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

$700
$1,490

53% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

Automated urinalysis test [CPT 81003]

$63
$65

4% lower than market

Biopsy of prostate gland [CPT 55700]

$1,029
$5,664

82% lower than market

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

$2,296
$4,119

44% lower than market

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

$3,673
$5,026

27% lower than market

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

$185
$277

33% lower than market

Blood test, clotting time [CPT 85610]

$77
$82

6% lower than market

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

$247
$391

37% lower than market

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

$234
$331

29% lower than market

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

$252
$225

12% higher than market

CT scan head or brain [CPT 70450]

$2,216
$2,196

1% higher than market

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

$4,804
$5,653

15% lower than market

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

$80
$114

30% lower than market

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

$50
$120

59% lower than market

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

$116
$161

28% lower than market

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

$2,296
$3,114

26% lower than market

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

$3,673
$3,475

6% higher than market

Diagnostic mammography of both breasts [CPT 77066]

$469
$524

11% lower than market

Diagnostic mammography of one breast [CPT 77065]

$359
$415

14% lower than market

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

$2,556
$2,501

2% higher than market

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

$2,556
$2,663

4% lower than market

Kidney function blood test panel [CPT 80069]

$124
$269

54% lower than market

Liver function blood test panel [CPT 80076]

$277
$290

4% lower than market

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

$3,902
$5,420

28% lower than market

MRI scan of leg joint [CPT 73721]

$1,686
$4,006

58% lower than market

MRI scan of lower spinal canal [CPT 72148]

$3,237
$3,863

16% lower than market

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

$112
$123

9% lower than market

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

$178
$249

29% lower than market

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

$193
$232

17% lower than market

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

$124
$255

52% lower than market

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

$5,327
$5,515

3% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$10,920
$22,056

50% lower than market

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

$2,520
$10,140

75% lower than market

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

$3,673
$5,132

28% lower than market

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

$6,720
$11,313

41% lower than market

Screening mammography of both breasts [CPT 77067]

$616
$426

45% higher than market

Shaving of shoulder bone using an endoscope [CPT 29826]

$11,340
$6,858

65% higher than market

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

$4,403
$4,671

6% lower than market

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

$169
$158

7% higher than market

Total Knee or Hip Replacement

$33,676
$52,307

36% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$1,111
$1,517

27% lower than market

Ultrasound pelvis through vagina [CPT 76830]

$997
$942

6% 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]

$438
$1,012

57% lower than market

OUTPATIENT CLINIC

Description

Our Charge
Market Charge

Variance

Established patient outpatient visit, minimal presenting problem [CPT 99211]

$85
$89

4% 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]

$1,819
$3,144

42% lower than market

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

$221
$558

61% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$386
$896

57% lower than market

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

$772
$1,330

42% lower than market

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

$1,075
$1,826

41% lower than market

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

$166
$384

57% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Albumin (protein) level [CPT 82040]

$91
$112

19% lower than market

Ammonia level [CPT 82140]

$183
$187

2% lower than market

Amylase (enzyme) level [CPT 82150]

$80
$223

64% lower than market

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

$106
$372

71% lower than market

Analysis for antibody to Rickettsia (bacteria) [CPT 86757]

$53
$369

86% lower than market

Analysis for antibody to varicella-zoster virus (chicken pox) [CPT 86787]

$71
$182

61% lower than market

Analysis of substance using immunoassay technique, multiple step method [CPT 83516]

$85
$324

74% lower than market

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

$466
$705

34% lower than market

Bacterial blood culture [CPT 87040]

$224
$206

8% higher than market

Bacterial colony count, urine [CPT 87086]

$188
$142

32% higher than market

Bacterial culture and colony count [CPT 87071]

$116
$121

5% lower than market

Bacterial culture for aerobic isolates [CPT 87077]

$96
$86

12% higher than market

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

$105
$224

53% lower than market

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

$241
$254

5% lower than market

Blood count, hemoglobin [CPT 85018]

$21
$51

59% lower than market

Blood creatinine level [CPT 82565]

$77
$106

28% lower than market

Blood gases measurement [CPT 82803]

$334
$291

15% higher than market

Blood glucose (sugar) level [CPT 82947]

$80
$96

17% 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]

$77
$97

21% lower than market

Blood potassium level [CPT 84132]

$76
$72

6% higher than market

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

$77
$91

15% lower than market

Blood unit compatibility test, antiglobulin technique [CPT 86922]

$189
$192

2% lower than market

Calcium level, ionized [CPT 82330]

$170
$203

16% lower than market

Carcinoembryonic antigen (CEA) protein level [CPT 82378]

$258
$313

18% lower than market

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

$98
$315

69% lower than market

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

$114
$194

41% lower than market

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

$88
$131

33% lower than market

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

$41
$91

55% lower than market

Cyanocobalamin (vitamin B-12) level [CPT 82607]

$228
$167

37% higher than market

Detection test by immunoassay technique for Hepatitis B surface antigen [CPT 87340]

$146
$160

8% lower than market

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

$112
$234

52% lower than market

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

$88
$286

69% lower than market

Digoxin level, total [CPT 80162]

$162
$158

3% higher than market

Drug test def 1-7 classes [HCPCS G0480]

$156
$317

51% lower than market

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

$96
$122

21% lower than market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution [CPT 87186]

$193
$152

27% higher than market

Ferritin (blood protein) level [CPT 82728]

$204
$234

13% lower than market

Folic acid level, serum [CPT 82746]

$210
$169

24% higher than market

Gammaglobulin (immune system protein) measurement [CPT 82784]

$206
$201

2% higher than market

Haptoglobin (serum protein) level [CPT 83010]

$233
$196

19% higher than market

Hemoglobin A1C level [CPT 83036]

$130
$144

10% lower than market

Hepatitis C antibody measurement [CPT 86803]

$136
$160

15% lower than market

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

$42
$54

23% lower than market

Immunologic analysis for detection of tumor antigen, quantitative; CA 19-9 [CPT 86301]

$237
$291

19% lower than market

Iron binding capacity [CPT 83550]

$80
$104

23% lower than market

Iron level [CPT 83540]

$76
$126

40% lower than market

LDL cholesterol level [CPT 83721]

$112
$129

13% lower than market

Lactate dehydrogenase (enzyme) level [CPT 83615]

$88
$108

19% lower than market

Lactic acid level [CPT 83605]

$101
$151

33% lower than market

Levetiracetam level [CPT 80177]

$197
$193

2% higher than market

Lipase (fat enzyme) level [CPT 83690]

$106
$155

32% lower than market

Liver enzyme (SGOT), level [CPT 84450]

$96
$132

28% lower than market

Liver enzyme (SGPT), level [CPT 84460]

$101
$126

20% lower than market

Magnesium level [CPT 83735]

$101
$126

20% lower than market

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

$173
$200

13% lower than market

Measurement of antibody (IgE) to allergic substance, crude allergen extract, each [CPT 86003]

$22
$45

51% lower than market

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

$59
$222

74% lower than market

Measurement of antibody for rheumatoid arthritis assessment [CPT 86200]

$249
$283

12% lower than market

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

$92
$212

56% lower than market

Natriuretic peptide (heart and blood vessel protein) level [CPT 83880]

$368
$272

35% higher than market

Nephelometry, test method using light [CPT 83883]

$81
$180

55% lower than market

Parathormone (parathyroid hormone) level [CPT 83970]

$48
$320

85% lower than market

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

$376
$401

6% lower than market

Phenytoin level, total [CPT 80185]

$168
$207

19% lower than market

Phosphate level [CPT 84100]

$80
$95

16% lower than market

Procalcitonin (hormone) level [CPT 84145]

$311
$298

4% higher than market

Protein measurement, serum [CPT 84165]

$166
$190

13% lower than market

Psa screening [HCPCS G0103]

$124
$220

44% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$561
$716

22% lower than market

Red blood cell concentration measurement [CPT 85014]

$22
$51

57% lower than market

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

$76
$96

21% lower than market

Red blood count automated, with additional calculations [CPT 85046]

$78
$66

19% higher than market

Rheumatoid factor analysis [CPT 86430]

$91
$156

42% lower than market

Rheumatoid factor level [CPT 86431]

$58
$128

55% lower than market

Screening test for antibody to noninfectious agent [CPT 86255]

$58
$233

75% lower than market

Screening test for autoimmune disorder [CPT 86038]

$151
$190

21% lower than market

Screening test for pathogenic organisms [CPT 87081]

$67
$136

51% lower than market

Screening test for red blood cell antibodies [CPT 86850]

$157
$206

24% lower than market

Smear for parasites [CPT 87177]

$48
$171

72% lower than market

Special Gram or Giemsa stain for microorganism [CPT 87205]

$48
$83

42% lower than market

Special stain for parasites [CPT 87209]

$48
$126

62% lower than market

Stool analysis for blood, by fecal hemoglobin determination by immunoassay [CPT 82274]

$72
$95

25% lower than market

Stool culture [CPT 87045]

$88
$187

53% lower than market

Stool culture, additional pathogens [CPT 87046]

$88
$112

21% lower than market

Strep test by immunoassay for Streptococcus [CPT 87880]

$26
$155

83% lower than market

Syphilis detection test [CPT 86592]

$81
$93

13% lower than market

Tacrolimus level [CPT 80197]

$366
$471

22% lower than market

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

$192
$206

7% lower than market

Testosterone (hormone) level, free [CPT 84402]

$112
$223

50% lower than market

Testosterone (hormone) level, total [CPT 84403]

$313
$318

1% lower than market

Thyroid hormone, T3 measurement, free [CPT 84481]

$286
$231

24% higher than market

Thyroxine (thyroid chemical), free [CPT 84439]

$154
$185

17% lower than market

Total protein level, urine [CPT 84156]

$50
$91

45% lower than market

Troponin (protein) analysis, quantitative [CPT 84484]

$172
$210

18% lower than market

Tuberculosis test, gamma interferon [CPT 86480]

$284
$230

23% higher than market

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

$91
$98

7% lower than market

Uric acid level, blood [CPT 84550]

$87
$124

30% lower than market

Urine microalbumin (protein) level [CPT 82043]

$60
$188

68% lower than market

Valproic acid level, total [CPT 80164]

$187
$176

7% higher than market

Vancomycin (antibiotic) level [CPT 80202]

$176
$219

20% lower than market

Vitamin B-1 (thiamine) level [CPT 84425]

$228
$304

25% lower than market

Vitamin D-3 level [CPT 82306]

$58
$256

77% lower than market

White blood cell measure, stool specimen [CPT 89055]

$66
$95

31% lower than market

OUTPATIENT MEDICINE SERVICES

Description

Our Charge
Market Charge

Variance

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

$124
$114

8% higher than market

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

$124
$174

29% lower than market

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

$569
$875

35% lower than market

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

$252
$363

31% lower than market

Hydration infusion into a vein [CPT 96361]

$143
$170

16% lower than market

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

$143
$260

45% lower than market

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

$143
$206

30% lower than market

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

$252
$389

35% lower than market

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

$129
$140

8% lower than market

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

$129
$185

30% lower than market

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

$90
$231

61% lower than market

Medical nutrition therapy performed in a group setting, each 30 minutes [CPT 97804]

$42
$69

39% lower than market

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

$63
$67

6% lower than market

Moderate sedation services by physician also performing a procedure, additional 15 minutes [CPT 99153]

$265
$185

43% higher than market

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

$115
$165

30% lower than market

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

$265
$304

13% 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]

$4,403
$5,804

24% lower than market

Water pool therapy with therapeutic exercises to 1 or more areas, each 15 minutes [CPT 97113]

$188
$147

27% higher than market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$20
$82

76% lower than market

OUTPATIENT OCCUPATIONAL/PHYSICAL THERAPY

Description

Our Charge
Market Charge

Variance

Application of electrical stimulation to 1 or more areas, each 15 minutes [CPT 97032]

$95
$151

37% lower than market

Elec stim other than wound [HCPCS G0283]

$119
$149

20% lower than market

Evaluation of occupational therapy, typically 45 minutes [CPT 97166]

$485
$340

43% higher than market

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

$230
$290

21% lower than market

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

$307
$330

7% lower than market

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

$124
$145

15% lower than market

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

$106
$96

11% higher than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

2019-ncov coronavirus, sars-cov-2/2019-ncov (covid-19), any technique, multiple types or subtypes (includes all targets), non-cdc

$179
$131

37% higher than market

Direct refer hospital observ [HCPCS G0379]

$240
$225

7% higher than market

Hep c screen high risk/other [HCPCS G0472]

$136
$115

18% higher than market

Primatrix [HCPCS Q4110]

$189
$317

40% lower than market

Tomosynthesis, mammo [HCPCS G0279]

$119
$86

38% higher than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Administration of 1 vaccine [CPT 90471]

$50
$106

53% lower than market

Alteplase recombinant [HCPCS J2997]

$224
$365

38% lower than market

Cefazolin sodium injection [HCPCS J0690]

$5
$14

68% lower than market

Cefepime hcl for injection [HCPCS J0692]

$14
$24

41% lower than market

Ceftriaxone sodium injection [HCPCS J0696]

$10
$24

61% lower than market

Dexamethasone sodium phos [HCPCS J1100]

$2
$6

68% lower than market

Dicyclomine injection [HCPCS J0500]

$192
$261

26% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$8
$17

51% lower than market

Ertapenem injection [HCPCS J1335]

$142
$274

48% lower than market

Fentanyl citrate injection [HCPCS J3010]

$9
$18

52% lower than market

Ferumoxytol, non-esrd [HCPCS Q0138]

$6
$9

40% lower than market

Furosemide injection [HCPCS J1940]

$8
$13

39% lower than market

Hydromorphone injection [HCPCS J1170]

$9
$21

60% lower than market

Infliximab not biosimil 10mg [HCPCS J1745]

$306
$1,011

70% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$3
$15

82% lower than market

Inj filgrastim excl biosimil [HCPCS J1442]

$3
$2

32% higher than market

Inj heparin sodium per 1000u [HCPCS J1644]

$8
$29

72% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$4
$10

55% lower than market

Inj perflutren lip micros,ml [HCPCS Q9957]

$160
$374

57% lower than market

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

$129
$231

44% lower than market

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

$129
$276

53% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$4
$12

67% lower than market

Leuprolide acetate suspnsion [HCPCS J9217]

$3,501
$8,446

59% lower than market

Lorazepam injection [HCPCS J2060]

$9
$16

46% lower than market

Methylprednisolone 80 mg inj [HCPCS J1040]

$28
$69

59% lower than market

Methylprednisolone injection [HCPCS J2930]

$19
$70

73% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$8
$21

61% lower than market

Octreotide injection, depot [HCPCS J2353]

$373
$797

53% lower than market

Omalizumab injection [HCPCS J2357]

$95
$120

21% lower than market

Ondansetron hcl injection [HCPCS J2405]

$2
$4

49% lower than market

Orphenadrine injection [HCPCS J2360]

$11
$64

84% lower than market

Penicillin g benzathine inj [HCPCS J0561]

$29
$57

49% lower than market

Phenytoin sodium injection [HCPCS J1165]

$9
$9

1% higher than market

Piperacillin/tazobactam [HCPCS J2543]

$10
$28

66% lower than market

Regadenoson injection [HCPCS J2785]

$141
$375

62% lower than market

Tocilizumab injection [HCPCS J3262]

$12
$16

23% lower than market

Triamcinolone acet inj nos [HCPCS J3301]

$9
$13

25% lower than market

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

$91
$225

60% lower than market

Vancomycin hcl injection [HCPCS J3370]

$12
$42

70% lower than market

Vitamin b12 injection [HCPCS J3420]

$8
$50

84% lower than market

Zoledronic acid 1mg [HCPCS J3489]

$150
$407

63% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$515
$899

43% lower than market

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

$725
$733

1% lower than market

Measurement and graphic recording of total and timed exhaled air capacity [CPT 94010]

$420
$366

15% higher than market

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

$189
$365

48% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Determination of lung volumes using plethysmography [CPT 94726]

$370
$465

20% lower than market

Measurement of lung diffusing capacity [CPT 94729]

$197
$386

49% lower than market

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

$78
$88

12% lower than market

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

$60
$197

70% lower than market

OUTPATIENT SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

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

$225
$315

29% lower than market

OUTPATIENT SUPPLIES

Description

Our Charge
Market Charge

Variance

Tc99m sestamibi [HCPCS A9500]

$416
$688

40% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Application of skin substitute (wound surface up to 100 sq cm) to face, scalp, eyelids, mouth, neck, ears, eye region, genitals, hands, feet, and/or multiple fingers or toes (first 25 sq cm or less) [CPT 15275]

$498
$3,401

85% lower than market

Arterial puncture withdrawal of blood for diagnosis [CPT 36600]

$51
$129

60% lower than market

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

$3,673
$4,327

15% lower than market

Fine needle aspiration of first lesion using ultrasound guidance [CPT 10005]

$1,827
$2,364

23% lower than market

Insertion of indwelling bladder catheter, simple [CPT 51702]

$299
$685

56% lower than market

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

$35
$35

Approximately equal to market

Removal of skin and tissue first 20 sq cm or less [CPT 11042]

$1,323
$1,959

32% lower than market

Transfusion of blood or blood products [CPT 36430]

$698
$891

22% lower than market

Ultrasound measurement of bladder capacity after voiding [CPT 51798]

$120
$678

82% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

Application of ultrasound to 1 or more areas, each 15 minutes [CPT 97035]

$174
$141

23% higher than market

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

$481
$538

11% lower than market

CT scan abdomen with contrast [CPT 74160]

$3,669
$2,829

30% higher than market

CT scan of abdomen and pelvis [CPT 74176]

$3,487
$4,596

24% lower than market

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

$6,137
$6,400

4% lower than market

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

$5,110
$4,829

6% higher than market

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

$3,255
$3,595

9% lower than market

CT scan of face [CPT 70486]

$2,876
$2,430

18% higher than market

CT scan of lower spine [CPT 72131]

$2,777
$2,854

3% lower than market

CT scan of middle spine [CPT 72128]

$2,789
$2,461

13% higher than market

CT scan of neck with contrast [CPT 70491]

$3,416
$2,647

29% higher than market

CT scan of upper spine [CPT 72125]

$2,925
$2,715

8% higher than market

CT scan pelvis [CPT 72192]

$2,616
$2,318

13% higher than market

Diagnostic CT scan of chest [CPT 71250]

$2,922
$2,415

21% higher than market

Diagnostic CT scan of chest before and after contrast [CPT 71270]

$4,172
$3,285

27% higher than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$3,533
$3,116

13% higher than market

Imaging of liver and bile duct system with use of drugs [CPT 78227]

$2,874
$3,294

13% lower than market

MRI scan brain [CPT 70551]

$3,208
$3,853

17% lower than market

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

$3,970
$4,852

18% lower than market

MRI scan of arm joint [CPT 73221]

$2,737
$3,910

30% lower than market

MRI scan of upper spinal canal [CPT 72141]

$3,068
$3,869

21% lower than market

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

$4,148
$6,127

32% lower than market

Screening digital tomography of both breasts [CPT 77063]

$88
$66

33% higher than market

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

$3,338
$3,913

15% lower than market

Ultrasound behind abdominal cavity [CPT 76770]

$1,061
$1,360

22% lower than market

Ultrasound evaluation of abdominal aorta to detect bulging (aneurysm) [CPT 76706]

$759
$531

43% higher than market

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

$2,583
$4,560

43% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$854
$1,315

35% lower than market

Ultrasound of head and neck [CPT 76536]

$929
$1,287

28% lower than market

Ultrasound of one breast, limited [CPT 76642]

$798
$989

19% lower than market

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

$1,008
$1,279

21% lower than market

Ultrasound of scrotum [CPT 76870]

$1,003
$976

3% higher than market

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

$2,031
$1,995

2% higher than market

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

$1,333
$1,306

2% higher than market

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

$1,959
$2,135

8% lower than market

Ultrasound study of arteries of both arms and legs, complete [CPT 93923]

$1,485
$1,098

35% higher than market

Ultrasound study of arteries of both arms and legs, limited [CPT 93922]

$957
$660

45% higher than market

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

$197
$402

51% lower than market

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

$248
$511

51% lower than market

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

$311
$399

22% lower than market

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

$187
$314

40% lower than market

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

$255
$507

50% lower than market

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

$279
$479

42% lower than market

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

$220
$591

63% lower than market

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

$240
$425

44% lower than market

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

$244
$475

49% lower than market

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

$214
$395

46% lower than market

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

$245
$515

52% lower than market

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

$298
$410

27% lower than market

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

$274
$611

55% lower than market

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

$322
$678

52% lower than market

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

$309
$812

62% lower than market

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

$211
$528

60% lower than market

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

$302
$908

67% lower than market

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

$202
$387

48% lower than market

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

$311
$555

44% lower than market

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

$232
$481

52% lower than market

X-ray of upper arm, minimum of 2 views [CPT 73060]

$225
$405

45% lower than market

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

$523
$978

47% lower than market

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

$277
$464

40% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Blood infection without major complications

$9,543
$19,716

52% lower than market

Infection of the skin

$6,436
$16,372

61% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Pneumonia with complications

$6,983
$17,513

60% lower than market

Pneumonia without complications

$6,832
$13,596

50% lower than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection without complications

$4,981
$14,162

65% 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.