Patient Fees

Intensive Care Unit
Progressive Care Unit
Routine Nursery
Routine Care

$2,146.21
$1,600.66
$1,079.10
$882.46

Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.

Normal vaginal delivery (mom & baby/room and board)
C-Section delivery (mom & baby/room and board)
Circumcision - newborn (CPT 54150)
Fetal Monitor (CPT 59050)

TBD
TBD
$273.58
$146

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.

Level 1
Level 2
Level 3
Level 4
Level 5

Critical Care (First 30-74 Minutes)

$270
$393.11
$611.32
$927.69
$1,351.80

$1,911.18

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services and or supplies that are used.

Aquatic Therapy-pool (CPT 97113)
Manual Therapy (CPT 97140)
PT Eval Low Complex (CPT 97161)
PT Eval Mod Complex (CPT 97162)
PT Eval High Complex (CPT 97163)
Therapeutic Activities (CPT 97530)
Therapeutic Neurologic Re-education (CPT 97112)
Work Conditioning - 15 Minutes (CPT W0710)

$132.19
$122.85
$200
$220
$240.35
$131.84
$140
$13.88

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services and/or supplies that are used.

OT Eval Low Complex (CPT 97165)
OT Eval Mod Complex (CPT 97166)
OT Eval High Complex (CPT 97167)
OT Activities of Daily Living (CPT 97535)
OT Manual Therapy (CPT 97140)
OT Neurological Re-education (CPT 97112)
OT Paraffin Bath (CPT 97018)
OT Therapeutic Exercise (CPT 97110)
OT Aquatic Therapy (CPT 97113)

$229.90
$235.13
$240.35
$113.96
$122.85
$140
$74.40
$135
$132.19
 

The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Arterial Blood Gas (CPT 82803)
EKG (CPT 93000)
PFT Study-Pulmonary Function Test (CPT 94060)
Polysomnogram Study (CPT 95810)
Cardiac Rehabilitation Monitored Exercise (CPT 93798)

$215
$189
$620.84
$3,692
$218.40

The following charges reflect the hospital’s 30 most common x-ray and radiological procedures. The following list does not include charges for drugs. Additionally, there may be charges for supplies specific to your treatment. Fees for the radiologist readings are also not reflected, and will be billed separately.

Abdomen (CPT 74000)
Abdominal Services (CPT 74022)
Ankle (CPT 73610)
Cervical Spine (CPT 72040)
Chest-1 view (CPT 71010)
Chest-2 views (CPT 71020)
Elbow (CPT 73070)
Foot (CPT 73630)
Hand (CPT 73130)
Hip (CPT 73510)
Humerus (CPT 73060)
Knee (CPT 73560)
Lumbar Spine (CPT 72100)
Pelvis (CPT 72170)
Sacrum (CPT 72220)
Shoulder (CPT 73030)

$287.05
$469.34
$327.60
$353.70
$279.60
$321.26
$341.97
$401.14
$351.60
$183.92
$320.77
$327.60
$487.22
$295.20
$346.20
$378

CAT Scans

CT Abdomen (with & without contrast) (CPT 74170)
CT Abdomen (without contrast) (CPT 74150)
CT Chest (with contrast) (CPT 71260)
CT Head (without contrast) (CPT 70450)
CT Head (with & without contrast)(CPT 70470)
CT Pelvis (with contrast) (CPT 72193)
CT Pelvis (without contrast) (CPT 72192)
CT Sinuses (CPT 70486)

$2,170.14
$1,599.88
$1,926.10
$1,396.89
$1,823.25
$1,614.81
$1,472.63
$1,496

Nuclear Medicine

Cardiolite Stress Test (Total Facility Charge) (CPT 78452)

$3,666.94

Ultrasound

Ultrasound Pelvis (CPT 76856)
Ultrasound Right Upper Quadrant (CPT 76705)

$755.39
$687

MRI

MRI Lumbar spine (without contrast) (CPT 72148)

$2,755.20

Other

DEXA (Bone Density Scan) (CPT 77080)
DX Mammogram Bilateral (CPT 77066)
Screening Mammogram - Bilateral (CPT 77067)
Screening Mammogram - Digital (CPT G0202)

$460.80
$287.38
$383.52
$230.66

The following charges reflect the hospital’s 30 most common laboratory procedures. These prices are based on specimens drawn in our facility or by our staff. * Please be informed that blood tests will have one additional charge of $14.00 per visit for the blood collection.

A1C– Glycated Hemoglobin (CPT 83036)
Amylase* (CPT 82150)
Blood Culture* (CPT 87040)
BMP-Basic metabolic panel (CPT 80048)
BNP–Brain Natriuretic Peptide (CPT 83880)
CBC–Complete blood count (CPT 85025)
CMP–Comprehensive metabolic panel (CPT 80053)
CRP–C-Reactive Protein (CPT 86040)
Creatinine* (CPT 82540)
D Dimer* (CPT 85379)
Electrolyte panel* (CPT 80051)
ESR* – Sedimentation rate (CPT 85652)
Free T4* (CPT 84439)
Glucose* (CPT 82947)
HCG* – (blood) (CPT 84702)
HFP* – Liver function panel (CPT 80076)
Lipid Panel* (CPT 80061)
Lipase* (CPT 83690)
Myoglobin* (CPT 83874)
Pro Time* (CPT 85610)
PSA* (CPT 84153)
Rapid Strep (CPT 87880)
Thera PT* – Pro Time (Coumadin level) (CPT 85610)
Troponin I* (CPT 84484)
TSH* – Thyroid Stimulating Hormone (CPT 84443)
Venipuncture (CPT 36415)

$81.45
$80.85
$148
$114
$204
$80
$170
$66
$43.26
$137
$78
$50
$102.52
$40.50
$135
$112
$113
$90
$146.47
$48
$123
$46.20
$48
$146
$121
$24

Operating Room charges are based on the complexity of a particular operation and the amount of time the surgery takes to complete. This does not include charges for anesthesia, drugs or supplies required for a particular procedure. Fees for physician services or anesthesia administration are not reflected and will be billed separately by your physician.

Level 1 (Endo) Initial 15 minutes
Level 2 - Initial 15 minutes
Level 3 - Initial 15 minutes
Level 4 - Initial 15 minutes

$1,655.28
$2,957.09
$4,176.13
$5,395.18