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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 3/31/2022. 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

$743
$1,349

45% lower than market

CMS SHOPPABLE SERVICE

Description

Our Charge
Market Charge

Variance

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

$4,034
$3,106

30% higher than market

Abdominal ultrasound (complete) [HCPCS 76700]

$559
$898

38% lower than market

Colon (large bowel) examination and biopsy with endoscope [HCPCS 45380]

$2,543
$7,684

67% lower than market

Colon (large bowel) examination and polyps or tumors removal by snare technique with endoscope [HCPCS 45385]

$2,614
$9,732

73% lower than market

Esophagus, stomach, and/or upper small bowel examination and biopsy with endoscope [HCPCS 43239]

$4,979
$7,752

36% lower than market

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

$1,583
$1,491

6% higher than market

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

$65
$67

3% lower than market

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

$155
$147

6% higher than market

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

$54
$70

23% lower than market

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

$124
$178

31% lower than market

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

$89
$83

6% higher than market

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

$41
$93

56% 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]

$57
$106

46% lower 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

$214
$142

51% higher than market

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

$96
$158

39% 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]

$88
$151

42% lower than market

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

$68
$183

63% lower than market

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

$124
$196

37% lower than market

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

$109
$75

46% higher 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]

$3,267
$4,607

29% lower than market

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

$427
$615

30% lower than market

OUTPATIENT CLINIC

Description

Our Charge
Market Charge

Variance

Hospital outpatient clinic visit for assessment and management of a patient [HCPCS G0463]

$198
$435

55% lower than market

OUTPATIENT EMERGENCY DEPARTMENT

Description

Our Charge
Market Charge

Variance

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

$792
$1,245

36% lower than market

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

$396
$424

7% lower than market

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

$545
$723

25% lower than market

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

$1,089
$1,662

34% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY

Description

Our Charge
Market Charge

Variance

Lab analysis also known as general health panel [HCPCS 80050]

$304
$318

4% lower than market

Lab analysis by immunoassay (ELISA) to identify clostridium difficile toxins (stool pathogen) [HCPCS 87324]

$49
$123

60% lower than market

Lab analysis by immunoassay (ELISA) to identify helicobacter pylori in stool (multiple-step method, qualitative or semiquantitative) [HCPCS 87338]

$92
$195

53% lower than market

Lab analysis by immunoassay (ELISA) to identify HIV-1 and HIV-2 [HCPCS 87389]

$73
$140

48% lower than market

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

$49
$54

10% 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]

$165
$183

10% lower than market

Lab analysis by nucleic acid (DNA or RNA) to identify chlamydia trachomatis by amplified probe technique [HCPCS 87491]

$61
$297

79% lower than market

Lab analysis of any culture (except blood) to identify anaerobic bacteria [HCPCS 87075]

$82
$229

64% lower than market

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

$68
$160

57% lower than market

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

$33
$128

74% lower than market

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

$33
$70

53% lower than market

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

$33
$122

73% lower than market

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

$64
$111

43% 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]

$28
$95

71% lower than market

Lab analysis to evaluate thyroid hormone in serum specimen [HCPCS 84479]

$21
$89

77% lower than market

Lab analysis to identify antibodies to varicella-zoster virus (chicken pox) [HCPCS 86787]

$39
$133

70% lower than market

Lab analysis to identify Hepatitis C antibodies [HCPCS 86803]

$60
$141

58% lower than market

Lab analysis to identify total thyroxine (thyroid chemical) function in serum specimen for screening [HCPCS 84436]

$57
$91

37% lower than market

Lab analysis to identify tumor antigens by immunoassay (quantitative, CA 125) [HCPCS 86304]

$65
$223

71% lower than market

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

$36
$35

2% higher than market

Lab analysis to measure free testosterone (hormone) level in serum specimen [HCPCS 84402]

$70
$276

75% lower than market

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

$105
$116

10% lower than market

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

$36
$36

1% higher than market

Lab analysis to measure red blood cell sedimentation rate to detect inflammation (non-automated) [HCPCS 85651]

$60
$100

41% lower than market

Lab analysis to measure rheumatoid factor level [HCPCS 86431]

$59
$105

44% lower than market

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

$274
$312

12% lower than market

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

$72
$159

55% lower than market

Lab analysis to measure the amount of C-reactive protein in serum by high sensitivity assay to identify infection or inflammation [HCPCS 86141]

$44
$136

68% lower than market

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

$43
$80

47% lower than market

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

$68
$174

61% lower 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]

$86
$441

80% lower than market

Lab analysis to measure the amount of microsomal antibodies (autoantibody) [HCPCS 86376]

$60
$124

52% lower than market

Lab analysis to measure the amount of substance by radioimmunoassay [HCPCS 83519]

$60
$164

64% lower than market

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

$62
$180

66% lower than market

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

$45
$145

69% lower than market

Lab analysis to measure the amount of total estradiol (hormone) [HCPCS 82670]

$76
$261

71% lower than market

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

$51
$123

58% lower than market

Lab analysis to measure the amount of total thyroid hormone, T3 in serum specimen [HCPCS 84480]

$63
$129

51% lower than market

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

$60
$128

53% lower than market

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

$159
$138

16% higher than market

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

$95
$96

1% lower than market

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

$65
$168

62% lower than market

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

$59
$81

28% lower than market

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

$41
$141

71% lower than market

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

$41
$125

67% lower than market

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

$60
$138

57% lower than market

Lab analysis to measure the glutamyltransferase (liver enzyme) level [HCPCS 82977]

$28
$82

66% lower than market

Lab analysis to measure the gonadotropin, follicle stimulating (reproductive hormone) level [HCPCS 83001]

$68
$131

48% lower than market

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

$71
$98

28% lower than market

Lab analysis to measure the ionized calcium level in blood specimen [HCPCS 82330]

$65
$121

46% lower than market

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

$63
$94

32% lower than market

Lab analysis to measure the iron level [HCPCS 83540]

$55
$71

23% lower than market

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

$55
$83

33% lower than market

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

$87
$112

23% lower than market

Lab analysis to measure the lead level in blood specimen [HCPCS 83655]

$53
$88

39% lower than market

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

$89
$98

9% lower than market

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

$56
$84

33% lower than market

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

$20
$110

81% lower than market

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

$141
$279

49% lower than market

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

$60
$309

81% lower than market

Lab analysis to measure the phosphate level [HCPCS 84100]

$55
$75

27% lower than market

Lab analysis to measure the total calcium level in blood specimen [HCPCS 82310]

$74
$69

7% higher than market

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

$52
$51

2% higher than market

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

$59
$109

46% lower than market

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

$62
$68

8% lower than market

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

$77
$196

61% lower than market

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

$72
$223

68% lower than market

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

$87
$224

61% lower than market

Lab analysis to screen for autoimmune disorders [HCPCS 86038]

$58
$138

58% lower than market

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

$163
$379

57% lower than market

Lab blood analysis to confirm blood unit compatibility by immediate spin technique [HCPCS 86920]

$163
$218

25% lower than market

Lab blood analysis to confirm blood unit compatibility by incubation technique [HCPCS 86921]

$163
$761

79% lower than market

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

$65
$207

69% lower 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]

$65
$165

60% lower than market

Lab blood analysis to identify the coating of red blood cells by antibody (Coombs test) (indirect, each reagent) [HCPCS 86885]

$98
$185

47% lower than market

Psa screening [HCPCS G0103]

$68
$173

60% lower than market

Rbc leukocytes reduced [HCPCS P9016]

$535
$1,185

55% lower than market

OUTPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

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

$173
$176

2% lower than market

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

$89
$194

54% lower than market

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

$297
$607

51% lower than market

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

$21
$203

90% lower than market

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

$248
$487

49% lower than market

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

$6
$196

97% lower than market

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

$173
$138

25% higher 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]

$3,465
$5,176

33% lower than market

Tissue removal from wounds per session (first 20 sq cm or less) [HCPCS 97597]

$169
$565

70% lower than market

Whole blood removal by needle to correct blood level imbalance [HCPCS 99195]

$178
$334

47% lower than market

OUTPATIENT OBSERVATION

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$2
$9

79% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION

Description

Our Charge
Market Charge

Variance

Admin influenza virus vac [HCPCS G0008]

$49
$114

57% lower than market

Admin pneumococcal vaccine [HCPCS G0009]

$47
$132

64% lower than market

Ceftriaxone sodium injection [HCPCS J0696]

$4
$17

77% lower than market

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

$84
$202

58% lower than market

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

$173
$476

64% lower than market

Fentanyl citrate injection [HCPCS J3010]

$18
$19

8% lower than market

Hydromorphone injection [HCPCS J1170]

$16
$21

26% lower than market

Inj enoxaparin sodium [HCPCS J1650]

$7
$11

34% lower than market

Inj pantoprazole sodium, via [HCPCS C9113]

$31
$56

45% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$8
$12

35% lower than market

Levofloxacin injection [HCPCS J1956]

$15
$46

68% lower than market

Methylprednisolone 40 mg inj [HCPCS J1030]

$48
$102

53% lower than market

Morphine sulfate injection [HCPCS J2270]

$8
$24

67% lower than market

Piperacillin/tazobactam [HCPCS J2543]

$9
$8

12% higher than market

Promethazine hcl injection [HCPCS J2550]

$13
$21

41% lower than market

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

$206
$166

24% higher than market

Triamcinolone acet inj nos [HCPCS J3301]

$1
$14

91% lower than market

OUTPATIENT PHYSICAL/OCCUPATIONAL/SPEECH THERAPY

Description

Our Charge
Market Charge

Variance

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

$116
$103

12% higher than market

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

$109
$105

4% higher than market

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

$159
$273

42% lower than market

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

$159
$326

51% lower than market

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

$114
$109

4% higher than market

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

$106
$127

17% lower than market

OUTPATIENT PULMONARY THERAPY

Description

Our Charge
Market Charge

Variance

External 48-hour EKG heart rhythm tracing, analysis, and interpretation with recording [HCPCS 93225]

$347
$580

40% lower than market

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

$198
$280

29% lower than market

OUTPATIENT RESPIRATORY THERAPY

Description

Our Charge
Market Charge

Variance

Airway inhalation treatment to relieve airway obstruction or for sputum collection (inhaled pressure or nonpressure treatment) [HCPCS 94640]

$89
$357

75% lower than market

OUTPATIENT SURGICAL SERVICES

Description

Our Charge
Market Charge

Variance

Blood or blood products transfusion [HCPCS 36430]

$2,395
$7,093

66% lower than market

Collection of blood specimen from arterial puncture for diagnosis [HCPCS 36600]

$5,936
$5,364

11% higher than market

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

$2,362
$5,424

56% lower than market

Indwelling bladder catheter insertion (simple) [HCPCS 51702]

$270
$3,218

92% lower than market

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

$20
$26

24% lower than market

Simple repair of wound of face, ears, eyelids, nose, lips and/or mouth (2.6 to 5.0 cm) [HCPCS 12013]

$895
$4,101

78% lower than market

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.5 cm or less) [HCPCS 12001]

$1,059
$2,570

59% lower than market

Simple repair of wound of scalp, neck, underarms, genitalia, trunk, arms, and/or legs (2.6 to 7.5 cm) [HCPCS 12002]

$1,438
$2,835

49% lower than market

Temporary bladder catheter insertion [HCPCS 51701]

$331
$5,177

94% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL

Description

Our Charge
Market Charge

Variance

Abdominal ultrasound (limited) [HCPCS 76705]

$391
$777

50% lower than market

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

$253
$323

22% lower than market

Ankle x-ray (2 views) [HCPCS 73600]

$253
$387

35% lower than market

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

$340
$382

11% lower than market

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

$253
$325

22% lower than market

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

$253
$352

28% lower than market

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

$782
$1,225

36% lower than market

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

$391
$799

51% lower than market

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

$698
$1,103

37% lower than market

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

$4,248
$1,598

166% higher than market

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

$340
$355

4% lower than market

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

$253
$316

20% lower than market

Elbow x-ray (2 views) [HCPCS 73070]

$253
$371

32% lower than market

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

$178
$319

44% lower than market

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

$253
$349

27% lower than market

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

$340
$358

5% lower than market

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

$340
$375

9% lower than market

Head and neck ultrasound [HCPCS 76536]

$293
$714

59% lower than market

Heart ultrasound including color-depicted blood flow rate, direction, and valve function [HCPCS 93306]

$1,047
$2,459

57% lower than market

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

$340
$347

2% lower than market

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

$253
$366

31% lower than market

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

$389
$594

34% lower than market

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

$1,534
$1,398

10% higher than market

Leg ultrasound of arteries and arterial grafts of both legs (complete study) [HCPCS 93925]

$838
$1,577

47% lower than market

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

$340
$333

2% higher than market

Neck CT scan of the soft tissue of the neck without contrast to examine injury, foreign bodies, or tumors [HCPCS 70490]

$1,678
$1,541

9% higher than market

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

$1,733
$1,511

15% higher than market

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

$253
$536

53% lower than market

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

$389
$802

51% lower than market

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

$1,822
$1,628

12% higher than market

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

$1,812
$1,587

14% higher than market

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

$315
$529

40% lower than market

Spinal x-ray of middle spine (2 views) [HCPCS 72070]

$389
$605

36% lower than market

Spinal x-ray of upper spine (2 or 3 views) [HCPCS 72040]

$340
$381

11% lower than market

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

$340
$328

4% higher than market

Toe(s) x-ray (minimum of 2 views) [HCPCS 73660]

$189
$388

51% lower than market

Wrist x-ray (2 views) [HCPCS 73100]

$253
$333

24% lower than market

INPATIENT CARDIOLOGY

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat without complications

$5,811
$13,453

57% lower than market

Heart Failure with complications

$8,627
$17,239

50% lower than market

INPATIENT MEDICINE

Description

Our Charge
Market Charge

Variance

Diabetes without complications

$10,125
$9,912

2% higher than market

Esophagitis, gastroent & misc digest disorders with major complications

$9,662
$73,310

87% lower than market

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

$5,324
$12,521

57% lower than market

Infection of the skin

$8,192
$14,403

43% lower than market

Stomach Disorder without complications

$12,606
$14,269

12% lower than market

INPATIENT PULMONOLOGY

Description

Our Charge
Market Charge

Variance

Chronic Lung Disease with major complications

$9,082
$20,854

56% lower than market

Chronic Lung Disease without complications

$8,922
$23,628

62% lower than market

Pneumonia with complications

$10,842
$20,153

46% lower than market

Pneumonia without complications

$8,816
$11,949

26% lower than market

Respiratory infections and inflammations with major complications

$13,073
$35,508

63% lower than market

INPATIENT UROLOGY

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection with major complications

$9,899
$20,591

52% lower than market

Kidney & urinary Infection without complications

$9,810
$19,198

49% lower than market

Kidney failure with complications

$9,759
$18,129

46% 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.