Past Healthcare vs Today’s Healthcare

Hospital pricing can be very complex and frustrating. For the most part, patients have remained in the dark about what they will be asked to pay for healthcare services until after the services have been provided. At NCMC, we aspire to bring this information to you prior to your services and explain how healthcare pricing works. Please visit the links below for detailed information our pricing. If you would like pricing on additional services, please contact us at (208) 934-8764.

Prices show the following;

Facility Fee – The charge for the use of a facility and equipment.
Professional Fee – The charge associated to the physician’s time and expertise.
Current Procedural Terminology (CPT) Code – The standard codes used by medical professionals to document and report medical services to insurance companies.
Service Description – The description tied to each CPT code that explains the service/exam provided.

While we offer hundreds of lab tests, this is a list of our most commonly ordered. If you need additional pricing, please contact us at (208) 934-8764.

Collection Fee – With each visit for blood work, a $15.00 collection fee is added to the visit to account for staff time and supplies needed to draw your blood. The charge is per visit, not per test.

CPT CODE SERVICE DESCRIPTION FACILITY FEE
80048 Basic Metabolic Panel  $       42.90
87040 Blood Culture  $       74.80
85025 Complete Blood Count w/ Auto Diff 4  $       40.00
80053 Comprehensive Metabolic Panel 1  $       54.00
86140 C-Reactive Protein  $       30.00
82550 Creatine Kinase  $       47.30
82553 Creatine Kinase-MB  $       75.00
84439 Free T4  $       46.20
83036 Hemoglobin A1c 1  $       49.50
85027 Hemogram 2  $       33.00
83605 Lactic Acid  $       80.00
83690 Lipase Level  $       45.00
80061 Lipid Panel 1  $       45.00
83880 N-Terminal pro B-Type Natriuretic Peptide  $     200.00
84153 Prostate Specific Antigen (PSA)  $       66.00
85610 PT/INR  $       25.00
84403 Testosterone  $     108.00
84443 Thyroid Stimulating Hormone  $       70.00
84484 Troponin  $       65.00

EKG Interpretation Fee – With each EKG, an interpretation fee of $54.00 is added to the exam to have a physician read the results.

CPT CODE SERVICE DESCRIPTION FACILITY FEE
93005 EKG 12-Lead (Lab)  $     147.40

Urinalysis

CPT CODE SERVICE DESCRIPTION FACILITY FEE
81000 Urinalysis (UA)  $       20.00
81015 Urinalysis Microscopic 1  $       20.00

Level Visits are determined by the complexity of diagnosis and time spent with the provider.

CPT CODE SERVICE DESCRIPTION VISIT FEE
99211 Established  Visit Level 1  $    75.00
99212 Established  Visit Level 2  $    90.00
99213 Established Visit Level 3  $  125.00
99214 Established  Visit Level 4  $  180.00
99215 Established  Visit Level 5  $  240.00
99201 New Visit Level 1  $    80.00
99202 New Visit Level 2  $  125.00
99203 New Visit Level 3  $  176.00
99204 New Visit Level 4  $  270.00
99205 New Visit Level 5  $  300.00

With so many imaging procedures, we have captured our most common and provided a break down of the pricing.  It is important to know when pricing imaging tests, to verify if the  radiologist (professional) fee has been included in the price.  In our pricing we have listed the radiologist (professional fee) separate.

CPT CODE SERVICE DESCRIPTION FACILITY FEE PROFESSIONAL FEE
70546 MRI Head $2,525.00 $250.00
74183 MRI Abdomen $2,500.00 $713.00
74181 MRI Abdomen $1,832.00 $355.00
70553 MRI Brain $2,561.00 $300.00
70551 MRI Brain $1,717.00 $376.00
71550 MRI Chest $2,145.00 $581.00
70543 MRI Face Neck Orbit $2,641.00 $695.00
23350 MRI Injection for Arthrography $600.00 $330.00
73723 MRI LE Joint Right $2,106.00 $421.00
73722 MRI LE Joint Left $1,755.00 $351.00
73721 MRI LE Joint Left $1,500.00 $305.00
73720 MRI LE Non Joint Right $2,256.00 $883.00
73718 MRI LE Non Joint Left $1,500.00 $565.00
72197 MRI Pelvis $2,500.00 $270.00
72195 MRI Pelvis $1,652.00 $468.00
72156 MRI Spine Cervical $2,404.00 $641.00
72141 MRI Spine Cervical $1,700.00 $458.00
72158 MRI Spine Lumbar $2,508.00 $500.00
72148 MRI Spine Lumbar $2,006.00 $501.00
72146 MRI Spine Thoracic $1,700.00 $475.00
73223 MRI UE Joint Left $1,811.00 $505.00
73222 MRI UE Joint Right $1,700.00 $416.00
73221 MRI UE Joint Right $1,500.00 $359.00

With so many imaging procedures, we have captured our most common and provided a break down of the pricing.  It is important to know when pricing imaging tests, to verify if the  radiologist (professional) fee has been included in the price.  In our pricing we have listed the radiologist (professional fee) separate.

CPT CODE SERVICE DESCRIPTION FACILITY FEE PROFESSIONAL FEE
76856 Ultrasound pelvic/transvag $731.00 $244.00
76700 US Abdomen Complete $450.00 $163.00
76705 US Abdomen Limited $400.00 $121.00
19083 US Biopsy Breast Left $1,400.00 $485.00
19084 US Biopsy Breast Left Addl Lesion $1,400.00 $155.00
76641 US Breast Right Complete $271.00 $84.00
76642 US Breast Right Limited $271.00 $84.00
93880 US Carotid Duplex Bilateral $500.00 $150.00
60100 US Core Needle Biopsy of Thyroid $800.00 $80.00
76942 US Guidance Needle Placement Non Rad $400.00 $116.00
76536 US Head/Neck Soft Tissue $450.00 $124.00
93970 US LE Venous Duplex Bilateral $500.00 $193.00
93971 US LE Venous Duplex Left $663.00 $120.00
76817 US Pregnancy Transvaginal $346.00 $104.00
76770 US Renal $426.00 $151.00
76870 US Scrotum (Contents) $450.00 $147.00
76999 US Soft Tissue Other Than Neck $395.00 $104.00

With so many imaging procedures, we have captured our most common and provided a break down of the pricing.  It is important to know when pricing imaging tests, to verify if the  radiologist (professional) fee has been included in the price.  In our pricing we have listed the radiologist (professional fee) separate.

CPT CODE SERVICE DESCRIPTION FACILITY FEE PROFESSIONAL FEE
74170 CT Abdomen $1,900.00 $355.00
74160 CT Abdomen $1,800.00 $301.00
74178 CT Abdomen/Pelvis $3,100.00 $565.00
74177 CT Abdomen/Pelvis $3,000.00 $756.00
72191 CT Angio Pelvis $2,024.00 $344.00
74175 CT Angiography Abdomen $1,996.00 $340.00
70496 CT Angiography Head $2,200.00 $356.00
70498 CT Angiography Neck $2,200.00 $350.00
77078 CT Bone Density Study $269.00 $42.00
71260 CT Chest $1,600.00 $308.00
71250 CT Chest $1,300.00 $270.00
70470 CT Head or Brain $2,000.00 $342.00
70460 CT Head or Brain $1,233.00 $291.00
70450 CT Head or Brain $1,200.00 $234.00
73700 CT Lower Extremity Left $1,119.00 $229.00
70487 CT Maxillofacial $1,292.00 $292.00
70486 CT maxillofacial $2,200.00 $245.00
70480 CT Orbit Sella etc. $1,176.00 $242.00
71275 CT PE CHEST $2,132.00 $345.00
72193 CT Pelvis $3,640.00 $622.00
72192 CT Pelvis $1,200.00 $622.00
70491 CT Soft Tissue Neck $1,691.00 $291.00
72125 CT Spine Cervical $1,400.00 $273.00
72132 CT Spine Lumbar $1,600.00 $309.00
72131 CT Spine Lumbar $1,308.00 $273.00
72128 CT Spine Thoracic $1,308.00 $273.00
73201 CT Upper Extremity Right $1,281.00 $291.00
73200 CT Upper Extremity Right $1,140.00 $234.00
74176 CT Urogram/Renal Stones $2,000.00 $300.00

With so many imaging procedures, we have captured our most common and provided a break down of the pricing.  It is important to know when pricing imaging tests, to verify if the  radiologist (professional) fee has been included in the price.  In our pricing we have listed the radiologist (professional fee) separate.

CPT CODE SERVICE DESCRIPTION FACILITY FEE PROFESSIONAL FEE
77067 MA Mammo SGK Screening $301.000 $99.00
77066 MA Mammogram Diagnostic Bilateral $368.00 $132.00
77065 MA Mammogram Diagnostic Right $265.00 $105.00

With so many imaging procedures, we have captured our most common and provided a break down of the pricing.  It is important to know when pricing imaging tests, to verify if the  radiologist (professional) fee has been included in the price.  In our pricing we have listed the radiologist (professional fee) separate.

CPT CODE SERVICE DESCRIPTION FACILITY FEE PROFESSIONAL FEE
70110 XR Mandible Complete Minimum 4 Views $312.00 $81.00
70150 XR Facial Bones Minimum 3 Views $287.00 $64.00
70160 XR Nasal Bones Minimum 3 Views $193.00 $71.00
70210 XR Waters View $158.00 $48.00
70220 XR Sinuses Paranasal Complete $287.00 $64.00
70250 XR Skull < 4 Views $203.00 $71.00
70328 XR TMJ Open and Closed Bilateral $140.00 $47.00
70360 XR Neck Soft Tissue $207.00 $48.00
71010 XR Chest 1 View $209.00 $56.00
71020 XR Chest 2 Views $209.00 $57.00
71045 XR Chest 1 View $188.00 $50.00
71046 XR Chest 2 Views $209.00 $57.00
71100 XR Ribs 2 Views Left $293.00 $70.00
71101 XR Ribs w/ PA Chest Left $293.00 $68.00
71111 XR Ribs w/ PA Chest Bilateral Minimum 4 Views $297.00 $92.00
72040 XR Spine Cervical 3 Views or Less $209.00 $48.00
72050 XR Spine Cervical Minimum 4 Views $347.00 $81.00
72052 XR Spine Cervical 6 Views or more $376.00 $90.00
72070 XR Spine Thoracic 2 Views $239.00 $70.00
72072 XR Spine Thoracic 3 Views $275.00 $70.00
72080 XR Spine Thoracolumbar 2 Views $245.00 $63.00
72083 XR Spine Scoliosis Study Standing $271.00 $82.00
72100 XR Spine Lumbosacral 2 or 3 Views $242.00 $70.00
72110 XR Spine Lumbosacral Minimum 4 Views $397.00 $97.00
72114 XR Spine Lumbosacral Complete w/ Bending $316.00 $82.00
72120 XR Spine Lumbosacral Bending Only / 4 + Views $271.00 $82.00
72170 XR Pelvis 1 or 2 Views $207.00 $52.00
72202 XR Sacrum/Coccyx Minimum 2 Views $211.00 $70.00
72220 XR Sacroiliac Joints 1 or 2 Views $247.00 $56.00
72255 XR Myelography Cervical Spine $800.00 $90.00
73000 XR Clavicle Right $209.00 $50.00
73010 XR Scapula Right $195.00 $56.00
73020 XR Shoulder 1 View Right $184.00 $48.00
73030 XR Shoulder Complete Right $233.00 $61.00
73040 XR Arthrogram Shoulder Right $306.00 $76.00
73060 XR Humerus Right $209.00 $50.00
73070 XR Elbow 2 Views Left $113.00 $31.00
73080 XR Elbow Complete Right $130.00 $36.00
73090 XR Forearm 2 Views Left $209.00 $50.00
73100 XR Wrist 2 Views Right $158.00 $50.00
73110 XR Wrist Complete Right $209.00 $59.00
73115 XR Arthrogram Wrist Left $600.00 $98.00
73120 XR Hand 2 Views Right $158.00 $48.00
73130 XR Hand Complete Right $415.00 $100.00
73140 XR Finger 4th Digit Left $100.00 $30.00
73501 XR Hip 1 View Right $109.00 $36.00
73502 XR Hip 2-3 Views Rt w/ Pelvis $150.00 $50.00
73521 XR Hips Bil w/ Pelvis 2 Views $150.00 $50.00
73522 XR Hips Bil w/ Pelvis 3-4 Views $150.00 $50.00
73525 XR Arthrogram Hip Left $800.00 $90.00
73552 XR Femur Left $233.00 $56.00
73560 XR Knee One or Two Views Left $178.00 $51.00
73562 XR Knee 3 Views Right $213.00 $58.00
73564 XR Knee Complete Left $222.00 $71.00
73590 XR Tibia/Fibula Left $209.00 $51.00
73600 XR Ankle 2 Views Right $165.00 $50.00
73610 XR Ankle Complete Right $215.00 $63.00
73620 XR Foot 2 Views Right $165.00 $48.00
73630 XR Foot Complete Right $209.00 $50.00
73650 XR Calcaneous Right $201.00 $48.00
73660 XR Toes Great Right $100.00 $30.00
74000 XR Abdomen 1 View $209.00 $57.00
74018 XR Abdomen 1 View $209.00 $57.00
74019 XR Abdomen 2 Views $249.00 $62.00
74020 XR Abdomen 2 Views $249.00 $62.00
74022 XR Abdomen Complete w/ Decub/Erect $347.00 $91.00
74220 XR Fluoro Esophagus $415.00 $95.00
74230 XR Fluoro Modified Esophagram $415.00 $115.00
74241 XR Upper GI + KUB $405.00 $127.00
74245 XR Upper GI w/ Small Bowel $555.00 $166.00
76000 XR Fluoroscopy Up to 1 Hour $473.00 $158.00
76010 XR Child  Nose-Rectum For FB $208.00 $48.00
77001 XR Fluoro Guidance for Central Venous Access $550.00 $100.00
77002 XR Fluoro Guidance for Injection $259.00 $120.00
77003 XR Fluoro Guidance Needle Placement $300.00 $145.00
77073 XR Bone Length Survey $158.00 $81.00
77074 XR Bone Survey Complete (Mets) $447.00 $166.00

Healthcare Terms

As we work to explain how healthcare pricing works, it is helpful to understand terms used on your insurance Explanation of Benefits statement.

Explanation of Benefits (EOB) – a statement you receive from your insurance company that explains how your benefits were applied to the hospital charges. It shows the hospital charges, how much your insurance paid and what the patient responsibility is.

Deductible – the amount a patient will pay before insurance will start paying for services (typical is $5,000)

Copay – a predetermined price that a patient will pay at the time of service based on their insurance carrier (office visits, ER visits, specialists, etc.)

Coinsurance – the amount (%) your insurance will cover for services. Typical is 80/20, the insurance pays 80% and the patient pays 20%.

Out of Pocket Maximum – the most a patient will have to pay out of pocket in a given period.

Cash Discounts

After appropriate paperwork is complete, patients may qualify for a cash discount or a sliding fee scale to help offset the amount owed.  Please call (208) 934-8764 for more information.