Financial Services
For a complete listing of charges, please click the link below:
Inpatient Pricing
| Description | Charge Amount |
|---|---|
| Medical Private | $800.00 |
| Medical Semi Private | $700.00 |
| Detox Semi Private | $700.00 |
| Detox Private | $800.00 |
| Behavioral Health Private Room | $800.00 |
| Behavioral Health Semi-Private Room | $700.00 |
Rural Health Clinic
| Charge Description | Charge Amount |
|---|---|
| NEW PT LEVEL 2 | $178.00 |
| NEW PT LEVEL 3 | $182.76 |
| NEW PT LEVEL 4 | $231.00 |
| PHYS NP AGE 12-17 | $131.00 |
| PHYS NP AGE 1-4 | $107.00 |
| PHYS NP AGE 18-39 | $148.00 |
| PHYS NP AGE 40-64 | $153.00 |
| PHYS NP AGE 5-11 | $121.00 |
| PHYS NP AGE 65 AND OLDER | $173.00 |
| PHYS NP PT AGE 0-1 | $102.00 |
| ESTABLISHED PT LEVEL 1 | $137.00 |
| ESTABLISHED PT LEVEL 2 | $152.00 |
| ESTABLISHED PT LEVEL 3 | $175.00 |
| ESTABLISHED PT LEVEL 4 | $180.00 |
| ESTABLISHED PT LEVEL 5 | $231.00 |
| ALBUTEROL INHALATION SOLUTION | $14.00 |
| ANNUAL WELLNESS VISIT - SUBSEQUENT | $108.00 |
| ANNUAL WELLNESS VISIT, INITITAL | $129.00 |
| ARTHROCENTESIS - MAJOR JOINT | $579.00 |
| B12 1000mcp | $16.50 |
| FLU SHOT | $15.00 |
| CATAPRES 0.1 mg PO | $3.00 |
| DECADRON 1MG | $1.25 |
| D.O.T. PHYSICAL | $60.00 |
| EAR IRRIGATION, IMPACTED CER | $138.42 |
| EKG WITH INTERPRETATION | $132.00 |
| FINGERSTICK, GLUCOSE | $9.00 |
| FOLEY CATHETER INSERTION | $47.00 |
| GAUZE, 4X4 | $3.00 |
| HFN CIRCUIT | $27.00 |
| HIGH FLOW NEBULIZER | $91.00 |
| I&D ABSCESS | $324.00 |
| INFLUENZA SWAB A&B | $90.00 |
| KENALOG/TRILOG 1cc | $18.70 |
| LASIX 40mg | $13.00 |
| LAYER CLSR S/T/E 2.6 - 7.5 cm | $328.00 |
| LEG BAG | $10.00 |
| MAALOX 30cc | $2.00 |
| MARCAINE / XYLOCAINE | $12.50 |
| NORFLEX 60mg | $41.80 |
| PAP SMEAR (BREAST & PELVIC EXAM) | $165.00 |
| PELVIC (ONLY) EXAM | $81.00 |
| PHENERGAN UP TO 50mg | $13.00 |
| PHYS ESTABLISHED PATIENT 18-39 | $115.00 |
| PPD | $21.20 |
| PREGNANCY TEST, URINE | $33.00 |
Laboratory Test(s)
| Description | Price |
|---|---|
| Acetaminophen (Tylenol) | $135.00 |
| Alcohol (Ethanol) | $118.00 |
| Ammonia | $130.00 |
| Amylase Serum | $79.00 |
| ANA Antinuclear Antibodies | $97.00 |
| Blood Alcohol - Legal | $62.00 |
| BNP Natriuretic Peptide | $278.00 |
| BUN - Blood Urea Nitrogen | $38.00 |
| Calcium | $39.00 |
| CBC (Needs Manual Diff) | $69.00 |
| CBC / Auto Diff | $85.00 |
| Ceruloplasmin | $71.00 |
| CK-MB | $149.00 |
| Clozapone/Norclozpine | $52.00 |
| Complement - Level 4 | $123.00 |
| Comprehensive Metabolic Panel | $147.00 |
| CPK | $102.00 |
| Creatinine | $38.00 |
| Culture, Urine | $60.00 |
| D-Dimer | $111.00 |
| Dilantin | $97.00 |
| D.O.T. Drug Screen | $78.00 |
| Drug Screen Comp Serim X6 | $19.00 |
| Drug Screen - Inhouse | $167.00 |
| Folate Serum | $106.00 |
| Gabapentin - Neurontin | $83.00 |
| HCG Quantitative | $114.00 |
| Hemoglobin | $18.00 |
| Hemoglobin - A1C | $81.00 |
| Hep B Surface AB | $78.00 |
| Hep C AB | $177.00 |
| Hep C PCR Quantatative | $516.00 |
| Hep B Surface AG | $97.00 |
| Hepatic Function Panel | $129.00 |
| Hepatitis Panel | $309.00 |
| Herpes Simplex I IGG | $110.00 |
| HIV Screen - PCR | $226.00 |
| HI V Viral Load | $591.00 |
| HIV - 1 AB Screen | $92.00 |
| Hydroxycarbaz (Trileptal) | $78.00 |
| IDP 10 with Alcohol | $180.00 |
| IDP 5 | $67.00 |
| Iron | $41.00 |
| Venipuncture | $10.00 |
| Lamotrigine (Lamictal) | $88.00 |
| Levetiracetam (Kepra) | $117.00 |
Radiology
| Radiology | Price | Descripton |
|---|---|---|
| ABD Series | $282.00 | 74021, Radiologic Examination Abdomen |
| ABD Survey | $392.00 | 74022, Radiologic Examination Abdomen; Complete Acute Abdomen Series Including Supine Erect A.... |
| Ankle Complete, Bilateral | $465.00 | 73610, Radiologic Examination Ankle; Complete Minimum of 3 Views |
| Ankle Complete, Min 3 Views | $233.00 | 73610; Radiologic Examination Ankle; Complete Minimum of 3 Views |
| Babygram | $253.00 | 71045; Radiologic Examination Chest; Single View |
| Bone Age Stu8dies | $378.00 | 77072; Bone Age Studies |
| Bone Survey (METS) Limited | $575.00 | 77074; radiologic Examination Osseous Survey; Limited (Eg for Metastases) |
| Bone Metabolic (AX/APPEN/SKEL) | $751.00 | 77075; Radiologic Examination Osseous Survey; Complete (Axia) and Appendicular Skeleton |
| C-Spine 2 or 3 Views | $272.00 | 72040; Radiologic Examination Spine Cervical; 2 or 3 Views |
| C-Spine Min 4 Views | $409.00 | 72050; Radiologic Examination Spine Cervical; 4 or 5 Views |
| Chest One Frontal View | $253.00 | 71045; Radiologic Examination Chest; Single View |
| Chest PA & Lateral | $308.00 | 71046; Radiologic Examination; Chest 2 Views |
| Clavicle Complete Bilateral | $441.00 | 73000; Radiologic Examination; Clavicle Complete |
| Clavicle Complete | $222.00 | 73000; Radiologic Examination; Clavicle Complete |
| Coccyx and Sacrum Min 2 Views | $247.00 | 72220; Radiologic Examination Sacrum and Coccyx Minimum of 2 Views |
| Elbow Complete - Min 3 Views | $233.00 | 73080; Radiologic Examination Elbow, Complete Minimum of 3 Views |
| Elbow Complete - Bilateral - Min 3 Views | $465.00 | 73080; Radiologic Examination Elbow, Complete Minimum of 3 Views |
| EXT Lower 2 Views Left Infant | $186.00 | 73592; Radiologic Examination; Lower Extremity Infant Minimum of 2 Views |
| EXT Lower 2 Views Right Infant | $186.00 | 73592; Radiologic Examination; Lower Extremity Infant Minimum of 2 Views |
| EXT Upper 2 Views Left Infant | $186.00 | 73092; Radiologic Examination; Upper Extremity Infant Minimum of 2 Views |
| EXT Upper 2 Views Right Infant | $186.00 | 73092; Radiologic Examination; Upper Extremity Infant minimum of 2 Views |
| Facial Bones 1-3 Views | $266.00 | 70140; Radiologic Examination; Facial Bones; Less than 3 Views |
| Facial Bones; Min 3 Views | $375.00 | 70150; Radiologic Examination Facial Bones; Complete Minimum of 3 Views |
| Femur, Bilateral | $465.00 | 73550; X-Ray Exam of Thigh |
| Femur, Complete | $233.00 | 73550; X-Ray Exam of Thigh |
| Finger(s), Bilateral | $432.00 | 73140; Radiologic Examination Finger(s) Minimum of 2 Views |
| Finger(s) | $217.00 | 73140; Radiologic Examination Finger(s) Minimum of 2 Views |
| Foot - Minimum 3 Views, Bilateral | $465.00 | 73630; Radiologic Examination Foot; Complete Minimum of 3 Views |
| Foot - Minimum 3 Views | $233.00 | 73630; Radiologic Examination Foot; Complete Minimum of 3 Views |
| Forearm, Bilateral - 2 Views Only | $430.00 | 73090; Radiologic Examination; Forearm 2 Views |
| Forearm - 2 Views | $430.00 | 73090; Radiologic Examination; Forearm 2 Views |
| Hand, Minimum 3 Views Bilateral | $465.00 | 73130; Radiologic Examination Hand, Minimum of 3 Views |
| Hand, Minimum 3 Views | $233.00 | 73130; Radiologic Examination Hand, Minimum of 3 Views |
| Hip - 2 Views - with Pelvis | $279.00 | 73502; Radiologic Examination Hip Unilateral With Pelvis When Performed; 2-3 Views |
| Hip, Bilateral, With AP Pelvis | $557.00 | 73523; Radiologic Examination Hips Bilateral With Pelvis When Performed, Minimum of 5 Views |
| Hip - Minimum 2 Views | $279.00 | 73502; Radiologic Examination Hip Unilateral With Pelvis When Performed, 2-3 Views |
| Humerus, Bilateral | $465.00 | 73060; Radiologic Examination; Humerus Minimum of 2 Views |
| Humerus | $233.00 | 73060; Radiologic Examination; Humerus Minimum of 2 Views |
| Knee 3 - 4 Views | $290.00 | 73562; Radiologic Examination Knee; 3 Views |
| Knee 3 - 4 Views, Bilateral | $578.00 | 73564; Radiologic Examination Knee; Complete 4 or More Views |
| Knees BLT AP and Standing 1 View | $217.00 | 73565; Radiologic Examination Knee; both Knees Standing Anteroposterior |
| KUB | $217.00 | 74018; Radiologic Examination Abdomen; 1 View |
| L-Spine Minimum 4 Views | $499.00 | 72110; Radiologic Examination Spine Lumbosacral; Minimum of 4 Views |
| Mandible Minimum 4 Views | $375.00 | 70110; Radiologic Examination Mandible; Complete Minimum of 4 Views |
| Nasal Bones Minimum 3 Views | $276.00 | 70160; Radiologic Examination Nasal Bones, Complete Minimum of 3 Views |
| Orbits Complete Minimum 4 Views | $409.00 | 70200; Radiologic Examination; Orbits Complete, Minimum of 4 Views |
| Oscalis (Heel), Bilateral | $432.00 | 73650; Radiologic Examination ; Calcaneus Minimum of 2 Views |
| Oscalis (Heel), Complete | $217.00 | 73650; Radiologic Examination ; Calcaneus Minimum of 2 Views |
| Pelvis 1 or 2 Views | $280.00 | 72170; Radiologic Examination ; Pelvis 1 or 2 Views |
| Ribs, Bilateral, Complete w/PA Chest | $389.00 | 71111; Radiologic Examination Ribs Bilateral; Including Posteroanterior Chest minimum of 4 Views |
| Ribs, Complete w/PA Chest | $371.00 | 71101; Radiologic Examination Ribs Unilateral; Including Posteroanterior Chest minimum of 3 Views |
| Ribs, Unilateral 2 Views | $217.00 | 71100; Radiologic Examination Ribs Unilateral, 2 Views |
| Shoulder Complete, Bilateral | $465.00 | 73030; Radiologic Examination Shoulder; Complete Minimum of 2 Views |
| Shoulder Complete | $233.00 | 73030; Radiologic Examination Shoulder; Complete Minimum of 2 Views |
Ultrasound Studies
| Ultrasound | Price | Description |
|---|---|---|
| Abdominal U/S Complete | $753.00 | 76700, Ultrasound Abdominal Real Time with Image Documentation; Complete |
| Limited Single Organ (e.g. GB) | $564.00 | 76705, Ultrasound Abdominal Real Time with Image Documentation; Limited (e.g. Single Organ Quad...) |
| Non Vascular Ext BLT | $972.00 | 76881; Ultrasound Complete Joint (Joint Space and Peri-Articular Soft Tissue Structure) |
| Non Vascular Ext Left | $456.00 | 76881; Ultrasound Complete Joint (Joint Space and Peri-Articular Soft Tissue Structure) |
| Non Vascular Ext Right | $456.00 | 76881; Ultrasound Complete Joint (Joint Space and Peri-Articular Soft Tissue Structure) |
| OB Pelvic 1st TRIM 1 Baby | $761.00 | 76801; Ultrasound Pregnant Uterus REal Time with Image Documentation Fetal and Maternal Eval |
| Pelvic Ultrasound | $485.00 | 76856; Ultrasound Pelvic (Nonobstetric) Real Time with Image Documentation, Complete |
| Retroperitoneal Ultrasound | $720.00 | 76770; Ultrasound Retroperitoneal (Eg Renal Aorta nodes) Real Time with Image Documentation |
| Scrotum and Contents Ultrasound | $660.00 | 76870; Ultrasound Scrotum and Contents |
| Thyroid Ultrasound | $456.00 | 76536; Ultrasound Soft Tissues of Head and Neck (Eg Thyroid Parathyroid Parotid) |
| Transvaginal OB | $849.00 | 76817; Ultrasound Pregnant Uterus Real Time with Image Documentation Transvaginal |
| Transvaginal Ultrasound | $840.00 | 76830, Ultrasound Transvaginal |
| US Abdomen Limited | $564.00 | 76705, Ultrasound Abdominal Real Time with Image Documentation; Limited (Eg Single Organ Quad) |
| US Abdomen Limited Liver | $564.00 | 76705, Ultrasound Abdominal Real Time with Image Documentation; Limited (Eg Single Organ Quad) |
| US Bladder | $720.00 | 76857, Ultrasound Pelvic (Nonobstetric) Real Time with Image Documentation, Limited or Follow-Up |
| US Ext Nonvascular Limited | $753.00 | 76882; Ultrasound limited joint or Other Nonvascular Extremity Structure(s) (Eg Joint Space P |
| US Soft Tissue Neck | $456.00 | 76536; Ultrasound Soft Tissues of Head and Neck (Eg Thyroid Parathyroid Parotid) Real Time |
| US Soft Tissue Back/Chest | $333.00 | 76604; Ultrasound Chest (Includes Mediastinum) Real Time With Image Documentation |
| Abdom Aorta, Duplex Complete | $1,047.00 | 93978; Duplex Scan of Aorta Inferior vena Cava Iliac Vasculature or Bypass Grafts |
| Carotids Bi-Lateral Duplex | $975.00 | 93880; Duplex Scan of Extracranial Arteries; Complete Bilateral Study |
| Lower Arterial Ext Right | $760.00 | 939926, Duplex Scan of Lower Extremity Arteries or Arterial Bypass Grafts; Unilateral or Limited Scan |
| Lower Arterial Ext R Bilateral | $925.00 | 939925; Duplex Scan of Lower Extremity Arteries or Arterial Bypass Grafts; Complete Bilateral Study |
| Lower Arterial Extremity Left | $760.00 | 93926, Duplex Scan of Lower Extremity Arteries or Arterial Byp0ass Grafts, Unilateral or Limited |
| Upper Arterial Ext LT | $760.00 | 93931, Duplex Scan of Upper Extremity Arteries or Arterial Bypass Grafts, Unilateral or Limited |
Pharmacy
| Description | Price |
|---|---|
| Abilfy 10MG Tab | $250.00 |
| Abilify 5MG Tab | $203.00 |
| Abilify 15MG Tab | $250.00 |
| Accolate 20mg Tablet | 29.00 |
| ACCUPRIL 10MG TAB | $28.00 |
| ACETAMINOPHEN SUPP 120 MG / 1 EA | $19.00 |
| ACETAMINOPHEN SUPP 325 MG / 1 EA | $19.00 |
| ACETAMINOPHEN SUPP 650 MG | $21.00 |
| ACETAMINOPHEN W/CODEINE 30/300 | $21.00 |
| ACETASOL HC OTIC | $1,163.00 |
| ACETAZOLAMIDE 250 MG / 1 TAB | $89.00 |
| ACETAZOLAMIDE SODIUM 500MG | $1.126.00 |
| ACETONEL 35MG TAB | $403.00 |
| ACETYLCYSTEINE 20% 4 ML | $140.00 |
| ACHROMYCIN 500MG IV | $559.00 |
| Ethyl Alcohol 100% 30 ML | $23.00 |
| Achromycin Opthalm Oint .10 MG | $373.00 |
| Achromycin V 250MG Cap | $21.00 |
| Charcoal W/Sorbitol 25 GM / 120 ML | $343.00 |
| Alteplase Inj 10 MG / 1 EA | $2404.00 |
| Actonel 35MG Tab | $423.00 |
| Actonel 5 MG Tab | $61.00 |
| Actos 15 MG Tab | $71.00 |
| Acyclovir 400MG Tab | $26.00 |
| Adalat 10 MG Capsule | $31.00 |
| Adenosine INJ 6 MG / 1 Ea | $865.00 |
| Epinephrine 1:1000 Inj 1 Ea | $170.00 |
| Fluticasone/Salmeterol 100/50 MG 1 Ea | $798.00 |
| Advair INH 250/50 | $991.00 |
| Fluticasone/Salmeterol 500/50 MG 1 Ea | $1,375.00 |
| Ibuprofen SUSP Children 30 ML | $40.00 |
| Aerobid Inhaler 7 grams | $94.00 |
| Oxmetazoline Nasal Spray 15 ML | $81.00 |
| Oxmetazoline Nose Drops | $76.00 |
| Aggrenox 25/200 Cap | $49.00 |
| Albuterol 0.083% 1MG INH | $13.00 |
| Aldactone Unit Dose 15MG | $21.00 |
| Alfenta 500MCG / 5 ML | $255.00 |
| Alovera Gel | $178.00 |
| Alpha Lipoic Acid 300 MG CAP | $21.00 |
| Brimonidine OPTH Soln 5 ML | $425.00 |
| Altace 2.5 MG CAP | $34.00 |
| Altace 5 MG CAP | $37.00 |
| Alupent Inhaler 14 Grams | $304.00 |
| Amaryl 2 MG Tab | $6.00 |
| Amaryl 2MG Tablet | $21.00 |
| Glimepride 4 MG / 1 TAB | $48.00 |
| Ambien 5MG | $75.00 |
| Amidate Inj 2 MG / 20 ML | $725.00 |
| Amikin 100 MG INJ | $326.00 |
| Aminocarproic Acid 500 MG Tab | $64.00 |
| Aminocarproic Acid 500 MG TAB | $51.00 |
| Aminophylline INJ 500 MG | $130.00 |
| Aminophylline INJ 250 MG | $51.00 |
Respiratory Therapy / Sleep Studies
| Description | Charge Amount |
|---|---|
| Bi-Level Ventilation | $4,600.00 |
| CPAP Titer, Sleep Study More | $4,600.00 |
| EKG | $247.00 |
| Home Sleep Test with type III Monitor, Unattended | $2.184.00 |
| HST (Home Sleep Study) | $2,184.00 |
| Initial Sleep Study | $3,834.00 |
| Polysomnography - Initial Study | $3,834.00 |
| Polysomnography - Unattended (Sleep Study) | $2,184.00 |
| Repeat CPAP Titration sleep | $4,600.00 |
| EKG Stress Test | $532.00 |
| Arterial Blood Gas | $184.00 |
| Incentive Spirometry | $80.00 |
| Holter Monitor | $218.00 |
Emergency Services
| Description | Charge Amount |
|---|---|
| ER Physician - Level 1 | $279.00 |
| ER Physician - Level 2 | $351.00 |
| ER Physician - Level 3 | $465.00 |
| ER Physician - Level 4 | $620.00 |
| ER Physician - Level 5 | $834.00 |
| ER Physician - Critical Care | $622.00 |
Operating Room - Surgery
| Description | Charge Amount |
|---|---|
| Surgical Procedure - Level 1 | $5,111.00 |
| Surgical Procedure - Level 2 | $5,963.00 |
| Surgical Procedure - Level 3 | $7,666.00 |
| Surgical Procedure - Level 4 | $9,540.00 |
| Surgical Procedure - Level 5 | $11,073.00 |
| Surgical Procedure - Level 6 | $12,777.00 |