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

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.

Inpatient Charges

Per Admission Charges

Download a complete price list for Center for Medicare and Medicaid Services (CMS) transparency for 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