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Room and Board - Per Day Charges
The following represents the hospital charges for room and care services only. The charges below do not include the fees for drugs, non-routine supplies and procedures that may be rendered during an inpatient visit.
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| Medical/Surgical - Semi Private |
$ 628.08 |
| Medical/Surgical - Private |
$ 726.18 |
| Progressive Pulmonary Care |
$ 803.36 |
| Intensive Care |
$ 1,841.91 |
| Pyschiatry |
$ 726.18 |
| Nursery |
$ 346.19 |
| Special Care Nursery |
$ 687.96 |
| Premie Baby Nursery |
$ 845.25 |
| Nursery Intensive Care |
$ 1,511.16 |
| Labor and Delivery |
$ 726.18 |
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| Labor, Delivery and Newborn Charges
The following list does not include anesthesia, drugs, or supplies for services rendered.
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CPT Code |
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| Normal Delivery |
59409 |
$ 2,301.05 |
| Labor and Delivery Triage Fee (Outpatient Only |
59899 |
$ 170.63 |
| Hearing Screening Newborn, 1st Intial |
92587 |
$ 107.49 |
| Circumcision |
54150 |
$ 2,614.91 |
| Fetal Non-Stress Test |
59025 |
$ 190.93 |
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| The following represents the average hospital charges per case. Note: This represents average charges per case based upon actual cases reviewed. Final charges will vary based upon total operating time, drugs, supplies and services utilized. |
| C-Section Delivery |
For CASE |
$ 6,176.21 |
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Emergency Department Charges
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| The following represents the hospital charges for each level of emergency care provided to patients. A Level 1 represents a basic emergency visit. A Level 5 represents a more comprehensive emergency visit. The charges below do not include the fees for drugs, supplies or additional procedures that may be rendered during the emergency department visit. |
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CPT Code |
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| Triage - Level 1 |
99281 |
$ 87.47 |
| Level 1 |
99281 |
$ 319.73 |
| Level 2 |
99282 |
$ 528.47 |
| Level 3 |
99283 |
$ 843.78 |
| Level 4 |
99284 |
$ 1,300.95 |
| Level 5 |
99285 |
$ 1,818.39 |
| Critical Care |
99291 |
$ 2,563.68 |
| Critical Care Additional |
99292 |
$ 483.63 |
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| Operating Room Charges |
| The following represents the hospital charges for each level of surgery that is provided at our hospital. A Level One represents a basic operating room procedure. A Level Three is a more comprehensive procedure, which utilizes more services. In addition, there are separate levels for Robotic Surgery or Laser Surgery Cases, which includes the use of special equipment. The following list does not include charges for anesthesia, drugs, supplies or implants/devices for services rendered. |
| Level One 0-30 Minutes |
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$ 1,392.92 |
| Level One Each Add'l 15 Minutes |
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$ 41.35 |
| Level Two 0-30 Minutes |
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$ 1,449.72 |
| Level Two Each Add'l 15 Minutes |
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$ 1,554.83 |
| Level Three 0-30 Minutes |
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$ 122.40 |
| Laser 0-30 Minutes |
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$ 69.29 |
| DaVinci Robotic 0-30 Minutes |
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$ 3,387.03 |
| DaVinci Robotic Each Add'l 15 Minutes |
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$ 69.29 |
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NonInvasive Cardiology Charges
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| The following represents the hospital charges for the most common procedures for the Noninvasive Cardiology Department. |
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CPT Code |
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| Electrocardiogram, Tracing Only, WO Inter/Report |
93005 |
$ 60.38 |
| Echo Trasth Complete W/2D, M-Mode, Spect Dop Color Flow Cop |
93306 |
$ 679.33 |
| Doppler Echocardiography Color Flow Velocity Mapping |
93325 |
$ 141.12 |
| Stress Echocardiography |
93350 |
$ 679.33 |
| Tee W Image Doc; W Probe Interpretation & Report |
93312 |
$ 706.90 |
| Doppler Echo Pulsed Wave W Spectral Display; Complete |
93320 |
$ 234.47 |
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Physical Therapy Charges
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| The following represents the hospital charges for the most common procedures for the Physical Therapy Department. |
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CPT Code |
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| Therapeutic Exercise, EA 15 Min |
97110 |
$ 37.49 |
| Manual Therapy Techniques, EA 15 Min |
97140 |
$ 37.49 |
| Gait Training, EA 15 Min |
97116 |
$ 27.20 |
| Physical Therapy Evaluation |
97001 |
$ 108.05 |
| Therapeutic Activities, Direct, EA 15 Min |
97530 |
$ 27.20 |
| Application of Modality, Hot or Cold |
97010 |
$ 27.20 |
| Apply Ultrasound, EA 15 Min |
97035 |
$ 37.49 |
| Therapeutic Group, EA 15 Min |
97150 |
$ 35.28 |
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Occupational Therapy Charges
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| The following represents the hospital charges for the most common procedures for the Occupational Therapy Department. |
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CPT Code |
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| Therapeautic Exercise, EA 15 Min |
97110 |
$ 37.49 |
| Occupation Therapy Evaluation |
97003 |
$ 97.02 |
| Self Care/Home Management Train, EA 15 Min |
97535 |
$ 27.20 |
| Therapeutic Activities, Direct, EA 15 Min |
97530 |
$ 27.20 |
| Manual Therapy Techniques, EA 15 Min |
97140 |
$ 37.49 |
| Neuromuscular Re-education, EA 15 Min |
97112 |
$ 27.20 |
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Neurology Charges
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| The following represents the hospital charges for the most common procedures for the Neurology Department. |
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CPT Code |
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| EEG Awake and Drowsy 20-40 Min |
95816 |
$ 283.12 |
| EEG Extended Monitoring, Greater than 1 Hour |
95813 |
$ 283.12 |
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Cardiac and Pulmonary Rehab Charges
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| The following represents the hospital charges for the most common procedures for Cardiac Rehab Program. |
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CPT Code |
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| Cardiac Rehab W/ECG Monit |
93798 |
$ 186.00 |
| Cardiac Rehab Phase III Visit |
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$ 10.00 |
| Cardiac Rehab Phase IV Visit |
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$ 7.70 |
| Pulm Rehab W/ Exercise & Monitoring, Per Hour, Per Session |
60424 |
$ 111.44 |
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| Radiology Charges |
| The following charges represent the hospital's top 30 most common radiology procedures. |
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CPT Code |
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| XRAY Chest, 2 Views |
71020 |
$ 151.38 |
| XRAY Chest, Frontal View, Portable |
71010 |
$ 151.38 |
| CT Head/Brain WO Contrast |
70450 |
$ 696.78 |
| Computed Tomography, ABD & Pelvis; W Contrast |
74177 |
$ 744.56 |
| CT Thorax W Contrast |
71260 |
$ 743.82 |
| US Echography, Abdominal, Complete |
76700 |
$ 280.77 |
| Computed Tomography, ABD & Pelvis; WO Contrast |
74176 |
$ 483.96 |
| XR Chest, Frontal View |
71010 |
$ 151.38 |
| XR Abdomen/KUB, Limited, 1 View |
74000 |
$ 132.13 |
| Ultrasound, Pelvic (Nonobstetric), Complete |
76856 |
$ 229.32 |
| US Duplex, Extremity Veins, Unilateral |
93971 |
$ 252.11 |
| US Echography, Transvaginal |
76830 |
$ 280.77 |
| XR Hand, Min 3 Views |
73130 |
$ 110.99 |
| XR Hip, Complete, Min 2 Views |
73510 |
$ 151.41 |
| Computer-Aided Detection: Screening Mammography |
77052 |
$ 10.29 |
| Mammography Producing Digital Imaging Screening Exam |
G0202 |
$ 112.00 |
| XR Ankle, Complete, Min 3 Views |
73610 |
$ 110.99 |
| XR Shoulder, Complete |
73030 |
$ 127.16 |
| US Pregnant Uterus, F/U, Per Fetus |
76816 |
$ 69.83 |
| XR ABD, Complete Acute Series, Single View Chest |
74022 |
$ 221.38 |
| XR Knee, Complete, 4 or More Views |
73564 |
$ 155.09 |
| CT Cervical Spine WO Contrast |
72125 |
$ 736.47 |
| XR Foot, Complete, Min 3 Views |
73630 |
$ 110.99 |
| XR Wrist, Complete |
73110 |
$ 110.99 |
| US Echography, Retroperitoneal (Renal), Complete |
76770 |
$ 230.06 |
| XR Spine, Lumbarsacral, AP & Bilateral |
72100 |
$ 102.90 |
| US Duplex, Extermity Veins, Bilateral |
93970 |
$ 396.17 |
| US PG Uterus, Fetal Anatomic Exam; Single/1st Gestation |
76811 |
$ 170.52 |
| Myocardial Perfusion Image, Tomographic; Multi Study/Rest/Stress |
78452 |
$ 908.73 |
| XR Spine, Lumbosacral, Complete, W Oblique Views |
72110 |
$ 171.99 |
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| Lab Charges |
| The following charges represent the hospital's top 30 most common lab procedures. |
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CPT Code |
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| Collection of Venous Blood By Venipuncture |
36415 |
$ 14.00 |
| Glucose; Quanitative, Point of Care |
82947 |
$ 14.70 |
| Basic Metabolic Panel (8) |
80048 |
$ 14.00 |
| CBC With Auto Differential |
85025 |
$ 13.13 |
| Prothrombin Time |
85610 |
$ 7.00 |
| CBC (Hemogram & PLT) |
85027 |
$ 8.82 |
| Comprehensive Metabolic Panel (14) |
80053 |
$ 62.48 |
| Troponin I, Quantitative |
84484 |
$ 13.23 |
| Tissue Level IV, Gross & Microscopic Examination |
88305 |
$ 110.99 |
| Magnesium |
83735 |
$ 9.56 |
| Transferase; Alanine Amino (ALT) (SGPT) |
84460 |
$ 6.62 |
| APTT |
85730 |
$ 8.09 |
| Hepatic Function Panel (7) |
80076 |
$ 11.03 |
| Transferase; Aspartate Amino (AST) (SGOT) |
84450 |
$ 6.62 |
| Lipid Profile |
80061 |
$ 18.38 |
| Thyroid Stimulation Hormone (TSH) |
84443 |
$ 51.45 |
| Glcosolated HGB |
83036 |
$ 13.23 |
| Vitamin D 25-OH |
82306 |
$ 41.90 |
| Gyn Cytopath/Thin Layer - Routine Screening |
G0123 |
$ 58.80 |
| Urine Culture With Colony Count |
87086 |
$ 36.75 |
| Urinalysis - Routine |
81001 |
$ 4.26 |
| Culture, Presumptive, Screening Only |
87081 |
$ 82.32 |
| Hematocrit (HCT); Automated |
85014 |
$ 3.68 |
| Chlamydia Trachomatis DNA By PCR |
87491 |
$ 94.82 |
| N. Gonorroheae RNA |
87591 |
$ 94.82 |
| Free Thyroxine |
84439 |
$ 37.49 |
| Blood Culture |
87040 |
$ 13.97 |
| SED Rate |
85652 |
$19.11 |
| Drug Screen, Single Class |
G0431 |
$ 107.45 |
| Cyanocobalamin (Vitamin B12) |
82607 |
$ 24.50 |
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| Procedural Based Charges |
| The following represent the average hospital charges per case for specific OUTPATIENT procedures. Note: This represents average charges per case based upon actual cases reviewed. Final charges will vary based upon services rendered. |
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CPT Code |
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| Laparoscopic Cholecystectomy |
47562 |
$ 6,134.04 |
| PRP I/Hern Init Reduc More Than 5 Yr |
49505 |
$ 3,663.57 |
| Hysteroscopy, Biopsy |
58558 |
$ 2,745.49 |
| Upper GI Endoscopy, Biopsy |
43239 |
$ 2,291.50 |
| Diagnostic Colonoscopy |
45378 |
$ 1,931.69 |
| Mastectomy Partial |
19301 |
$ 6,304.07 |
| Dental Surgery Procedure |
41899 |
$ 3,321.80 |
| Knee Arthoscopy/Surgery |
29881 |
$ 3,321.80 |
| Hysteroscopy, Ablation |
58563 |
$ 5,973.19 |
| Removal of Tonsils |
42826 |
$ 3,345.63 |
| Colonoscopy and Biopsy |
45390 |
$ 2,117.39 |
| Cystouretero W/ Lithotripsy |
52353 |
$ 5,332.51 |
| Create Eardrum Opening |
69436 |
$ 2,861.60 |
| Cath Place Coronary Art Image SI; W/L Heart Cath |
93458 |
$ 5,116.08 |
| Carpal Tunnel Surgery |
64721 |
$ 2,482.03 |
| Low Back Disk Surgery |
63030 |
$ 4, 575.64 |
| Repair Bladder Defect |
57288 |
$ 6,755.20 |
| Laser Vaporization of Prostate |
52648 |
$ 7,592.31 |
| Cystoscopy and Treatment |
52332 |
$ 4,317.05 |
| Cataract Surgery |
66984 |
$ 3,738.83 |
| Colonoscopy, Lesion Removal |
45385 |
$ 2,234.70 |
| Correction of Bunion |
28296 |
$ 3,602.77 |
| Repair Umbilical Hernia |
49585 |
$ 3,746.65 |
| Laparascopy, Remove Adnexa |
58661 |
$ 8,457.43 |
| Repair of Nasal Septum |
30520 |
$ 4,121.32 |
| Shoulder Arthroscopy/Surgery |
29826 |
$ 5,669.88 |
| Knee Arthroscopy Surgery |
29880 |
$ 3,385.02 |
| Laparascopy, Appendectomy |
44970 |
$ 10,354.84 |
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