Estimated Hospital Charges

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St. Mary's Regional Medical Center
Estimated Charges for Selected Procedures
2016

Reimbursement to the hospital (and the patients financial responsibility) will also vary based on the term of any insurance coverage, contractual reimbursement rates, deductible, copay, and coinsurance.

       
  Inpatient (Top 15 Admissions)
(Basic Per Diem Med Surg Bed Charge: $1,414.00)
   
       
MS DRG Procedure Median Charge Uninsured Self
Pay Charge
Childbirth Related
775 Normal Vaginal Delivery (Mother) $7,485 $3,743
774 Normal Vaginal Delivery (w/ complicating diagnosis) $9,025 $4,513
766 Normal Cesarean Section (Mother) $12780 $6,390
765 Cesarean Section when there are complications $13,590 $6,795
794

Neonate with other significant problems

$3,606 $1,803
795 Normal Newborn (Baby) $3,428 $1,714
       
Medical/Other
101 Seizures w/out Major Complications $16,435 $8,218
291 Heart Failure and Shock w/ MCC $21,140 $10,570
392 Esophagitis, Gastroenteritis & Misc Digestive Disorders w/ Complications (age 17 or older) $19,500 $9,750
470 Major Joint Replacement or Reattachment $50,345 $25,173
603 Cellulitis w/o MCC $14,899 $7,450
641

Misc Disorders of Nutrition, Metabolism, Fluids/Electrolytes w/o MCC

$7,224 $3,612
871 Septicemia or Severe Sepsis w/o MV 96+ Hours w/MCC $33,569 $16,785
872 Septicemia or Severe Sepsis w/o MV 96+ Hours w/o MCC $21,964 $10,982
       
Psychoses or Drug Related
881 Depressive Neuroses $8,018 $4,009
885 Psychoses $9,973 $4,987
895

Alcohol/Drug Abuse or Dependence with Rehabiliation Therapy

$10,488 $5,244
897 Alcohol/Drug Abuse or Dependency $6,279 $3,140
       

The above 2016 charge estimates are based on historical patient visits in 2015, including Mental Health and Substance Abuse services. Charges for specific patients will depend on many factors including the physician, the condition of the patient, unexpected complications, or additional procedures required. These charges are to be considered estimates only and are not a guarantee of final costs. These are hospital charges only except where indicated. Other fees and charges are not included such as surgeon or other physician fees, radiologist, and other non-facility fees.

       

St. Mary's Regional Medical Center
Estimated Charges for Selected Procedures
2016

Reimbursement to the hospital (and the patients financial responsibility) will also vary based on the term of any insurance coverage, contractual reimbursement rates, deductible, copay, and coinsurance.

       
Top 20 Outpatient Services
  Description of Service Median Charge Uninsured Self Pay Median Charge
 

Cardiac Catheterization-Left Heart Cardiac Catheterization

$14,057 $7,029
  Cataract Removal $8,802 $4,401
  Closed [Endoscopic] Biopsy of Large Intestine $3,109 $1,555
  Colonoscopy $2,667 $1,334
  Cystometrogram $3,018 $1,509
  Dilation and Curettage of Uterus (D&C) $10,033 $5,017
  Dilation of Esophagus $4,913 $2,457
  Endoscopic Bronchial Biopsy (Closed) $4,345 $2,173
  Endoscopic Gall Bladder Removal (Laparoscopic Cholecystectomy) $20,108 $10,054
  Endoscopic Polypectomy of Large Intestine $4,784 $2,392
  Endoscopic Polypectomy of Rectum $4,618 $2,309
  Esophagogastroduodenoscopy (EGD) with Closed Biopsy $3,710 $1,855
  Excision of Semilunar Cartilage of Knee $11,110 $5,555
  Extracorporeal Shockwave Lithotripsy [ESWL] of the Kidney, Ureter and/or Bladder $5,679 $2,840
  Fetal Monitoring $433 $217
  Insertion of Totally Implantable Vascular Device $9,414 $4,707
  Local Destruction of Lesion or Tissue of Skin/Subcutaneous Tissue $1,730 $865
  Tonsillectomy w/ Adenoidectomy $9,629 $4,815
  Transurethral Excision or Destruction of Lesion or Tissue of Bladder $11,796 $5,898
  Upper Eye Lid Rhytidectomy $8,677 $4,339
 
  Other Miscellaneous Outpatient Services
  Cat Scan (CT) of the Abdomen and Pelvis w/out Contrast $2,690 $1,345
  Cat Scan (CT) of the Head w/out Contrast $1,166 $583
  Chest X-Ray (PA & Lateral) $278 $139
  Digital Mammography (Mammogram) Screening $294 $147
 

MRI-Brain /out Contrast

$2,180 $1,090
 

MRI-Extrimity w/out Contrast

$2,180 $1,090
 

MRI-Lumbar w/out Contrast

$2,180 $1,090
       

The above 2016 charge estimates are based on historical patient visits in 2015. Charges for specific patients will depend on many factors including the physician, the condition of the patient, unexpected complications, or additional procedures required. These charges are to be considered estimates only and are not a guarantee of final costs. These are hospital charges only except where indicated. Other fees and charges are not included such as surgeon or other physician fees, radiologist, and other non-facility fees.

       

St. Mary's Regional Medical Center
Estimated Charges for Selected Procedures
2016

Reimbursement to the hospital (and the patients financial responsibility) will also vary based on the term of any insurance coverage, contractual reimbursement rates, deductible, copay, and coinsurance.

       
Emergency Room (includes physician fee)*
  Procedure Charges* Uninsured Self Pay Charge*
  Level 1 (least critical) $176 $88
  Level 2 $274 $137
  Level 3 $567 $284
  Level 4 $987 $494
  Level 5 (most critical) $1,710 $855
       
*Charges shown are for basic facility and professional fees and do not include any additional services that may be performed in the Emergency Department.
       

The above 2016 charge estimates are based on rates as of 01/01/2016. Charges for specific patients will depend on many factors including the physician, the condition of the patient, unexpected complications, or additional procedures required. These charges are to be considered estimates only and are not a guarantee of final costs. These are hospital charges only except where indicated. Other fees and charges are not included such as surgeon or other physician fees, radiologist, and other non-facility fees.

       
Provider Based Primary Care Physician Practices
Procedure Insured and Uninsured Charges**
99201 New Patient Level 1 $79
99202 New Patient Level 2 $136
99203 New Patient Level 3 $195
99204 New Patient Level 4 $302
99205 New Patient Level 5 $380
99211 Established Patient Level 1 $39
99212 Established Patient Level 2 $78
99213 Established Patient Level 3 $132
99214 Established Patient Level 4 $197
99215 Established Patient Level 5 $266
99241 Primary Care Physician Consult Level 1 $147
99242 Primary Care Physician Consult Level 2 $233
99243 Primary Care Physician Consult Level 3 $302
99244 Primary Care Physician Consult Level 4 $424
99245 Primary Care Physician Consult Level 5 $571
       
**Charges shown are for basic facility and professional fees and do not include any additional services that may be performed in the facility, practice or in any other non primary care physician practice.
       

The above 2016 charge estimates are based on rates as of 01/01/2016. Charges for specific patients will depend on many factors including the physician, the condition of the patient, unexpected complications, or additional procedures required. These charges are to be considered estimates only and are not a guarantee of final costs. These are hospital charges only except where indicated. Other fees and charges are not included such as surgeon or other physician fees, radiologist, and other non-facility fees.

       
       
Rev 1/19/16

 

© 2016 St. Mary's Regional Medical Center 93 Campus Avenue, Lewiston, Maine 04240 Phone: 207-777-8100