Estimated Hospital Charges

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St. Mary's Regional Medical Center
Estimated Charges for Selected Procedures
2014

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: $1,347.00)
   
       
MS DRG Procedure Median Charge Uninsured Self
Pay Charge
Childbirth Related
775 Normal Vaginal Delivery (Mother) $7,140 $3,570
774 Normal Vaginal Delivery (w/ complicating diagnosis) $7,563 $3,782
766 Normal Cesarean Section (Mother) $13,396 $6,698
765 Cesarean Section when there are complications $14,190 $7,095
795 Normal Newborn (Baby) $2,963 $1,482
       
Medical/Other
101 Seizures w/out Major Complications $17,372 $8,686
194 Simple Pneumonia and Pleurisy $12,674 $6,337
292 Heart Failure and Shock w/ Complications $13,943 $6,972
392 Esophagitis, Gastroenteritis & Misc Digestive Disorders w/ Complications (age 17 or older)  $13,327 $6,664
470 Major Joint Replacement or Reattachment $42,538 $21,269
871 Septicemia or Severe Sepsis w/o MV 96+ Hours w/MCC $27,909 $13,955
872 Septicemia or Severe Sepsis w/o MV 96+ Hours w/o MCC $17,030 $8,515
       
Psychoses or Drug Related
881 Depressive Neuroses $7,235 $3,618
885 Psychoses $10,604 $5,302
897 Alcohol/Drug Abuse or Dependency $6,597 $3,299
       
The above 2014 charge estimates are based on historical patient visits in 2012, 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.
       
Top 20 Outpatient Services
  Description of Service Median Charge Uninsured Self Pay Median Charge
  Cataract Removal $7,818 $3,909
  Closed [Endoscopic] Biopsy of Large Intestine $2,203 $1,102
  Colonoscopy $1,584 $792
  Cystometrogram $2,860 $1,430
  Cystoscopy, Nec $1,588 $794
  Dilation and Curettage of Uterus (D&C) $7,498 $3,749
  Dilation of Esophagus $3,639 $1,820
  Endometrial Ablation $14,923 $7,462
  Endoscopic Bronchial Biopsy (Closed) $4,932 $2,466
  Endoscopic Gall Bladder Removal (Laparoscopic Cholecystectomy) $19,395 $9,698
  Endoscopic Polypectomy of Large Intestine $2,279 $1,140
  Endoscopic Polypectomy of Rectum $1,785 $893
  Esophagogastroduodenoscopy (EGD) with Biopsy $2,155 $1,078
  Excision of Semilunar Cartilage of Knee $10,393 $5,197
  Extracorporeal Shockwave Lithotripsy [ESWL] of the Kidney, Ureter and/or Bladder $8,514 $4,257
  Fetal Monitoring $315 $158
  Insertion of Totally Implantable Vascular Device $9,299 $4,650
  Other Local Destruction of Lesion or Tissue of Skin/Subcutaneous Tissue $1,542 $771
  Other Transurethral Excision or Destruction of Lesion or Tissue of Bladder $8,598 $4,299
  Ureteral Catheterization $11,109 $5,555
 
  Other Miscellaneous Outpatient Services
  Cat Scan (CT) of the Abdomen and Pelvis w/out Contrast $2,562 $1,281
  Cat Scan (CT) of the Head w/out Contrast $1,110 $555
  Chest X-Ray (PA & Lateral) $265 $133
  Digital Mammography (Mammogram) Screening $280 $140
       
Emergency Room (includes physician fee)*
  Procedure Charges* Uninsured Self Pay Charge*
  Level 1 (least critical) $168 $84
  Level 2 $261 $131
  Level 3 $540 $270
  Level 4 $940 $470
  Level 5 (most critical) $1,629 $815
       
*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 2014 charge estimates are based on rates as of 01/01/2013.  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 2014 charge estimates are based on rates as of 01/01/2013.  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.
       
       
       

 

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