Patient Pricing & Price Transparency
Below are the most frequent charges and insurance reimbursements 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.
Guest Estimates / Insurance Reimbursements for Common Healthcare Services
Access the Price Estimates Frequently Asked Questions.
Patient Protection for Out-Of-Network Billing.
Uninsured Patients
- Financial Assistance Information
- Information on Price Estimates for services scheduled at least 3 days in advance.
- For questions about price estimates for unscheduled services, contact us at PriceEstimates@stelizabeth.com
The charges listed on the price lists below do not include co-provider charges unless otherwise noted.
Pricing is current as of January 1, 2024.
Emergency Department Charges
The Emergency Department charges are based on the complexity level for the services provided. Physician charges, Pharmacy items and other testing are additional.
Procedure |
CPT |
Charge |
|---|---|---|
| Level 1 | 99281 | $339.63 |
| Level 2 | 99282 | $579.28 |
| Level 3 | 99283 | $1,044.36 |
| Level 4 | 99284 | $1,706.46 |
| Level 5 | 99285 | $2,264.22 |
| Critical Care | 99291 | $2,430.03 |
Laboratory Charges
Laboratory charges reflect the most commonly performed procedures. Additional charges may be added as necessary.
Procedure |
CPT |
Charge |
|---|---|---|
| Amylase Serum | 82150 | $23.65 |
| Basic Metabolic Panel | 80048 | $30.88 |
| Bilirubin Total | 82247 | $18.32 |
| B-12 | 82607 | $55.04 |
| C.B.C. | 85025 | $28.36 |
| Calcium | 82310 | $18.83 |
| Comp Metabolic Panel | 80053 | $38.54 |
| Free T4 | 84439 | $32.92 |
| Glucose | 82947 | $14.34 |
| Glycohemoglobin | 83036 | $35.44 |
| Hematocrit | 85014 | $8.65 |
| Hemoglobin | 85018 | $8.65 |
| Hemogram | 85027 | $23.62 |
| Hepatic Panel | 80076 | $29.82 |
| Lipase | 83690 | $25.15 |
| Lipid Panel (Reflex) | 80061 | $48.87 |
| Lipid Panel (Screening) | 80061 | $48.87 |
| Magnesium | 83735 | $24.46 |
| Phosphorus | 84100 | $17.30 |
| Potassium | 84132 | $17.37 |
| Prothrombin Time (PT/INR) | 85610 | $15.66 |
| PSA Total (Screening) | 84153 | $67.12 |
| PTT | 85730 | $21.94 |
| Renal Functional Panel | 80069 | $31.68 |
| TSH | 84443 | $61.32 |
| TSH Reflexive | 84443 | $61.32 |
| Troponin | 84484 | $45.52 |
| Urinalysis Routine | 81001 | $11.57 |
| Urine Culture | 87086 | $29.46 |
| Vitamin D 25 Hydroxy | 82306 | $108.04 |
| OP Venous Collection | 36415 | $31.28 |
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 | $1,270.31 |
| MRI Brain Without Contrast | 70551 | $805.15 |
| MRI Lumbar Spine Without Contrast | 72148 | $805.15 |
| MRI Abdomen Without Contrast | 74181 | $805.15 |
| MRI Lumbar With and Without Contrast | 72158 | $1,270.31 |
| MRI Abdomen With and Without Contrast | 74183 | $1,270.31 |
| MRI Cervical Spine With and Without Contrast | 72156 | $1,270.31 |
| MRI Low Ext Any Joint With and Without Contrast | 73723 | $1,270.31 |
| CT Head Without Contrast | 70450 | $368.50 |
| CT Pelvis With Contrast | 72193 | $621.78 |
| CT Abdomen With Contrast | 74160 | $621.78 |
| CT Abdomen Without Contrast | 74150 | $368.50 |
| CT Pelvis Without Contrast | 72192 | $368.50 |
| CT Abdomen & Pelvis Without Contrast | 74176 | $805.15 |
| CT Abdomen & Pelvis With Contrast | 74177 | $1,270.31 |
| CT Abdomen & Pelvis With and Without Contrast | 74178 | $1,270.31 |
| CT Chest With Contrast | 71260 | $621.78 |
| CT Limited Sinus | 76380 | $299.56 |
| CT Chest Without Contrast | 71250 | $368.50 |
| CT Cervical Spine Without Contrast | 72125 | $368.50 |
| CTA Chest Non Coronary | 71275 | $621.78 |
| Gallbladder Ultrasound | 76705 | $368.50 |
| Renal Ultrasound | 76775 | $368.50 |
| Head/Neck Ultrasound | 76536 | $368.50 |
| Testicular Ultrasound | 76870 | $368.50 |
| Abdominal Ultrasound | 76700 | $368.50 |
| Limited Abdominal Ultrasound Scan | 76705 | $368.50 |
| Carotid Artery Duplex Scan | 93880 | $805.15 |
| Hysterosonography | 76831 | $805.15 |
| Chest PA & Lateral X-Ray | 71046 | $299.56 |
| Abdomen X-Ray | 74018 | $299.56 |
| Lumbosacral Spine X-Ray | 72100 | $368.50 |
| Ankle X-Ray | 73610 | $299.56 |
| Foot and Toes X-Ray | 73630 | $299.56 |
| Hand and Finger X-Ray | 73130 | $299.56 |
| Knee X-Ray 4 Views | 73564 | $368.50 |
| Cervical Spine X-Ray 4/5 Views | 72050 | $368.50 |
| Wrist X-Ray | 73110 | $299.56 |
| Shoulder X-Ray | 73030 | $299.56 |
| Elbow X-Ray | 73080 | $299.56 |
| Lower Leg Tibia-Fibula X-Ray | 73590 | $299.56 |
| Chest X-Ray – 1 View | 71045 | $299.56 |
| Ribs Unilateral X-Ray | 71101 | $368.50 |
| Forearm X-Ray | 73090 | $299.56 |
| Knee X-Ray – 3 Views | 73562 | $299.56 |
| Pelvis X-Ray | 72170 | $368.50 |
| Ribs X-Ray Bilateral | 71111 | $368.50 |
| Myocardial Spect Multiple | 78452 | $4,576.26 |
| Barium Swallow | 74220 | $621.78 |
| Colon (Barium Enema) | 74270 | $621.78 |
| Cystogram | 74430 | $1,270.31 |
| IVP | 74400 | $621.78 |
| Small Bowel | 74250 | $621.78 |
| Voiding Cystogram | 74455 | $805.15 |
| Colon with Air | 74280 | $621.78 |
| Clavicle | 73000 | $299.56 |
| Pediatric Bone Survey | 77076 | $368.50 |
| Bone Age (Hand and Wrist) | 77072 | $368.50 |
| Oscalcis | 73650 | $299.56 |
| Osseous Survey Complete | 77075 | $368.50 |
| Humerus | 73060 | $299.56 |
| Nasal Bones | 70160 | $299.56 |
| Sacroiliac Joints | 72202 | $368.50 |
| Dorsal (Thoracic) Spine | 72072 | $368.50 |
| NM Total Body Bone Scan | 78306 | $1,340.10 |
| NM Three Phase Bone Scan | 78315 | $1,340.10 |
| Pelvic Mass Sonography | 76856 | $368.50 |
| Intravaginal Sonogram | 76830 | $368.50 |
| Screening Mammography Digital Bilateral | 77067 | $299.12 |
| Diagnostic Mammography Digital Bilateral | 77066 | $360.66 |
| Diagnostic Mammography Digital Unilateral | 77065 | $282.91 |
| Breast Tomosynthesis Bilateral | G0279 | $77.75 |
| Breast Ultrasound Unilateral Complete | 76641 | $368.50 |
| Breast Ultrasound Limited | 76642 | $299.56 |
| Dexa Bone Density Scan | 77080 | $368.50 |
Respiratory Therapy/Pulmonary Services Charges
These Respiratory Therapy/Pulmonary Service charges reflect the most commonly performed procedures.
Procedure |
CPT |
Charge |
|---|---|---|
| 1st Day of Mechanical Ventilation | 94002 | $1,919.50 |
| Pulse Oximetry Check | 94760 | $93.00 |
| Pulmonary Rehab Includes Cont Oximetry | 94626 | $198.20 |
| Pulmonary Rehab Group | G0239 | $117.09 |
| Bronchodilation Responsiveness Spirometry | 94060 | $965.61 |
| Pulmonary Function Testing Plethysmography | 94726 | $965.61 |
| Diffusing Capacity CO2 Membrane | 94729 | $393.59 |
Sleep Disorders Center
These Sleep Disorders Center Therapy charges reflect the most commonly performed procedures.
Procedure |
CPT |
Charge |
|---|---|---|
| Polysomnogram with CPAP Trial | 95811 | $3,221.60 |
| Polysomnogram | 95810 | $3,221.60 |
| Multiple Sleep Latency Test | 95805 | $1,666.81 |
| Sleep Study Unattended | 95806 | $501.44 |
| Home Sleep Test | G0399 | $501.44 |
Physical Therapy Charges
These Physical Therapy charges reflect the most commonly performed procedures.
Procedure |
CPT |
Charge |
|---|---|---|
| PT-Gait Training – 15 Minutes | 97116 | $102.09 |
| PT-Manual Therapy – 15 Minutes | 97140 | $94.21 |
| PT-Phys Therapy – 15 Minutes | 97110 | $102.09 |
| PT-Moderate Complex 30 Min Evaluation | 97162 | $348.10 |
| PT-Functional Activities | 97530 | $126.76 |
| PT Neuromuscular Reeducation | 97112 | $116.91 |
Speech Charges
These Speech charges reflect the most commonly performed procedures.
Procedure |
CPT |
Charge |
|---|---|---|
| Dysphagia Treatment – 30 Minutes | 92526 | $294.23 |
| Otoacoustic Emission | 92587 | $965.61 |
| Speech Therapy – 45 Minutes | 92507 | $266.60 |
| Speech Evaluation | 92523 | $793.47 |
| Video Swallowing Evaluation | 92611 | $315.80 |
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 | $198.20 |
| Holter Monitor Record | 93225 | $400.33 |
| Holter Monitor Analysis | 93226 | $400.33 |
| Event Monitor Record | 93270 | $120.67 |
| Event Monitor Analysis | 93271 | $344.12 |
| Ambulatory Blood Pressure Monitor Record | 93786 | $400.33 |
| Ambulatory Blood Pressure Monitor Analysis | 93788 | $400.33 |
| EEG | 95819 | $965.61 |
| Stress Test (Regular or Pharmalogical) | 93017 | $965.61 |
| ECHO 2D M Doppler | 93307 | $805.15 |
| Stress ECHO | 93350 | $1,734.74 |
| ECHO Complete | 93306 | $1,734.74 |
