Usual & Customary Charges
Community Memorial Hospital
Patient Price Information List
Effective February 1, 2009
In compliance with state law, Community Memorial Hospital is providing this price list containing our charges for room and board, Emergency Department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients but a patient's responsibility may vary depending on payment plans negotiated with individual health insurers or underinsured patients should consult with our admitting and billing staff to determine whether they qualify for discounts. The prices are correct as of February
1, 2009.
Room and Board–Per Day Charges
|
Charges |
Semi Private |
$739.00 |
Swing Bed |
$479.00 |
Obstetrics |
$738.00 |
Newborn |
$563.00 |
Labor and Delivery
The following list does not include charges for anesthesia, drugs, or supplies required for a particular procedure performed in the OB department. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.
|
Charges |
Vaginal Delivery |
$2,186.00 |
Cesarean Delivery |
OR Time |
OB Observation 1st hour |
$31.00 |
OB Observation addn'l hour |
$31.00 |
Circumcision |
$134.00 |
Emergency Room
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. This will be a separate fee billed by the hospital.
Emergency Room:
|
Charges |
Basic |
$117.00 |
Moderate |
$182.00 |
Complex |
$300.00 |
Severe |
$427.00 |
Comprehensive |
$747.00 |
Emergency Room Physician:
|
Charges |
Basic |
$119.00 |
Moderate |
$192.00 |
Complex |
$265.00 |
Severe |
$319.00 |
Comprehensive |
$484.00 |
Surgery:
Surgery charges are based on time in the operating room. These charges include set up charges and most supply charges. There will be additional charges for orthopedic implants. These charges do not include preoperative testing or additional charges for further studies. Anesthesia is an additional charge billed by the hospital.
|
Charges |
Surgery
initial half hour |
$1,804.00 |
Surgery each added 1/4 hour |
$691.00 |
Special Procedure Room |
$1,592.00 |
CRNA per unit |
$168.00 |
Laboratory:
The following charges reflect the 30 most common services offered by our Laboratory Department. Patients may have additional charges depending on the services performed.
|
Charges |
Prothrombin Time |
$58.00 |
Blood Count Complete |
$60.00 |
Venipuncture |
$21.00 |
Basic Metabolic Panel |
$102.00 |
Creatinine-Blood |
$97.00 |
Lipid Panel |
$114.00 |
Thyroid Stimulating Hormone |
$127.00 |
Comprehensive Metabolic Panel |
$125.00 |
Electrolyte Panel |
$78.00 |
Renal Function |
$130.00 |
Urea Nitrogen, Quantitative |
$53.00 |
Hemoglobin; A1C |
$102.00 |
Digoxin |
$143.00 |
Culture MIC |
$42.00 |
Creatine Kinase: Total |
$115.00 |
AST (SGOT) |
$53.00 |
Cult Bacterial |
$106.00 |
UA Dipstick |
$17.00 |
Hepatic Function Panel |
$123.00 |
LDH |
$94.00 |
Troponin |
$77.00 |
Potassium Serum |
$58.00 |
Thyroxin; Total |
$107.00 |
Thyroid Hormone Uptake |
$94.00 |
Glucose, Quantitative |
$73.00 |
Indentification Organism |
$30.00 |
Vitamin B12 |
$147.00 |
Tacrolimus |
$226.00 |
Phenytoin |
$102.00 |
Diagnostic Imaging:
The following charges reflect the 30 most common services offered by our Diagnostic Imaging Department. Patients may have additional charges depending on the services performed.
These charges do not reflect the physician charge for reading
the results.
| |
Charges |
CT Abdomen w contrast |
$1,335.00 |
CT Head/Brain w/o contrast |
$1,185.00 |
CT Pelvis
w contrast |
$1,380.00 |
CT Chest
w contrast |
$1,293.00 |
CT Abdomen w/o contrast |
$1,193.00 |
CT Cervical Spine
w/o contrast |
$1,110.00 |
Chest 2 Views |
$141.00 |
Screening Mammography |
$135.00 |
Bone Density Study |
$343.00 |
Hip 2 Views |
$187.00 |
Shoulder Complete |
$200.00 |
Chest Single View |
$81.00 |
Spine, Lumbar 4 Views |
$276.00 |
Knee 3 Views |
$209.00 |
Abdomen Acute Series |
$328.00 |
MRI Lumbar Spine |
$2,042.00 |
MRI Any Joint Lower Ext |
$1,552.00 |
MRI Brain |
$1,860.00 |
MRI Any Joint Upper Ext |
$1,552.00 |
US Retroperitoneal |
$595.00 |
US Abdomen |
$612.00 |
Respiratory Therapy
The following charges reflect the most common services offered by our Respiratory Therapy Department. Patients may have additional charges depending on the services performed.
|
Charges |
Pulse Ox Single |
$61.00 |
Overnight Sat Study |
$157.00 |
CO2 Monitor |
$88.00 |
CPR |
$267.00 |
Aerosol Treatment |
$68.00 |
Breath Alcohol Test |
$82.00 |
Bi PAP Daily |
$206.00 |
Incentive Spirometer |
$31.00 |
Intubation |
$400.00 |
|
Arterial Blood Gas |
$259.00 |
Physical Therapy
The following charges reflect the most common services offered by our Physical Therapy
Department. Patients may have additional charges depending on the services performed.
|
Charges |
Evaluation |
$219.00 |
Exercise 15 minutes |
$86.00 |
Gait Training |
$67.00 |
Gait Training Each |
$67.00 |
Debridement Large |
$168.00 |
Debridement Small |
$141.00 |
Whirlpool |
$103.00 |
Ultrasound |
$102.00 |
Paraffin Bath |
$60.00 |
Electrical Stimulation |
$82.00 |
Occupational Therapy
The following charges reflect the most common services offered by our Occupational Therapy Department. Patients may have additional charges depending on the services performed.
|
Charges |
Evaluation |
$308.00 |
Orthotic Fit/Training 15 min |
$62.00 |
Range of Motion |
$42.00 |
Group Therapy |
$87.00 |
Work Reconditioning
2 hours |
$269.00 |
Therapeutic Exercise |
$82.00 |
Cognitive/Perceptual 15 min |
$74.00 |
Wheelchair Management |
$58.00 |
Iontophoresis 15
min |
$82.00 |
