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, 2012
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
Noninvasive Cardiology Charges
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 |
$4,800.00 |
| Intensive Care |
$4,600.00 |
| TCU Private |
$2,376.00 |
| TCU Semi-Private |
$2,376.00 |
| PACU Recovery Room - First Two Hours |
$758.52 |
| PACU Recovery Room – Each Additional Hour |
$185.22 |
| Labor and Delivery Private |
$1,188.00 |
| Newborn Care per Day Level 1 |
$1,242.00 |
| OB Private |
$1,188.00 |
| Pediatric Private |
$1,188.00 |
| Med Surg Private |
$1,188.00 |
| Med Surg Semi-Private |
$1,188.00 |
| Behavioral Health |
$1,728.00 |
| Behavioral Health Semi-Private |
$1,728.00 |
| Observation First Hour |
$365.00 |
| Observation Each Hour |
$50.00 |
| SDS Post Service Charge 4 Hours |
$423.36 |
| SDS Post Service Charge Add Hour |
$162.07 |
| Skilled Nursing Private R&B |
$982.00 |
| Hospice Inpatient Private |
$1188.00 |
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) |
- |
$2,887.50 |
| C-Section LDRP (Additional Per Minute Charge) |
- |
$74.80 |
| Fetal Monitor/Telemetry |
59050 |
$350.00 |
| Vaginal Delivery |
- |
$4,200.00 |
| Fetal Non Stress Test |
59025 |
$329.52 |
Operating Room Charges
The Operating Room charges are based on the complexity level for the particular procedure. There is an additional per minute charge. Anesthesia, Pharmacy items and supplies are also additional.
| Procedure |
Charge |
| Level 1 |
$1,166.00 |
| Level 2 |
$1,500.00 |
| Level 3 |
$2,394.70 |
| Level 4 |
$2,887.50 |
| Per Minute |
$74.80 |
Emergency Department Charges
The Emergency Department charges are based on the complexity level for the services provided.
| Procedure |
CPT # |
Charge |
| Level 1 |
99281 |
$277.20 |
| Level 2 |
99282 |
$472.80 |
| Level 3 |
99283 |
$819.60 |
| Level 4 |
99284 |
$1,339.20 |
| Level 5 |
99285 |
$1,680.00 |
| Critical Care |
99291 |
$1,680.00 |
Laboratory Charges
Laboratory charges reflect the most commonly performed procedures. Additional charges may be added as necessary.
| Procedure |
CPT # |
Charge |
| Amylase Serum |
82150 |
$30.00 |
| Basic Metabolic Panel |
80048 |
$30.00 |
| Bilirubin Total |
82247 |
$22.50 |
| C.B.C. |
85025 |
$35.00 |
| Calcium |
82310 |
$22.50 |
| Comp Metabolic Panel |
80053 |
$40.00 |
| Free T4 |
84439 |
$40.00 |
| Glucose |
82947 |
$17.50 |
| Glycohemoglobin |
83036 |
$45.00 |
| Hematocrit |
85014 |
$10.00 |
| Hemogram |
85027 |
$30.00 |
| Hepatic Panel |
80076 |
$30.00 |
| Lipid Panel (Reflex) |
80061 |
$50.00 |
| Lipid Panel (Screening) |
80061 |
$50.00 |
| Phosphorus |
84100 |
$22.50 |
| Potassium |
84132 |
$20.00 |
| Prothrombin Time (PT/INR) |
85610 |
$17.50 |
| PSA Total (Screening) |
84153 |
$81.94 |
| PTT |
85730 |
$30.00 |
| TSH |
84443 |
$75.00 |
| TSH Reflexive |
84443 |
$75.00 |
| Urinalysis Routine |
81001 |
$15.00 |
| Urine Culture |
87086 |
$35.00 |
| OP Venous Collection |
36415 |
$9.00 |
X-Ray and Other Radiological Procedures
These Radiological charges reflect the most commonly performed procedures. Procedures requiring contrast will result in an additional charge.
| Procedure |
CPT # |
Charge |
| MRI Brain With and Without Contrast |
70553 |
$1,838.03 |
| MRI Lumbar Spine Without Contrast |
72148 |
$1,348.20 |
| MRI Abdomen Without Contrast |
74181 |
$1,339.54 |
| MRI Lumbar With and Without Contrast |
72158 |
$1,716.75 |
| MRI Abdomen With and Without Contrast |
74183 |
$2,150.66 |
| MRI Cervical Spine With and Without Contrast |
72156 |
$1,720.69 |
| MRI Low Ext Any Joint With and Without Contrast |
73723 |
$1,796.45 |
| CT Head Without Contrast |
70450 |
$652.84 |
| CT Pelvis With Contrast |
72193 |
$967.05 |
| CT Abdomen With Contrast |
74160 |
$985.16 |
| CT Abdomen Without Contrast |
74150 |
$807.98 |
| CT Pelvis Without Contrast |
72192 |
$807.19 |
| CT Abdomen & Pelvis Without Contrast |
74176 |
$1,615.16 |
| CT Abdomen & Pelvis With Contrast |
74177
|
$1,952.21 |
| CT Abdomen & Pelvis With and Without Contrast |
74178 |
$2,295.56 |
| CT Chest With Contrast |
71260 |
$965.48 |
| CT Limited Sinus |
76380 |
$603.75 |
| CT Chest Without Contrast |
71250 |
$767.03 |
| Gallbladder Ultrasound |
76705 |
$409.50 |
| Renal Ultrasound |
76775 |
$348.71 |
| Head/Neck Ultrasound |
76536 |
$301.61 |
| Testicular Ultrasound |
76870 |
$352.49 |
| Abdominal Ultrasound |
76700 |
$431.55 |
| Limited Abdominal Ultrasound Scan |
76705 |
$409.50 |
| Hysterosonography |
76831 |
$557.22 |
| Chest PA & Lateral X-Ray |
71020 |
$250.00 |
| Abdomen X-Ray |
74000 |
$150.00 |
| Lumbosacral Spine X-Ray |
72100 |
$165.38 |
| Ankle X-Ray |
73610 |
$151.20 |
| Foot and Toes X-Ray |
73630 |
$174.83 |
| Hand and Finger X-Ray |
73130 |
$157.82 |
| Knee X-Ray |
73564 |
$168.53 |
| Cervical Spine X-Ray 4/5 Views |
72050 |
$277.83 |
| Wrist X-Ray |
73110 |
$164.43 |
| Shoulder X-Ray |
73030 |
$157.82 |
| Elbow X-Ray |
73080 |
$178.61 |
| Lower Leg Tibia-Fibula X-Ray |
73590 |
$150.00 |
| Chest X-Ray – 1 View |
71010 |
$225.00 |
| Ribs Unilateral X-Ray |
71101 |
$250.00 |
| Forearm X-Ray |
73090 |
$150.00 |
| Knee X-Ray – 3 Views |
73562 |
$170.10 |
| Pelvis X-Ray |
72170 |
$153.09 |
| Pelvis X-Ray – Both Hips |
73520 |
$224.44 |
| Ribs X-Ray Bilateral |
71111 |
$280.67 |
| Myocardial Spect Multiple |
78452 |
$3,251.75 |
| M40 View RM Per Dose |
A9502 |
$113.75 |
| Barium Swallow |
74220 |
$300.00 |
| Colon (Barium Enema) |
74270 |
$304.76 |
| Cystogram |
74430 |
$550.00 |
| IVP |
74400 |
$550.00 |
| Small Bowel |
74250 |
$307.13 |
| Stomach/Esophagus |
74241 |
$317.52 |
| Stomach/Esophagus with Air |
74247 |
$329.81 |
| Voiding Cystogram |
74455 |
$550.00 |
| Colon with Air |
74280 |
$450.00 |
| Chest X-Ray with Obliques |
71022 |
$250.00 |
| Clavicle |
73000 |
$150.00 |
| Pediatric Bone Survey |
77076 |
$221.97 |
| Bone Age (Hand and Wrist) |
77072 |
$150.00 |
| Oscalcis |
73650 |
$150.00 |
| Osseous Survey Complete |
77075 |
$250.00 |
| Humerus |
73060 |
$150.00 |
| Nasal Bones |
70160 |
$150.00 |
| Sacroiliac Joints |
72202 |
$153.56 |
| Scoliosis Series |
72090 |
$250.00 |
| Dorsal (Thoracic) Spine |
72072 |
$175.77 |
| NM Biliary Drain With/Without CCK with Choletec |
78223 |
$1,008.79 |
| NM Total Body Bone Scan |
78306 |
$945.79 |
| NM Three Phase Bone Scan |
78315 |
$1,116.68 |
| NM VQ Scan |
78585 |
$950.00 |
| Pelvic Mass Sonography |
76856 |
$351.23 |
| Intravaginal Sonogram |
76830 |
$460.69 |
| Screening Mammography Digital Bilateral |
G0202 / 77057 |
$294.27 |
| Diagnostic Mammography Digital Bilateral |
G0204 / 77056 |
$348.42 |
| Diagnostic Mammography Digital Unilateral |
G0206 / 77055 |
$273.36 |
| Computer Aided Detection (CAD) Screening |
77052 |
$40.00 |
| Computer Aided Detection (CAD) Diagnostic |
77051 |
$40.00 |
| Breast Ultrasound (Unilateral or Bilateral) |
76645 |
$264.60 |
Respiratory Therapy Charges
These Respiratory Therapy charges reflect the most commonly performed procedures.
| Procedure |
CPT # |
Charge |
| 1st Nebulizer Treatment |
94664 |
$84.06 |
| Additional Nebulizer Treatment |
94640 |
$84.06 |
| 1st Day of Mechanical Ventilation |
94002 |
$585.45 |
| 1st Metered Dose Inhaler Treatment |
94664 |
$84.06 |
| Additional Metered Dose Inhaler Treatment |
94640 |
$84.06 |
| Pulse Oximetry Check |
94760 |
$53.84 |
Sleep Disorders Center
These Sleep Disorders Center Therapy charges reflect the most commonly performed procedures.
| Procedure |
CPT # |
Charge |
| Polysomnogram with CPAP Trial* |
95811 |
$2,284.68 |
| Polysomnogram* |
95810 |
$2,284.68 |
| Multiple Sleep Latency Test* |
95805 |
$2,284.68 |
| *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 |
$75.69 |
| PT-Manual Therapy – 15 Minutes |
97140 |
$80.64 |
| PT-Phys Therapy – 15 Minutes |
97110 |
$85.53 |
| 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 |
$255.96 |
| Dysphagia Treatment - 30 Minutes |
92526 |
$270.78 |
| Otoacoustic Emission |
92587 |
$185.04 |
| Speech Therapy – 45 Minutes |
92507 |
$237.27 |
| Speech Evaluation |
92506 |
$472.17 |
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 |
$193.86 |
| Holter Monitor Analysis |
93226 |
$193.86 |
| Event Monitor (King of Hearts) Record |
93270 |
$193.86 |
| Event Monitor (King of Hearts) Analysis |
93271 |
$324.66 |
| Ambulatory Blood Pressure Monitor Record |
93786 |
$193.86 |
| Ambulatory Blood Pressure Monitor Analysis |
93788 |
$193.86 |
| EEG |
95819 |
$487.62 |
| Stress Test (Regular or Pharmalogical) |
93017 |
$700.00 |
| ECHO Doppler |
93307 |
$1,177.47 |
| Stress ECHO |
93350 |
$1,177.47 |