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Charges for Healthcare Services
Lab and X-ray Charges
Average charges are estimates; your out-of-pocket expense will depend on your individual insurance coverage (such as co-insurance or deductibles). To determine your estimated out-of-pocket expenses, please contact your insurance company by calling the number on the back of your insurance card, have your policy number and group number available. If you have questions, please contact Customer Service.
(Estimates valid between January 1, 2008 and December 31, 2008.)
| Lab Work |
|
| Service Type |
Hospital Charges
Estimated Average Charge
|
|
|
$37 |
86900 |
|
$67 |
86850 |
|
$91 |
80048 |
Blood Differential (Manual)
|
$40 |
85007 |
|
$62 |
85025 |
|
$44 |
85027 |
CKMB (Creatine Kinase MB XFraction Only)
|
$111 |
82553 |
|
$17 |
36415 |
Comprehensive Metabolic Panel
|
$97 |
80053 |
|
$61 |
82550 |
|
$110 |
86920 |
ESR (Erythrocyte Sedimentation Rate)
|
$35 |
85652 |
|
$49 |
83036 |
|
$83 |
80061 |
Prothrombin Time (Protime)
|
$36 |
85610 |
PSA (Prostate Specific Antigen)
|
$85 |
84153 |
PTT (Partial Thromboplastin Time)
|
$48 |
85730 |
|
$37 |
86901 |
|
$63 |
84439 |
|
$54 |
84436 |
|
$138 |
84484 |
TSH (Thyroid Stimulating Hormone)
|
$79 |
84443 |
|
$32 |
81000 |
Urine Culture*
* Organism ID and Sensitivity Extra
|
$61 |
87086 |
| Radiology (X-ray) Services |
|
| Service Type |
Hospital Charges
Estimated Average Charge
|
|
| Chest X-ray (single view) |
$158 |
71010 |
| Chest X-ray (two views) |
$196 |
71020 |
| Chest X-ray (multiple views) |
$446 |
71030 |
| Foot X-ray |
$183 |
73630 |
| OB-Ultrasound |
$485 |
76805 |
| Spine X-ray |
$150 |
72020 |
| Ultrasound, pelvis, complete |
$456 |
76856 |
| MRI |
|
| Service Type |
Hospital Charges
Estimated Average Charge
|
|
| Brain |
$2,383 |
70553 |
| Knee |
$1,452 |
73721 |
| Pelvis |
$1,734 |
72197 |
| Spine |
$1,934 |
72148 |
| CT Scan |
|
| Service Type |
Hospital Charges
Estimated Average Charge
|
|
| Abdominal |
$1,999 |
74160 |
| Chest |
$1,386 |
71250 |
| Head |
$1,204 |
70450 |
| Pelvis |
$1,257 |
72194 |
| Mammograms |
|
| Service Type |
|
|
Bilateral screening |
$90 |
77057 |
Bilateral diagnostic |
$133 |
77056 |
| Stress Tests |
|
| Service Type |
Hospital Charges
Estimated Average Charge |
|
Bicycle stress test/echocardiogram |
$1,769 |
93320 |
93350 |
93005 |
93325 |
Radiologic stress test |
$2,791 |
78465 |
78478 |
78480 |
Treadmill stress test |
$973 |
93350 |
The services you receive from your provider are based on your individual need and medical condition. Actual charges will vary based on services delivered, medical condition. Additional tests or services not listed in the estimate may be ordered by your doctor or provider, in order to treat, diagnose or care for individual needs.
*After your dismissal, you will receive a statement from Faith Regional Health Services for your hospital care. Physicians, excluding the emergency, infectious disease and psychiatry physicians, involved in your care will bill you separately from the hospital. These physicians may include anesthesiologists, surgeons, cardiologists, radiologists and other specialists.
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