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Patient Price Information List

Disclaimer: Hemphill County Hospital District 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, Hemphill County Hospital District has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2020. Hemphill County Hospital District's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

AllianceHealth Woodward

Woodward

OK

Childress Regional Medical Center

Childress

TX

Newman Memorial Hospital

Shattuck

OK

Ochiltree General Hospital

Perryton

TX

Pampa Regional Medical Center

Pampa

TX

Parkview Hospital

Wheeler

TX

Roger Mills Memorial Hospital

Cheyenne

OK

Shamrock General Hospital

Shamrock

TX

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$642
$888

28% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

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

$2,200
$3,744

41% lower than market

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

$80
$139

43% lower than market

Blood test, clotting time [CPT 85610]

$49
$57

14% lower than market

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

$112
$177

37% lower than market

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

$87
$149

42% lower than market

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

$112
$164

32% lower than market

CT scan head or brain [CPT 70450]

$1,436
$1,472

2% lower than market

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

$3,659
$3,034

21% higher than market

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

$80
$70

14% higher than market

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

$37
$90

58% lower than market

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

$52
$100

48% lower than market

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

$2,479
$3,902

36% lower than market

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

$2,200
$2,927

25% lower than market

Kidney function blood test panel [CPT 80069]

$141
$111

27% higher than market

Liver function blood test panel [CPT 80076]

$194
$134

44% higher than market

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

$59
$52

14% higher than market

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

$62
$153

59% lower than market

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

$2,200
$4,442

50% lower than market

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

$2,963
$4,166

29% lower than market

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

$99
$99

1% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$532
$834

36% lower than market

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

$369
$567

35% lower than market

OUTPATIENT CLINIC

Description

Our Charge
Market Charge

Variance

Hospital outpt clinic visit [HCPCS G0463]

$180
$379

53% lower than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

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

$359
$437

18% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$494
$674

27% lower than market

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

$718
$1,320

46% lower than market

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

$988
$1,719

43% lower than market

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

$214
$256

16% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Acute hepatitis panel [CPT 80074]

$78
$455

83% lower than market

Ammonia level [CPT 82140]

$63
$145

57% lower than market

Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [CPT 87635]

$43
$142

70% lower than market

Amylase (enzyme) level [CPT 82150]

$86
$90

4% lower than market

Analysis for antibody to Epstein-Barr virus (mononucleosis virus), viral capsid [CPT 86665]

$83
$161

48% lower than market

Analysis for antibody to Helicobacter pylori (gastrointestinal bacteria) [CPT 86677]

$70
$146

52% lower than market

Analysis for antibody to Herpes simplex virus [CPT 86694]

$44
$105

59% lower than market

Analysis for antibody to Herpes simplex virus, type 1 [CPT 86695]

$119
$193

38% lower than market

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

$37
$140

73% lower than market

Bacterial blood culture [CPT 87040]

$60
$150

60% lower than market

Bacterial colony count, urine [CPT 87086]

$58
$104

45% lower than market

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

$58
$116

50% lower than market

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

$74
$243

70% lower than market

Blood count, hemoglobin [CPT 85018]

$33
$38

13% lower than market

Blood gases measurement [CPT 82803]

$249
$284

13% lower than market

Blood group typing (ABO) [CPT 86900]

$59
$187

68% lower than market

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

$59
$143

59% lower than market

Blood unit compatibility test, antiglobulin technique [CPT 86922]

$148
$454

67% lower than market

Blood unit compatibility test, immediate spin technique [CPT 86920]

$148
$341

57% lower than market

Blood unit compatibility test, incubation technique [CPT 86921]

$148
$595

75% lower than market

Body fluid cell count with cell identification [CPT 89051]

$45
$101

55% lower than market

Calcium level, ionized [CPT 82330]

$59
$122

51% lower than market

Calcium level, total [CPT 82310]

$67
$69

2% lower than market

Carbamazepine level, total [CPT 80156]

$65
$146

55% lower than market

Carcinoembryonic antigen (CEA) protein level [CPT 82378]

$59
$181

68% lower than market

Chemical analysis of stone [CPT 82360]

$69
$158

56% lower than market

Cortisol (hormone) measurement, total [CPT 82533]

$56
$177

68% lower than market

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

$11
$70

84% lower than market

Cryoglobulin (protein) measurement [CPT 82595]

$48
$69

30% lower than market

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

$37
$131

71% lower than market

Detection test by immunoassay technique for HIV-1 and HIV-2 [CPT 87389]

$70
$140

50% lower than market

Detection test by immunoassay technique for clostridium difficile toxins (stool pathogen) [CPT 87324]

$44
$116

62% lower than market

Detection test by immunoassay technique for giardia (intestinal parasite) [CPT 87329]

$72
$130

44% lower than market

Detection test by nucleic acid for chlamydia trachomatis, amplified probe technique [CPT 87491]

$53
$272

81% lower than market

Detection test by nucleic acid for cytomegalovirus, quantification [CPT 87497]

$276
$425

35% lower than market

Detection test by nucleic acid for organism, quantification [CPT 87799]

$450
$530

15% lower than market

Digoxin level, total [CPT 80162]

$41
$129

68% lower than market

Drug test def 1-7 classes [HCPCS G0480]

$71
$208

66% lower than market

Drug test def 8-14 classes [HCPCS G0481]

$68
$201

66% lower than market

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

$25
$93

73% lower than market

Ferritin (blood protein) level [CPT 82728]

$37
$113

67% lower than market

Folic acid level, serum [CPT 82746]

$54
$126

57% lower than market

Gammaglobulin (immune system protein) measurement [CPT 82784]

$105
$189

44% lower than market

Gene analysis (coagulation factor V) Leiden variant [CPT 81241]

$97
$586

83% lower than market

General health panel [CPT 80050]

$276
$351

21% lower than market

Glutamyltransferase (liver enzyme) level [CPT 82977]

$59
$74

19% lower than market

Gonadotropin, follicle stimulating (reproductive hormone) level [CPT 83001]

$68
$155

56% lower than market

Hemoglobin A1C level [CPT 83036]

$64
$95

32% lower than market

Hepatitis C antibody measurement [CPT 86803]

$54
$160

66% lower than market

Immunologic analysis for detection of organism by immunoassay technique, multiple-step method [CPT 87449]

$44
$59

25% lower than market

Immunologic analysis for detection of tumor antigen, quantitative; CA 125 [CPT 86304]

$59
$209

72% lower than market

Insulin measurement, total [CPT 83525]

$50
$135

63% lower than market

Iron binding capacity [CPT 83550]

$57
$92

38% lower than market

Iron level [CPT 83540]

$50
$78

36% lower than market

LDL cholesterol level [CPT 83721]

$53
$80

34% lower than market

Lactate dehydrogenase (enzyme) level [CPT 83615]

$50
$76

34% lower than market

Lactic acid level [CPT 83605]

$79
$115

32% lower than market

Lead level [CPT 83655]

$51
$88

42% lower than market

Levetiracetam level [CPT 80177]

$79
$137

42% lower than market

Lipase (fat enzyme) level [CPT 83690]

$80
$92

12% lower than market

Magnesium level [CPT 83735]

$51
$75

32% lower than market

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

$39
$65

40% lower than market

Measurement C-reactive protein for detection of infection or inflammation, high sensitivity [CPT 86141]

$40
$137

71% lower than market

Measurement of DNA antibody, native or double stranded [CPT 86225]

$74
$456

84% lower than market

Measurement of substance using immunoassay technique, by radioimmunoassay [CPT 83519]

$54
$145

63% lower than market

Measurement of total estradiol (hormone) [CPT 82670]

$68
$265

74% lower than market

Metanephrines level [CPT 83835]

$63
$216

71% lower than market

Microsomal antibodies (autoantibody) measurement [CPT 86376]

$37
$137

73% lower than market

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

$124
$255

51% lower than market

Nephelometry, test method using light [CPT 83883]

$71
$171

59% lower than market

Organic acid level [CPT 83921]

$50
$255

81% lower than market

Parathormone (parathyroid hormone) level [CPT 83970]

$54
$282

81% lower than market

Phenytoin level, total [CPT 80185]

$47
$119

61% lower than market

Phosphatase (enzyme) measurement, alkaline, isoenzymes [CPT 84080]

$60
$204

70% lower than market

Phosphate level [CPT 84100]

$50
$59

15% lower than market

Prealbumin (protein) level [CPT 84134]

$59
$129

54% lower than market

Prolactin (milk producing hormone) level [CPT 84146]

$56
$203

73% lower than market

Protein measurement, serum [CPT 84165]

$57
$156

63% lower than market

Psa screening [HCPCS G0103]

$62
$167

63% lower than market

Qualitative or semiquantitative detection test by immunoassay technique for helicobacter pylori in stool, multiple-step method [CPT 87338]

$87
$186

53% lower than market

Quantitation of therapeutic drug [CPT 80299]

$76
$182

58% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$486
$1,488

67% lower than market

Red blood cell antibody detection test, indirect [CPT 86885]

$89
$185

52% lower than market

Red blood cell concentration measurement [CPT 85014]

$33
$38

13% lower than market

Red blood cell sedimentation rate, to detect inflammation, non-automated [CPT 85651]

$54
$92

41% lower than market

Rheumatoid factor level [CPT 86431]

$53
$95

44% lower than market

Screening test for autoimmune disorder [CPT 86038]

$52
$121

57% lower than market

Screening test for mononucleosis (mono) [CPT 86308]

$86
$93

8% lower than market

Special Gram or Giemsa stain for microorganism [CPT 87205]

$51
$68

24% lower than market

Stool culture [CPT 87045]

$80
$119

33% lower than market

Tacrolimus level [CPT 80197]

$142
$190

25% lower than market

Testing for presence of drug, by chemistry analyzers [CPT 80307]

$55
$627

91% lower than market

Testosterone (hormone) level, free [CPT 84402]

$63
$206

69% lower than market

Testosterone (hormone) level, total [CPT 84403]

$79
$192

59% lower than market

Theophylline level [CPT 80198]

$63
$113

44% lower than market

Thyroid hormone evaluation [CPT 84479]

$19
$84

77% lower than market

Thyroid hormone, T3 measurement, free [CPT 84481]

$62
$152

59% lower than market

Thyroid hormone, T3 measurement, total [CPT 84480]

$57
$145

60% lower than market

Thyroxine (thyroid chemical), free [CPT 84439]

$95
$103

8% lower than market

Thyroxine (thyroid chemical), total [CPT 84436]

$41
$85

52% lower than market

Total protein level, blood [CPT 84155]

$47
$72

34% lower than market

Total protein level, urine [CPT 84156]

$53
$85

38% lower than market

Troponin (protein) analysis, quantitative [CPT 84484]

$144
$144

Approximately equal to market

Uric acid level, blood [CPT 84550]

$56
$61

8% lower than market

Urine microalbumin (protein) level [CPT 82043]

$18
$100

81% lower than market

Urine pregnancy test [CPT 81025]

$65
$93

30% lower than market

Valproic acid level, total [CPT 80164]

$54
$137

60% lower than market

Vancomycin (antibiotic) level [CPT 80202]

$68
$154

56% lower than market

Vitamin A level [CPT 84590]

$62
$133

53% lower than market

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

$70
$173

60% lower than market

Vitamin B-6 level [CPT 84207]

$62
$370

83% lower than market

Vitamin D-3 level [CPT 82306]

$65
$265

75% lower than market

OUTPATIENT MEDICINE SERVICES

Description

Our Charge
Market Charge

Variance

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

$175
$426

59% lower than market

Hydration infusion into a vein [CPT 96361]

$68
$175

61% lower than market

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

$65
$187

65% lower than market

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

$199
$492

60% lower than market

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

$97
$133

27% lower than market

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

$57
$112

49% lower than market

Removal of tissue from wounds per session, first 20 sq cms or less [CPT 97597]

$146
$405

64% 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]

$3,143
$4,875

36% lower than market

Therapeutic removal of whole blood to correct blood level imbalance [CPT 99195]

$162
$330

51% lower than market

Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older [CPT 90732]

$246
$270

9% lower than market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$28
$105

74% lower than market

OUTPATIENT OCCUPATIONAL/PHYSICAL THERAPY

Description

Our Charge
Market Charge

Variance

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

$144
$231

38% lower than market

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

$144
$339

57% lower than market

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

$92
$109

16% lower than market

Re-evaluation of physical therapy, typically 20 minutes [CPT 97164]

$87
$174

50% lower than market

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

$99
$92

7% higher than market

Therapeutic procedure to re-educate brain-to-nerve-to-muscle function, each 15 minutes [CPT 97112]

$103
$105

2% lower than market

Walking training to 1 or more areas, each 15 minutes [CPT 97116]

$99
$102

3% lower than market

OUTPATIENT OTHER

Description

Our Charge
Market Charge

Variance

Direct refer hospital observ [HCPCS G0379]

$171
$841

80% lower than market

Inj pantoprazole sodium, via [HCPCS C9113]

$31
$80

62% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Abatacept injection [HCPCS J0129]

$124
$137

9% lower than market

Admin influenza virus vac [HCPCS G0008]

$42
$82

49% lower than market

Admin pneumococcal vaccine [HCPCS G0009]

$45
$69

35% lower than market

Administration of 1 vaccine [CPT 90471]

$45
$141

68% lower than market

Ceftriaxone sodium injection [HCPCS J0696]

$16
$28

41% lower than market

Dexamethasone sodium phos [HCPCS J1100]

$3
$5

32% lower than market

Diphenhydramine hcl injectio [HCPCS J1200]

$17
$19

12% lower than market

Dopamine injection [HCPCS J1265]

$9
$19

52% lower than market

Fentanyl citrate injection [HCPCS J3010]

$18
$20

13% lower than market

Glucagon hydrochloride/1 mg [HCPCS J1610]

$741
$866

14% lower than market

Hydromorphone injection [HCPCS J1170]

$19
$19

1% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$26
$43

40% lower than market

Inj heparin sodium per 1000u [HCPCS J1644]

$5
$11

58% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$4
$11

66% lower than market

Inj nalbuphine hydrochloride [HCPCS J2300]

$19
$24

21% lower than market

Inj naloxone hydrochloride [HCPCS J2310]

$52
$90

43% lower than market

Inj, propofol, 10 mg [HCPCS J2704]

$2
$12

83% lower than market

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

$44
$180

75% lower than market

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

$97
$427

77% lower than market

Insulin injection [HCPCS J1815]

$1
$2

66% lower than market

Iron sucrose injection [HCPCS J1756]

$2
$6

64% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$15
$17

12% lower than market

Levofloxacin injection [HCPCS J1956]

$30
$84

65% lower than market

Lidocaine injection [HCPCS J2001]

$19
$25

24% lower than market

Methylprednisolone 40 mg inj [HCPCS J1030]

$48
$101

53% lower than market

Metoclopramide hcl injection [HCPCS J2765]

$11
$25

57% lower than market

Morphine sulfate injection [HCPCS J2270]

$8
$19

58% lower than market

Ondansetron hcl injection [HCPCS J2405]

$3
$6

44% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$27
$28

3% lower than market

Promethazine hcl injection [HCPCS J2550]

$13
$31

59% lower than market

Triamcinolone acet inj nos [HCPCS J3301]

$14
$37

62% lower than market

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

$206
$219

6% lower than market

Vancomycin hcl injection [HCPCS J3370]

$29
$28

5% higher than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

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

$315
$568

45% lower than market

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

$180
$249

28% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

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

$80
$488

84% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Arterial puncture withdrawal of blood for diagnosis [CPT 36600]

$27
$350

92% lower than market

Closed treatment of shoulder dislocation with manipulation [CPT 23650]

$374
$1,313

72% lower than market

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

$2,002
$3,234

38% lower than market

Insertion of indwelling bladder catheter, simple [CPT 51702]

$103
$368

72% lower than market

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

$18
$24

27% lower than market

Insertion of temporary bladder catheter [CPT 51701]

$153
$381

60% lower than market

Removal of foreign body from tissue, accessed beneath the skin, simple [CPT 10120]

$469
$1,161

60% lower than market

Repair of wound (2.5 centimeters or less) of the face, ears, eyelids, nose, lips, and/or mucous membranes [CPT 12011]

$317
$555

43% lower than market

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

$332
$538

38% lower than market

Repair of wound (2.6 to 5.0 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes [CPT 12013]

$332
$618

46% lower than market

Repair of wound (2.6 to 7.5 centimeters) of the scalp, neck, underarms, genitals, trunk, arms and/or legs [CPT 12002]

$332
$521

36% lower than market

Transfusion of blood or blood products [CPT 36430]

$808
$1,756

54% lower than market

OUTPATIENT TRANSPORTATION SERVICES

Description

Our Charge
Market Charge

Variance

Als1-emergency [HCPCS A0427]

$898
$930

3% lower than market

Bls-emergency [HCPCS A0429]

$493
$840

41% lower than market

Ground mileage [HCPCS A0425]

$10
$15

33% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

CT scan abdomen before and after contrast [CPT 74170]

$2,676
$2,772

3% lower than market

CT scan abdomen with contrast [CPT 74160]

$2,226
$2,436

9% lower than market

CT scan leg [CPT 73700]

$1,392
$1,462

5% lower than market

CT scan of lower spine [CPT 72131]

$1,652
$1,603

3% higher than market

CT scan of neck [CPT 70490]

$1,598
$1,616

1% lower than market

CT scan of upper spine [CPT 72125]

$1,643
$1,577

4% higher than market

CT scan pelvis [CPT 72192]

$1,572
$1,496

5% higher than market

Diagnostic CT scan of chest [CPT 71250]

$1,365
$1,510

10% lower than market

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

$997
$2,488

60% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$354
$595

40% lower than market

Ultrasound of head and neck [CPT 76536]

$266
$722

63% lower than market

Ultrasound of scrotum [CPT 76870]

$253
$871

71% lower than market

Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow [CPT 93975]

$689
$774

11% lower than market

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

$709
$1,228

42% lower than market

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

$354
$734

52% lower than market

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

$665
$1,070

38% lower than market

Ultrasound study of arteries and arterial grafts of both legs [CPT 93925]

$798
$1,718

54% lower than market

Ultrasound study of arteries and arterial grafts of one leg or limited [CPT 93926]

$399
$868

54% lower than market

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

$230
$295

22% lower than market

X-ray of ankle, 2 views [CPT 73600]

$219
$397

45% lower than market

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

$309
$353

13% lower than market

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

$353
$663

47% lower than market

X-ray of both hips with pelvis, 3-4 views [CPT 73522]

$387
$971

60% lower than market

X-ray of both sides of the ribs including the chest, minimum of 4 views [CPT 71111]

$535
$582

8% lower than market

X-ray of breast bone, minimum of 2 views [CPT 71120]

$309
$789

61% lower than market

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

$230
$291

21% lower than market

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

$309
$325

5% lower than market

X-ray of elbow, 2 views [CPT 73070]

$230
$340

32% lower than market

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

$309
$343

10% lower than market

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

$162
$275

41% lower than market

X-ray of foot, 2 views [CPT 73620]

$230
$439

48% lower than market

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

$309
$337

8% lower than market

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

$230
$312

26% lower than market

X-ray of hand, 2 views [CPT 73120]

$230
$702

67% lower than market

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

$309
$359

14% lower than market

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

$309
$318

3% lower than market

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

$230
$346

34% lower than market

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

$353
$594

41% lower than market

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

$286
$496

42% lower than market

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

$309
$351

12% lower than market

X-ray of middle spine, 2 views [CPT 72070]

$353
$488

28% lower than market

X-ray of paranasal sinus, complete, minimum of 3 views [CPT 70220]

$309
$383

19% lower than market

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

$230
$488

53% lower than market

X-ray of ribs of one side of body, 2 views [CPT 71100]

$266
$366

27% lower than market

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

$353
$527

33% lower than market

X-ray of shoulder, 1 view [CPT 73020]

$230
$470

51% lower than market

X-ray of soft tissue of neck [CPT 70360]

$230
$611

62% lower than market

X-ray of spine of neck, 2 or 3 views [CPT 72040]

$309
$347

11% lower than market

X-ray of toes, minimum of 2 views [CPT 73660]

$180
$285

37% lower than market

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

$230
$346

34% lower than market

X-ray of wrist, 2 views [CPT 73100]

$230
$406

43% lower than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat with complications

$9,073
$11,157

19% lower than market

Abnormal or Irregular Heartbeat without complications

$3,597
$13,669

74% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$10,836
$42,179

74% lower than market

Heart Failure with complications

$10,859
$15,572

30% lower than market

Other circulatory system diagnoses with complications

$12,467
$21,156

41% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Anemia or other red blood cell disorders without complications

$6,151
$19,298

68% lower than market

Blood Infection with major complications

$13,161
$19,631

33% lower than market

Diabetes without complications

$8,545
$10,910

22% lower than market

Esophagitis, gastroent & misc digest disorders with major complications

$2,588
$63,619

96% lower than market

G.I. hemorrhage without complications

$10,530
$18,998

45% lower than market

G.I. obstruction with complications

$6,485
$11,893

45% lower than market

G.I. obstruction with major complications

$23,663
$23,560

Approximately equal to market

General symptoms of illness such as fever, pain, shortness of breath

$8,837
$13,345

34% lower than market

Infection of the skin

$11,837
$13,259

11% lower than market

Nutritional or Metabolic Disorders without major complications

$5,859
$13,030

55% lower than market

Skin ulcers with complications

$5,762
$11,692

51% lower than market

Stomach Disorder without complications

$8,692
$10,709

19% lower than market

INPATIENT NEUROLOGY

Description

Our Charge
Market Charge

Variance

Degenerative nervous system disorders without complications

$3,170
$36,132

91% lower than market

Transient ischemia

$10,719
$18,448

42% lower than market

INPATIENT ORTHOPEDICS

Description

Our Charge
Market Charge

Variance

Fractures of hip, pelvis & thigh without major complications

$7,382
$13,790

46% lower than market

Medical back problems without major complications

$8,886
$14,699

40% lower than market

Pathological fractures & musculoskelet & conn tiss malig with compications

$7,324
$20,717

65% lower than market

Pathological fractures & musculoskelet & conn tiss malig with major complications

$5,577
$36,957

85% lower than market

INPATIENT PSYCHIATRY

Description

Our Charge
Market Charge

Variance

Mental disturbances and retardation

$3,584
$41,330

91% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$6,808
$19,824

66% lower than market

Chronic Lung Disease without complications

$7,921
$20,572

61% lower than market

Pneumonia with complications

$9,702
$16,308

41% lower than market

Pneumonia with major complications

$8,572
$26,453

68% lower than market

Pneumonia without complications

$6,437
$13,571

53% lower than market

Pulmonary embolism without major complications

$7,320
$18,410

60% lower than market

Respiratory Failure

$19,232
$23,540

18% lower than market

Respiratory infections and inflammations with major complications

$17,522
$29,545

41% lower than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection with major complications

$8,809
$17,520

50% lower than market

Kidney & urinary Infection without complications

$8,145
$14,960

46% lower than market

Kidney failure with complications

$6,388
$11,853

46% lower than market

Kidney failure with major complications

$9,014
$20,097

55% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Hemphill County Hospital District 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 Hemphill County Hospital District, 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 Hemphill County Hospital District 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 Hemphill County Hospital District 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 806-323-6422.

If you need more information about the price of a future service, please contact our Customer Service at 806-323-6422. 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.