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Patient Pricing

Below are the most frequent charges at St. Elizabeth Healthcare. All patients are charged the same irrespective of one’s ability to pay. The patient’s responsibility may vary depending upon the co-pays, coinsurance and non covered service of each insurance policy.

Uninsured or underinsured patients should contact our Financial Counselors at (859) 301-2104 to determine the percentage of discount available as per the St. Elizabeth Healthcare policy. The charges listed on this price list do not include charges for physician’s fees unless otherwise noted.

Pricing is current as of January 1, 2014

To download a complete price list please click here.

Please click on one of the categories below to view pricing.
Room and Board
Labor and Delivery
Operating Room
Emergency Department
Laboratory
X-ray and Other Radiological Procedures
Respiratory Therapy
Sleep Disorders Center
Physical Therapy
Speech and Audiology
Non Invasive Cardiology

Room and Board
Per Day Charges
Room and Board charges include routine nursing services, routine supplies and meals.

Room and Board Charge (per day)
Cardiac Surgery Recovery $5,264.40
Intensive Care $5,045.05
TCU Private $2,605.88
TCU Semi-Private $2,605.88
PACU Recovery Room - First Two Hours $876.10
PACU Recovery Room – Each Additional Hour $213.93
Labor and Delivery Private $1,302.94
Newborn Care per Day Level 1 $1,362.16
OB Private $1,302.94
Pediatric Private $1,302.94
Med Surg Private $1,302.94
Med Surg Semi-Private $1,302.94
Behavioral Health $1,895.18
Behavioral Health Semi-Private $1,895.18
Observation First Hour $365.00
Observation Each Hour $50.00
SDS Post Service Charge 4 Hours $488.98
SDS Post Service Charge Add Hour $187.19
Skilled Nursing Private R&B $1,302.94
Hospice Inpatient Private $1,302.94


Labor and Delivery Charges
The charges listed are for the actual procedure. Room and board, anesthesia, pharmacy items, and supplies are additional.

Procedure CPT # Charge
C-Section LDRP (Base Fee includes first 30 minutes) - $5,700.00
C-Section LDRP (Additional Per Minute Charge) - $95.00
Fetal Monitor/Telemetry 59050 $356.00
Vaginal Delivery - $5,000.00
Fetal Non Stress Test 59025 $398.00


Operating Room Charges

The Operating Room charges are based on the complexity level for the particular procedure. All procedure charges include the first 30 minutes of OR time. There is an additional per minute charge after the first 30 minutes. Anesthesia, Pharmacy items and supplies are also additional.

Procedure Charge
Minor Surgical Procedure $4,200.00
Major Surgical Procedure $4,900.00
Complex Surgical Procedure $5,700.00
Minor Per Minute Charge $78.00
Major Per Minute Charge $92.00
Complex Per Minute Charge $95.00


Emergency Department Charges

The Emergency Department charges are based on the complexity level for the services provided. Physician charges, Pharmacy items and supplies are additional.

Procedure CPT # Charge
Level 1 99281 $320.17
Level 2 99282 $546.08
Level 3 99283 $946.64
Level 4 99284 $1,546.78
Level 5 99285 $1,940.40
Critical Care 99291 $1,940.40


Laboratory Charges

Laboratory charges reflect the most commonly performed procedures. Additional charges may be added as necessary.

Procedure CPT # Charge
Amylase Serum 82150 $31.19
Basic Metabolic Panel 80048 $32.24 
Bilirubin Total 82247 $24.15 
C.B.C. 85025 $37.42
Calcium 82310 $24.82
Comp Metabolic Panel 80053 $40.46
Free T4 84439 $43.40
Glucose 82947 $18.87
Glycohemoglobin 83036 $46.69
Hematocrit 85014 $10.26
Hemogram 85027 $31.12
Hepatic Panel 80076 $32.24
Lipid Panel (Reflex) 80061 $54.81
Lipid Panel (Screening) 80061 $54.81
Phosphorus 84100 $22.82
Potassium 84132 $22.12
Prothrombin Time (PT/INR) 85610 $18.90
PSA Total (Screening) 84153 $88.52
PTT 85730 $28.88
TSH 84443 $80.85
TSH Reflexive 84443 $80.85
Urinalysis Routine 81001 $15.23
Urine Culture 87086 $48.85
OP Venous Collection 36415 $10.50


X-Ray and Other Radiological Procedures

These Radiological charges reflect the most commonly performed procedures. Procedures requiring contrast will result in an additional charge. Physician charges are additional.

Procedure CPT # Charge
MRI Brain With and Without Contrast 70553 $1,844.57
MRI Lumbar Spine Without Contrast 72148 $1,136.31
MRI Abdomen Without Contrast 74181 $1,136.31
MRI Lumbar With and Without Contrast 72158 $1,844.57 
MRI Abdomen With and Without Contrast 74183 $1,844.57
MRI Cervical Spine With and Without Contrast 72156 $1,844.57
MRI Low Ext Any Joint With and Without Contrast 73723 $1,844.57
CT Head Without Contrast 70450 $582.71
CT Pelvis With Contrast 72193 $997.53 
CT Abdomen With Contrast 74160 $997.53
CT Abdomen Without Contrast 74150 $646.38
CT Pelvis Without Contrast 72192 $646.38
CT Abdomen & Pelvis Without Contrast 74176 $1,292.13
CT Abdomen & Pelvis With Contrast

74177

$1,620.02
CT Abdomen & Pelvis With and Without Contrast 74178 $1,836.45
CT Chest With Contrast 71260 $997.53
CT Limited Sinus 76380 $483.00
CT Chest Without Contrast 71250 $613.62
Gallbladder Ultrasound 76705 $409.50
Renal Ultrasound 76775 $333.42
Head/Neck Ultrasound 76536 $333.42
Testicular Ultrasound 76870 $333.42
Abdominal Ultrasound 76700 $409.50
Limited Abdominal Ultrasound Scan 76705 $409.50
Hysterosonography 76831 $541.59
Chest PA & Lateral X-Ray 71020 $250.00
Abdomen X-Ray 74000 $154.25
Lumbosacral Spine X-Ray 72100 $154.25
Ankle X-Ray 73610 $154.25
Foot and Toes X-Ray 73630 $154.25
Hand and Finger X-Ray 73130 $154.25
Knee X-Ray 4 Views 73564 $237.81
Cervical Spine X-Ray 4/5 Views 72050 $237.81
Wrist X-Ray 73110 $154.25
Shoulder X-Ray 73030 $154.25
Elbow X-Ray 73080 $154.25
Lower Leg Tibia-Fibula X-Ray 73590 $154.25
Chest X-Ray – 1 View 71010 $225.00
Ribs Unilateral X-Ray 71101 $237.81
Forearm X-Ray 73090 $154.25
Knee X-Ray – 3 Views 73562 $154.25
Pelvis X-Ray 72170 $154.25
Pelvis X-Ray – Both Hips 73520 $237.81
Ribs X-Ray Bilateral 71111 $237.81
Myocardial Spect Multiple 78452 $3,450.00
Barium Swallow 74220 $277.69
Colon (Barium Enema) 74270 $412.31
Cystogram 74430 $703.46
IVP 74400 $703.46
Small Bowel 74250 $277.69
Stomach/Esophagus 74241 $412.31
Stomach/Esophagus with Air 74247 $412.31
Voiding Cystogram 74455 $703.46
Colon with Air 74280 $412.31
Chest X-Ray with Obliques 71022 $258.52
Clavicle 73000 $154.25
Pediatric Bone Survey 77076 $237.81
Bone Age (Hand and Wrist) 77072 $154.25
Oscalcis 73650 $154.25
Osseous Survey Complete 77075 $237.81
Humerus 73060 $154.25
Nasal Bones 70160 $154.25
Sacroiliac Joints 72202 $154.25
Scoliosis Series 72090 $237.81
Dorsal (Thoracic) Spine 72072 $237.81
NM Total Body Bone Scan 78306 $878.46
NM Three Phase Bone Scan 78315 $893.34
Pelvic Mass Sonography 76856 $333.42
Intravaginal Sonogram 76830 $460.69
Screening Mammography Digital Bilateral G0202 / 77057 $317.24
Diagnostic Mammography Digital Bilateral G0204 / 77056 $383.64
Diagnostic Mammography Digital Unilateral G0206 / 77055 $300.65
Computer Aided Detection (CAD) Screening 77052 $32.00
Computer Aided Detection (CAD) Diagnostic 77051 $32.00
Breast Ultrasound (Unilateral or Bilateral) 76645 $264.60
Dexa Bone Density Scan 77080 $247.98


Respiratory Therapy Charges
These Respiratory Therapy charges reflect the most commonly performed procedures.

Procedure CPT # Charge
1st Nebulizer Treatment 94664 $117.80
Additional Nebulizer Treatment 94640 $117.80
1st Day of Mechanical Ventilation 94002 $830.55
1st Metered Dose Inhaler Treatment 94664 $117.80
Additional Metered Dose Inhaler Treatment 94640 $117.80
Pulse Oximetry Check 94760 $64.58


Sleep Disorders Center
These Sleep Disorders Center Therapy charges reflect the most commonly performed procedures.

Procedure CPT # Charge
Polysomnogram with CPAP Trial* 95811 $2,512.87 
Polysomnogram* 95810 $2,512.87
Multiple Sleep Latency Test* 95805 $2,512.87 
* Includes Physician Interpretation*


Physical Therapy Charges

These Physical Therapy charges reflect the most commonly performed procedures.

Procedure CPT # Charge
PT-Gait Training – 15 Minutes 97116 $92.09
PT-Manual Therapy – 15 Minutes 97140 $97.72
PT-Phys Therapy – 15 Minutes 97110 $104.27
PT-Complex Initial Evaluation 97001 $250.00


Speech and Audiology Charges
These Speech and Audiology Therapy charges reflect the most commonly performed procedures.

Procedure CPT # Charge
Audiological Assessment 92557 $297.43 
Dysphagia Treatment - 30 Minutes 92526 $270.78
Otoacoustic Emission 92587 $219.18
Speech Therapy – 45 Minutes 92507 $235.76
Speech Evaluation 92523 $338.95


Non Invasive Cardiology Charges

These Non Invasive Cardiology charges reflect the most commonly performed procedures. The test fee may not include the Cardiologist’s interpretation.

Procedure CPT # Charge
EKG 93005 $125.00
Holter Monitor Record 93225 $223.31
Holter Monitor Analysis 93226 $223.31
Event Monitor (King of Hearts) Record 93270 $223.31
Event Monitor (King of Hearts) Analysis 93271 $374.20
Ambulatory Blood Pressure Monitor Record 93786 $223.31
Ambulatory Blood Pressure Monitor Analysis 93788 $223.31
EEG 95819 $579.45
Stress Test (Regular or Pharmalogical) 93017 $700.00
ECHO Doppler 93307 $1,310.87
Stress ECHO 93350 $1,310.87


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