (non-automated) [HCPCS 81002]

$6
$33

81% lower than market

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

$174
$176

1% lower than market

Lab analysis to evaluate kidney function via a blood test panel [HCPCS 80069]

$166
$280

41% lower than market

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

$98
$93

6% higher than market

Lab analysis to idenitfy tuberculosis (TB) by gamma interferon release assay [HCPCS 86480]

$363
$288

26% higher than market

Lab analysis to idenitfy tumor antigens by immunoassay (quantitative, CA 19-9) [HCPCS 86301]

$365
$285

28% higher than market

Lab analysis to identify Hepatitis C antibodies [HCPCS 86803]

$174
$216

20% lower than market

Lab analysis to identify SARS-CoV-2 by immunoassay with visual observation [HCPCS 87811]

$78
$60

30% higher than market

Lab analysis to identify antibodies for autoimmune disorder assessment (any method) [HCPCS 86235]

$32
$275

88% lower than market

Lab analysis to identify antibodies for rheumatoid arthritis assessment [HCPCS 86200]

$348
$317

10% higher than market

Lab analysis to identify antibodies to Ehrlichia (bacteria transmitted by ticks) [HCPCS 86666]

$136
$442

69% lower than market

Lab analysis to identify antibodies to Rickettsia (bacteria) [HCPCS 86757]

$68
$175

61% lower than market

Lab analysis to identify antibodies to native or double stranded DNA [HCPCS 86225]

$32
$303

90% lower than market

Lab analysis to identify antibodies to white blood cells [HCPCS 86021]

$623
$504

24% higher than market

Lab analysis to identify organisms by an immunologic technique (other than immunoflurescence) [HCPCS 87147]

$54
$73

27% lower than market

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

$322
$258

25% higher than market

Lab analysis to identify tumor antigens by immunoassay (quantitative, CA 15-3) [HCPCS 86300]

$74
$362

79% lower than market

Lab analysis to measure blood count (hemoglobin) [HCPCS 85018]

$30
$58

48% lower than market

Lab analysis to measure blood glucose (sugar) level with hand-held instrument [HCPCS 82962]

$17
$119

86% lower than market

Lab analysis to measure coagulation function measurement of D-dimer (quantitative) [HCPCS 85379]

$263
$343

23% lower than market

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

$103
$131

21% lower than market

Lab analysis to measure complete blood cell count (red cells, white blood cell, and platelets), automated test [HCPCS 85027]

$67
$124

46% lower than market

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

$160
$192

17% lower than market

Lab analysis to measure free thyroxine (thyroid chemical) in serum specimen [HCPCS 84439]

$198
$213

7% lower than market

Lab analysis to measure red blood cell concentration [HCPCS 85014]

$30
$58

49% lower than market

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (automated) [HCPCS 85652]

$94
$116

19% lower than market

Lab analysis to measure red blood count with additional calculations (automated test) [HCPCS 85046]

$95
$69

37% higher than market

Lab analysis to measure the LDL cholesterol level [HCPCS 83721]

$143
$152

6% lower than market

Lab analysis to measure the ammonia level [HCPCS 82140]

$217
$209

4% higher than market

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

$241
$239

1% higher than market

Lab analysis to measure the amount of acetaminophen in blood specimen [HCPCS 80143]

$273
$166

64% higher than market

Lab analysis to measure the amount of albumin, total and direct bilirubin, alkaline phosphatase, total protein, alanine amino transferase, and asparate amino transferase in blood specimen to evaluate liver function [HCPCS 800

$355
$337

5% higher than market

Lab analysis to measure the amount of alcohol in any specimen other than breath or urine [HCPCS 82077]

$200
$153

31% higher than market

Lab analysis to measure the amount of blood gases [HCPCS 82803]

$426
$351

21% higher than market

Lab analysis to measure the amount of blood in stool specimen by peroxidase activity [HCPCS 82272]

$57
$70

19% lower than market

Drug screening read by direct visual reading with instrument assistance [HCPCS 80306]

$246
$421

42% lower than market

Lab analysis by immunoassay (ELISA) to identify bacteria toxin (shiga-like toxin) [HCPCS 87427]

$332
$113

193% higher than market

Lab analysis by immunoassay (ELISA) to identify infectious organism antigen (multiple-step method, each organism) [HCPCS 87449]

$113
$232

51% lower than market

Lab analysis to measure the amount of carbamazepine (total) in blood specimen [HCPCS 80156]

$256
$184

39% higher than market

Lab analysis by immunoassay to identify Strep (streptococcus) [HCPCS 87880]

$41
$188

78% lower than market

Lab analysis to measure the amount of free PSA (prostate specific antigen) in serum specimen [HCPCS 84154]

$246
$291

15% lower than market

Lab analysis by immunologic analysis technique on serum (immunofixation) [HCPCS 86334]

$423
$224

89% higher than market

Lab analysis to measure the amount of free thyroid hormone, T3 in serum specimen [HCPCS 84481]

$366
$288

27% higher than market

Lab analysis to measure the amount of gammaglobulin (immune system protein) [HCPCS 82784]

$277
$255

9% higher than market

Lab analysis to measure the amount of hepatitis A antibody, hepatitis B core antibody, hepatitis B surface antigen, and hepatitis C antibody in blood specimen to evaluate acute hepatitis [HCPCS 80074]

$968
$693

40% higher than market

Lab analysis to measure the amount of immune system protein (complement) antigens (each component) [HCPCS 86160]

$217
$254

15% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify antigen of severe acute respiratory syndrome coronavirus 2 (Covid-19) [HCPCS 87635]

$252
$190

32% higher than market

Lab analysis to measure the amount of lipids (cholesterol and triglycerides) in blood specimen [HCPCS 80061]

$299
$317

6% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify multiple types of the influenza virus (first 2 types or sub-types) [HCPCS 87502]

$358
$317

13% higher than market

Lab analysis to measure the amount of protein in body fluid specimen [HCPCS 84166]

$142
$285

50% lower than market

Lab analysis by nucleic acid (DNA or RNA) to measure the amount of cytomegalovirus [HCPCS 87497]

$788
$879

10% lower than market

Lab analysis by nucleic acid (DNA or RNA) to measure the amount of organisms [HCPCS 87799]

$657
$874

25% lower than market

Lab analysis to measure the amount of protein in serum specimen [HCPCS 84165]

$202
$131

53% higher than market

Lab analysis of any culture (except blood) to identify fungus (mold or yeast) [HCPCS 87102]

$77
$150

49% lower than market

Lab analysis to measure the amount of salicylate in blood specimen [HCPCS 80179]

$208
$192

8% higher than market

Lab analysis of any culture (except urine, blood, or stool) to identify bacteria [HCPCS 87070]

$141
$269

48% lower than market

Lab analysis to measure the amount of substance by other immunoassay technique [HCPCS 83520]

$82
$435

81% lower than market

Lab analysis to measure the amount of tacrolimus in blood specimen [HCPCS 80197]

$467
$600

22% lower than market

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

$166
$307

46% lower than market

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

$236
$301

21% lower than market

Lab analysis to measure the amount of total cortisol (hormone) [HCPCS 82533]

$285
$268

6% higher than market

Lab analysis to measure the amount of total digoxin in blood specimen [HCPCS 80162]

$208
$181

15% higher than market

Lab analysis to measure the amount of total phenytoin in blood specimen [HCPCS 80185]

$214
$244

12% lower than market

Lab analysis to measure the amount of total valproic acid in blood specimen [HCPCS 80164]

$240
$181

33% higher than market

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

$212
$252

16% lower than market

Lab analysis to measure the amount of vancomycin (antibiotic) in serum specimen [HCPCS 80202]

$225
$252

11% lower than market

Lab analysis to measure the amount of white blood cells in stool specimen [HCPCS 89055]

$103
$110

6% lower than market

Lab analysis to measure the amylase (enzyme) level in serum specimen [HCPCS 82150]

$108
$263

59% lower than market

Lab analysis to measure the blood potassium level in blood specimen [HCPCS 84132]

$98
$85

15% higher than market

Lab analysis to measure the carcinoembryonic antigen (cea) protein level [HCPCS 82378]

$330
$395

17% lower than market

Lab analysis to measure the creatinine level in blood specimen to test for kidney function or muscle injury [HCPCS 82565]

$94
$115

19% lower than market

Lab analysis to measure the creatinine level to test for kidney function or muscle injury (other than blood specimen) [HCPCS 82570]

$77
$113

32% lower than market

Lab analysis to measure the cyanocobalamin (vitamin b-12) level [HCPCS 82607]

$291
$204

43% higher than market

Lab analysis to measure the direct bilirubin level [HCPCS 82248]

$136
$122

11% higher than market

Lab analysis to measure the ferritin (blood protein) level [HCPCS 82728]

$261
$260

Approximately equal to market

Lab analysis to measure the folic acid level in serum specimen [HCPCS 82746]

$269
$207

30% higher than market

Lab analysis to measure the glucose (sugar) level in blood [HCPCS 82947]

$103
$106

3% lower than market

Lab analysis to measure the haptoglobin (serum protein) level in serum specimen [HCPCS 83010]

$284
$172

65% higher than market

Lab analysis to measure the hemoglobin A1C level in blood specimen [HCPCS 83036]

$158
$166

5% lower than market

Lab analysis to measure the iron binding capacity [HCPCS 83550]

$98
$123

21% lower than market

Lab analysis to measure the liver enzyme (sgpt), level in serum or plasma specimen [HCPCS 84460]

$123
$159

23% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$93
$146

37% lower than market

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

$130
$145

11% lower than market

Lab analysis to measure the lactate dehydrogenase (enzyme) level [HCPCS 83615]

$113
$126

11% lower than market

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

$130
$169

23% lower than market

Lab analysis to measure the microalbumin (protein) level in urine specimen [HCPCS 82043]

$204
$228

10% lower than market

Lab analysis to measure the level of blood proteins (nephelometry) using light [HCPCS 83883]

$104
$230

55% lower than market

Lab analysis to measure the natriuretic peptide (heart and blood vessel protein) level in plasma specimen [HCPCS 83880]

$470
$319

47% higher than market

Lab analysis to measure the lipase (fat enzyme) level [HCPCS 83690]

$142
$183

22% lower than market

Lab analysis to measure the liver enzyme (sgot), level in serum or plasma specimen [HCPCS 84450]

$123
$161

23% lower than market

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

$228
$383

41% lower than market

Lab analysis to measure the phosphate level [HCPCS 84100]

$98
$104

6% lower than market

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

$113
$142

21% lower than market

Lab analysis to measure the total protein level in blood specimen [HCPCS 84155]

$202
$90

125% higher than market

Lab analysis to measure the total protein level in urine specimen [HCPCS 84156]

$94
$103

9% lower than market

Lab analysis to measure the triglycerides level in serum or plasma specimen [HCPCS 84478]

$130
$187

31% lower than market

Lab analysis to measure the uric acid level in blood specimen [HCPCS 84550]

$112
$146

23% lower than market

Lab analysis to measure the vitamin B-1 (thiamine) level in blood specimen [HCPCS 84425]

$292
$331

12% lower than market

Lab analysis to measure the vitamin D-3 level in serum or plasma specimen [HCPCS 82306]

$218
$312

30% lower than market

Lab analysis to measure total testosterone (hormone) level in serum specimen [HCPCS 84403]

$461
$395

17% higher than market

Lab analysis to measure urea nitrogen level in serum or plasma specimen to assess kidney function (quantitative) [HCPCS 84520]

$112
$105

6% higher than market

Lab analysis to screen for autoimmune disorders [HCPCS 86038]

$227
$257

12% lower than market

Lab analysis to screen for pathogenic organisms [HCPCS 87081]

$86
$137

37% lower than market

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

$353
$409

14% lower than market

Lab blood analysis to confirm blood unit compatibility by antiglobulin technique [HCPCS 86922]

$241
$208

16% higher than market

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

$99
$97

3% higher than market

Lab blood analysis to identify antigens on red blood cell surface and determine the patient's blood group type (ABO) [HCPCS 86900]

$98
$112

12% lower than market

Lab blood analysis to screen for antibodies to red blood cell antigens (each serum technique) [HCPCS 86850]

$201
$229

12% lower than market

Lab examination of specimen by the selective celllular enhancement technique to diagnose disease [HCPCS 88112]

$253
$217

17% higher than market

Pathology lab analysis by flow cytometry technique for DNA or cell analysis technical component (each additional marker) [HCPCS 88185]

$160
$223

28% lower than market

Pathology lab analysis of special stained specimen slides to examine tissue (each additional procedure) [HCPCS 88341]

$307
$282

9% higher than market

Pathology lab analysis of special stained specimen slides to examine tissue (each multiplex stain) [HCPCS 88344]

$454
$355

28% higher than market

Pathology lab analysis of special stained specimen slides to examine tissue (initial procedure) [HCPCS 88342]

$408
$337

21% higher than market

Pathology lab analysis of tissue with microscope (intermediate complexity) [HCPCS 88305]

$436
$533

18% lower than market

Pathology lab analysis of tissue with microscope (moderately high complexity) [HCPCS 88307]

$692
$798

13% lower than market

Pathology lab analysis of tissue with microscope (moderately low complexity) [HCPCS 88304]

$335
$324

3% higher than market

Psa screening [HCPCS G0103]

$166
$268

38% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$717
$804

11% lower than market

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Semi-Private Room

$900
$1,802

50% lower than market

CT SCAN

Description

Our Charge
Market Charge

Variance

Abdominal and pelvic CT scan with contrast for injury, foreign bodies, or tumors [HCPCS 74177]

$6,132
$6,419

4% lower than market

Abdominal and pelvic CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 74176]

$4,451
$5,022

11% lower than market

Abdominal and pelvic CT scan without contrast, followed by contrast for injury, foreign bodies, or tumors [HCPCS 74178]

$7,833
$7,119

10% higher than market

CTA scan of chest blood vessels with contrast to examine injury, foreign bodies, or tumors [HCPCS 71275]

$4,155
$4,379

5% lower than market

CTA scan of head blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70496]

$3,237
$3,110

4% higher than market

CTA scan of neck blood vessels with contrast to examine blood clots or aneurysms [HCPCS 70498]

$3,518
$3,789

7% lower than market

Chest CT scan with contrast to examine injury, foreign bodies, or tumors [HCPCS 71260]

$4,509
$3,587

26% higher than market

Chest CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 71250]

$3,730
$2,910

28% higher than market

Facial CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70486]

$3,671
$2,862

28% higher than market

Head or brain CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 70450]

$2,829
$2,646

7% higher than market

Leg CT scan without contrast for injury, foreign bodies, or tumors [HCPCS 73700]

$3,478
$2,621

33% higher than market

Neck CT scan of the soft tissue of the neck with contrast to examine injury, foreign bodies, or tumors [HCPCS 70491]

$4,360
$3,249

34% higher than market

Pelvis CT scan without contrast to examine injury, foreign bodies, or tumors [HCPCS 72192]

$3,339
$2,816

19% higher than market

Spinal CT scan of lower spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72131]

$3,545
$3,336

6% higher than market

Spinal CT scan of middle spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72128]

$3,390
$3,083

10% higher than market

Spinal CT scan of upper spine without contrast to examine injury, foreign bodies, or tumors [HCPCS 72125]

$3,734
$3,270

14% higher than market

CLINIC

Description

Our Charge
Market Charge

Variance

Established patient office or outpatient visit with physician or other healthcare professional to diagnose and treat illness or injury (presenting problem is minimal) [HCPCS 99211]

$214
$122

76% higher than market

Established patient office or outpatient visit with physician to diagnose and treat illness or injury (total time 10-19 minutes) [HCPCS 99212]

$155
$120

29% higher than market

EKG/ECG/ECHO

Description

Our Charge
Market Charge

Variance

Physician services for outpatient heart rehab with continuous EKG monitoring (per session) [HCPCS 93798]

$338
$348

3% lower than market

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

$292
$473

38% lower than market

EMERGENCY ROOM

Description

Our Charge
Market Charge

Variance

Critical care delivery to critically ill or injured patient (first 30-74 minutes) [HCPCS 99291]

$2,323
$4,602

50% lower than market

Emergency department visit for minor problem [HCPCS 99281]

$212
$436

51% lower than market

Emergency department visit for problem of high severity [HCPCS 99284]

$986
$1,510

35% lower than market

Emergency department visit for problem of low to moderate severity [HCPCS 99282]

$282
$689

59% lower than market

Emergency department visit for problem of moderate severity [HCPCS 99283]

$494
$1,088

55% lower than market

Emergency department visit for problem with significant threat to life [HCPCS 99285]

$1,372
$2,188

37% lower than market

IMAGING

Description

Our Charge
Market Charge

Variance

Abdominal and pelvic vessels CTA scan with contrast [HCPCS 74174]

$6,523
$6,433

1% higher than market

Bone density measurement of the axial skeleton (hips, pelvis, spine) [HCPCS 77080]

$615
$607

1% higher than market

Imaging of heart vessels with SPECT tomography and drugs or exercise (multiple studies) [HCPCS 78452]

$5,852
$7,496

22% lower than market

Transthoracic echocardiography with contrast, or without contrast followed by with contrast, real-time with image documentation (2d), includes m-mode recording, when performed, complete, with spectral doppler echocardiography

$3,297
$5,761

43% lower than market

PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Piperacillin/tazobactam [HCPCS J2543]

$10
$19

49% lower than market

Regadenoson injection [HCPCS J2785]

$141
$350

60% lower than market

Tc99m sestamibi [HCPCS A9500]

$582
$682

15% lower than market

Tetanus, diphtheria toxoids and acellular pertussis (whooping cough) vaccine for injection into muscle (7 years of age or older) [HCPCS 90715]

$123
$151

19% lower than market

Vancomycin hcl injection [HCPCS J3370]

$12
$36

65% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$150
$393

62% lower than market

Acetaminophen injection [HCPCS J0131]

$1
$1

16% lower than market

Alteplase recombinant [HCPCS J2997]

$228
$234

3% lower than market

Amiodarone hcl [HCPCS J0282]

$10
$11

12% lower than market

Cefazolin sodium injection [HCPCS J0690]

$9
$14

34% lower than market

Cefepime hcl for injection [HCPCS J0692]

$24
$21

18% higher than market

Ceftriaxone sodium injection [HCPCS J0696]

$12
$17

30% lower than market

Dexamethasone sodium phos [HCPCS J1100]

$1
$7

88% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$8
$22

62% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of new drug) [HCPCS 96375]

$165
$266

38% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (initial drug) [HCPCS 96374]

$165
$315

48% lower than market

Drugs unclassified injection [HCPCS J3490]

$28
$78

64% lower than market

Ertapenem injection [HCPCS J1335]

$142
$225

37% lower than market

Fentanyl citrate injection [HCPCS J3010]

$9
$18

53% lower than market

Furosemide injection [HCPCS J1940]

$4
$13

68% lower than market

Gamunex-c/gammaked [HCPCS J1561]

$145
$120

21% higher than market

Infliximab not biosimil 10mg [HCPCS J1745]

$123
$238

48% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$4
$10

63% lower than market

Inj heparin sodium per 1000u [HCPCS J1644]

$8
$9

6% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$4
$9

54% lower than market

Inj perflutren lip micros,ml [HCPCS Q9957]

$160
$543

70% lower than market

Inj, propofol, 10 mg [HCPCS J2704]

$1
$10

92% lower than market

Injection, dalbavancin [HCPCS J0875]

$46
$1,099

96% lower than market

Injection, remdesivir, 1 mg [HCPCS J0248]

$16
$18

15% lower than market

Injection, vedolizumab [HCPCS J3380]

$76
$90

15% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$16
$11

45% higher than market

Leuprolide acetate suspnsion [HCPCS J9217]

$1,186
$3,105

62% lower than market

Lidocaine injection [HCPCS J2001]

$2
$6

67% lower than market

Lorazepam injection [HCPCS J2060]

$9
$18

53% lower than market

Meropenem [HCPCS J2185]

$1
$8

83% lower than market

Methylprednisolone 40 mg inj [HCPCS J1030]

$11
$47

78% lower than market

Methylprednisolone 80 mg inj [HCPCS J1040]

$28
$76

63% lower than market

Methylprednisolone injection [HCPCS J2930]

$19
$44

57% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$8
$19

56% lower than market

Normal saline solution infus [HCPCS J7030]

$18
$37

52% lower than market

Ondansetron hcl injection [HCPCS J2405]

$2
$4

49% lower than market

PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

Elec stim other than wound [HCPCS G0283]

$158
$218

27% lower than market

Electrical stimulation application to 1 or more areas (each 15 minutes) [HCPCS 97032]

$212
$179

18% higher than market

Function improvement activities with one-on-one contact between patient and provider (each 15 minutes) [HCPCS 97530]

$136
$163

17% lower than market

Hot wax bath application to 1 or more areas [HCPCS 97018]

$158
$110

44% higher than market

Physcial therapy exercise of walking training to 1 or more areas (each 15 minutes) [HCPCS 97116]

$212
$182

16% higher than market

Physical therapy evaluation (typically 20 minutes) [HCPCS 97161]

$308
$362

15% lower than market

Physical therapy evaluation (typically 30 minutes) [HCPCS 97162]

$392
$423

7% lower than market

Physical therapy exercise to develop strength, endurance, range of motion, and flexibility (each 15 minutes) [HCPCS 97110]

$233
$197

18% higher than market

Physical therapy procedure to re-educate brain-to-nerve-to-muscle function (each 15 minutes) [HCPCS 97112]

$212
$183

15% higher than market

Physical therapy techniques to 1 or more regions (each 15 minutes) [HCPCS 97140]

$158
$206

23% lower than market

Speech, language, voice, communication, and/or hearing processing disorder treatment [HCPCS 92507]

$286
$434

34% lower than market

RESPIRATORY/PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

Amount and speed of breathed air measurement and graphic recording before and after medication administration [HCPCS 94060]

$926
$991

7% lower than market

Lung diffusing capacity measurement [HCPCS 94729]

$252
$710

65% lower than market

Lung volumes measurement by plethysmography [HCPCS 94726]

$473
$579

18% lower than market

Total and timed exhaled air capacity measurement and graphic recording [HCPCS 94010]

$536
$418

28% higher than market

SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Needle insertion into vein for collection of blood sample [HCPCS 36415]

$37
$41

10% lower than market

ULTRASOUND

Description

Our Charge
Market Charge

Variance

Abdominal ultrasound (complete) [HCPCS 76700]

$1,419
$1,863

24% lower than market

Abdominal ultrasound (limited) [HCPCS 76705]

$1,090
$1,489

27% lower than market

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (complete, both arms or legs) [HCPCS 93970]

$2,593
$2,188

18% higher than market

Arms or legs veins ultrasound with assessment of compression and functional maneuvers (limited, one arm or leg) [HCPCS 93971]

$1,702
$1,505

13% higher than market

Arteries of both arms and legs ultrasound (complete) [HCPCS 93923]

$1,895
$1,525

24% higher than market

Arteries of both arms and legs ultrasound (limited) [HCPCS 93922]

$1,222
$881

39% higher than market

Blood flow (outside of the brain) ultrasound on both sides of head and neck [HCPCS 93880]

$2,500
$2,732

8% lower than market

Breast ultrasound (one breast, limited) [HCPCS 76642]

$1,019
$1,087

6% lower than market

Head and neck ultrasound [HCPCS 76536]

$1,186
$1,570

24% lower than market

Imaging of pelvis by ultrasound through vagina [HCPCS 76830]

$1,212
$1,150

5% higher than market

Pelvis ultrasound, not pregrnancy related (complete) [HCPCS 76856]

$1,287
$1,532

16% lower than market

Ultrasound application to 1 or more areas (each 15 minutes) [HCPCS 97035]

$223
$204

9% higher than market

Ultrasound of area behind abdominal cavity (complete) [HCPCS 76770]

$1,355
$1,578

14% lower than market

MRI

Description

Our Charge
Market Charge

Variance

Imaging of abdomen by MRI without contrast, followed by contrast [HCPCS 74183]

$5,067
$5,720

11% lower than market

Imaging of arm joint by MRI without contrast [HCPCS 73221]

$3,493
$4,743

26% lower than market

Imaging of brain by MRI without contrast [HCPCS 70551]

$4,095
$4,434

8% lower than market

Imaging of brain by MRI without contrast, followed by contrast [HCPCS 70553]

$4,981
$6,225

20% lower than market

Imaging of leg by MRI without contrast [HCPCS 73718]

$3,661
$4,141

12% lower than market

Imaging of leg joint by MRI without contrast [HCPCS 73721]

$3,565
$4,768

25% lower than market

Imaging of lower spinal canal by MRI without contrast [HCPCS 72148]

$4,132
$4,538

9% lower than market

Imaging of upper spinal canal by MRI without contrast [HCPCS 72141]

$3,917
$4,445

12% lower than market

VACCINE ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Immunization administration of vaccine into, between, or beneath the skin or into muscle (single vaccine) [HCPCS 90471]

$65
$129

50% lower than market

X-RAY

Description

Our Charge
Market Charge

Variance

Abdominal x-ray (single view) [HCPCS 74018]

$264
$447

41% lower than market

Abdominal x-ray, complete study including 2 or more views of abdomen and single view of chest [HCPCS 74022]

$500
$881

43% lower than market

Ankle x-ray (minimum of 3 views) [HCPCS 73610]

$317
$594

47% lower than market

Arm x-ray of forearm (2 views) [HCPCS 73090]

$273
$498

45% lower than market

Arm x-ray of upper arm (minimum of 2 views) [HCPCS 73060]

$288
$472

39% lower than market

Chest x-ray (2 views) [HCPCS 71046]

$403
$567

29% lower than market

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

$251
$362

31% lower than market

Elbow x-ray, complete study (minimum of 3 views) [HCPCS 73080]

$357
$556

36% lower than market

Finger(s) x-ray (minimum of 2 views) [HCPCS 73140]

$292
$480

39% lower than market

Foot x-ray (2 views) [HCPCS 73620]

$263
$421

38% lower than market

Foot x-ray, complete study (minimum of 3 views) [HCPCS 73630]

$311
$548

43% lower than market

Hand x-ray (minimum of 2 views) [HCPCS 73130]

$313
$565

45% lower than market

Hip x-ray of both hips with pelvis (2 views) [HCPCS 73521]

$397
$577

31% lower than market

Hip x-ray of both hips with pelvis (3 to 4 views) [HCPCS 73522]

$599
$528

13% higher than market

Hip x-ray of hip with pelvis (2 to 3 views) [HCPCS 73502]

$380
$459

17% lower than market

Knee x-ray (1 or 2 views) [HCPCS 73560]

$284
$544

48% lower than market

Knee x-ray (3 views) [HCPCS 73562]

$334
$679

51% lower than market

Knee x-ray (4 or more views) [HCPCS 73564]

$431
$776

44% lower than market

Lower leg x-ray (2 views) [HCPCS 73590]

$269
$585

54% lower than market

Pelvis x-ray (1 or 2 views) [HCPCS 72170]

$259
$457

43% lower than market

Rib cage x-ray of ribs on one side of body including chest (minimum of 3 views) [HCPCS 71101]

$397
$789

50% lower than market

Shoulder x-ray, complete study (minimum of 2 views) [HCPCS 73030]

$296
$565

48% lower than market

Spinal x-ray of lower and sacral spine (2 or 3 views) [HCPCS 72100]

$394
$952

59% lower than market

Spinal x-ray of lower and sacral spine (minimum of 4 views) [HCPCS 72110]

$586
$1,179

50% lower than market

Spinal x-ray of middle spine (3 views) [HCPCS 72072]

$404
$1,040

61% lower than market

Spinal x-ray of upper spine (4 or 5 views) [HCPCS 72050]

$668
$1,092

39% lower than market

Thighbone x-ray (minimum of 2 views) [HCPCS 73552]

$281
$656

57% lower than market

Wrist x-ray, complete study (minimum of 3 views) [HCPCS 73110]

$354
$547

35% lower than market

MAMMOGRAPHY

Description

Our Charge
Market Charge

Variance

Digital tomography of both breasts (screening exam) [HCPCS 77063]

$113
$88

29% higher than market

Mammography of both breasts (screening exam) [HCPCS 77067]

$787
$518

52% higher than market

Mammography of both breasts for diagnosis [HCPCS 77066]

$599
$604

1% lower than market

Mammography of one breast for diagnosis [HCPCS 77065]

$458
$480

5% lower than market

OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$46
$374

88% lower than market

OTHER OUTPATIENT PROCEDURES

Description

Our Charge
Market Charge

Variance

Blood vessel compression or decompression device application to 1 or more areas [HCPCS 97016]

$158
$138

15% higher than market

Drug administration beneath the skin or into muscle by injection for therapy, diagnosis, or prevention [HCPCS 96372]

$165
$223

26% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (each additional hour) [HCPCS 96366]

$184
$237

23% lower than market

Drug administration into vein by infusion for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96365]

$322
$520

38% lower than market

Drug administration into vein by infusion of additional sequential infusion of new drug for therapy, prevention, or diagnosis (up to 1 hour) [HCPCS 96367]

$184
$319

42% lower than market

Drug administration into vein by push technique for therapy, diagnosis, or prevention (each additional push of same drug) [HCPCS 96376]

$165
$271

39% lower than market

Hep c screen high risk/other [HCPCS G0472]

$165
$152

9% higher than market

Hydration administration into vein by infusion (31 minutes to 1 hour) [HCPCS 96360]

$322
$436

26% lower than market

Hydration administration into vein by infusion (each additional hour) [HCPCS 96361]

$184
$243

24% lower than market

Implanted venous access drug delivery device irrigation [HCPCS 96523]

$109
$204

46% lower than market

Mechanical traction application to 1 or more areas [HCPCS 97012]

$158
$223

29% lower than market

Oxygen saturation measurement in blood by ear or finger device (multiple determinations) [HCPCS 94761]

$147
$228

36% lower than market

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

$5,620
$6,403

12% lower than market

Sleep pattern monitoring of patient in sleep lab, sleep staging with 4 or more parameters of sleep (6 years of age or older) [HCPCS 95810]

$5,620
$5,346

5% higher than market

Therapeutic excercises and water pool therapy to 1 or more areas (each 15 minutes) [HCPCS 97113]

$240
$160

50% higher than market

CARDIOLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Heart Failure with major complications

$7,434
$26,915

72% lower than market

PULMONOLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Pneumonia with complications

$9,919
$20,587

52% lower than market

Respiratory infections and inflammations with major complications

$17,276
$31,175

45% lower than market

UROLOGY (INPATIENT)

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$6,485
$19,100

66% 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.