Patient Price List

T J Regional Health

Patient Price Information List

 T J Samson Regional Health is providing this price list containing standard charges for our Glasgow and Columbia hospitals. The price list does not contain the pricing for any professional physician, pharmacy, or supply charges.  The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers.  Uninsured or underinsured patients should consult Financial Counseling at 270-659-5624 to determine whether they may qualify for any discounts.

Effective January 1, 2019

Room and Board- Per Day Charges

ROOM AND BOARD MEDICAL SURGICAL

$1,224.00

ROOM AND BOARD MONITORED BED

$1,246.00

ROOM AND BOARD ICU

$2,207.00

ROOM AND BOARD NURSERY

$612.00

ROOM AND BOARD NSY INTERMEDIATE

$1,246.00

ROOM AND BOARD NURSERY ICU

$2,207.00

ROOM AND BOARD SKILLED UNIT PRIVATE

$591.00

ROOM AND BOARD SKILLED UNIT SEMIPRIVATE

$569.00

EMERGENCY ROOM SERVICES

Emergency Department charges are based on the level of emergency care provided to our patients.  The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment.  The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment.  They also do not include fees for Emergency Department physicians, whose services will be billed separately.

EMERGENCY LEVEL I CARE

$115.00

EMERGENCY LEVEL II CARE

$250.00

EMERGENCY LEVEL III CARE

$411.00

EMERGENCY LEVEL IV CARE

$753.00

EMERGENCY DEPARTMENT VISIT HIGH SEV

$989.00

CRITICAL CARE 30 TO 74 MIN

$1,208.00

CRITICAL CARE EA ADDL 30 MIN

$604.00

OPERATING ROOM SERVICES

The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure.  Fees for physician services or anesthesia administration are also not reflected, and will be billed separately.

OR LEVEL 1 INITIAL 30 MINUTES

OR LEVEL 1 ADDITIONAL 15 MINUTES

$1,775.00

$382.00

OR LEVEL 2 INITIAL 30 MINUTES

OR LEVEL 2 ADDITIONAL 15 MINUTES

$3,250.00

$630.00

OR LEVEL 3 INITIAL 30 MINUTES

OR LEVEL 3 ADDITIONAL 15 MINUTES

$4,173.00

$898.00

OR LEVEL 4 INITIAL 30 MINUTES

OR LEVEL 4 ADDITIONAL 15 MINUTES

$5,634.00

$1,213.00

OR LEVEL 5 INITIAL 30 MINUTES

OR LEVEL 5 ADDITIONAL 15 MINUTES

$7,465.00

$1,607.00

OR LEVEL 6 INITIAL 30 MINUTES

OR LEVEL 6 ADDITIONAL 15 MINUTES

$9,705.00

$2,089.00

PRE OP AMB SERVICES

$298.00

RECOVERY PACU PHASE 1 INITIAL 30 MIN

RECOVERY PACU PHASE 1 ADD 15 MIN

$590.12

$170.00

RECOVERY PACU PHASE 2 INITIAL 30 MIN

RECOVERY PACU PHASE 2 ADD 15 MIN

$210.00

$90.00

MAC ANESTHESIA PER MIN

GENERAL ANESTHESIA PER MIN

$4.00

$6.00

ENDOSCOPY / BRONCHSCOPY

The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure.  Fees for physician services or anesthesia administration are also not reflected, and will be billed separately.

ENDOSCOPY LEVEL 1 PROCEDURE

$1,939.00

ENDOSCOPY LEVEL 2 PROCEDURE

$2,198.00

ENDOSCOPY LEVEL 3 PROCEDURE

$2,714.00

ENDOSCOPY LEVEL 4 PROCEDURE

$3,102.00

ENDOSCOPY LEVEL 5 PROCEDURE

$4,782.00

ENDOSCOPY RECOVERY PER MIN

$6.00

BRONCH SUITE PER MINUTE

$127.00

BRONCH SUITE RECOVERY PER MINUTE

$6.00

WOMEN AND NEWBORN CARE

The following list does not include charges for anesthesia, drugs, supplies, or additional procedures required.  Fees for physician services or anesthesia administration are also not reflected, and will be billed separately.

L D BRIEF  LEVEL 1

$647.00

L D ROUTINE LEVEL 2

$776.00

L D INTERMEDIATE LEVEL 3

$932.00

L D COMPLEX LEVEL 4

$1,118.00

L D EXTENSIVE LEVEL 5

$1,342.00

DELIVERY

$5,046.00

FETAL NON STRESS TEST                                                                                                                                59025

$321.00

EXTERNAL CEPHALIC VERSION                                                                                                                      59412

$4,545.00

EPIDURAL WO IMAGING                                                                                                                                62322

$940.00

CIRCUMCISION PROCEDURE

$225.00

WOUND CARE CENTER

The following charges do not include fees for drugs, supplies or additional procedures that may be required during treatment.  They also do not include physician’s fees whose services will be billed separately.

BENIGN LESION PARING (CORN / CALLUS)

11055

$280.00

CHEMICAL CAUTERY GRANULATION TISSUE

17250

$280.00

NEGATIVE PRESSURE WOUND TREATMENT LESS THAN 50CM

97605

$280.00

TRIM DYSTROPHIC NAIL ANY NO W NM ABN

G0127

$90.00

DEBRIDEMENT SUBQ TISSUE 1ST 20 SQ CM OR LESS

11042

$495.00

DEBRIDEMENT SUBQ TISSUE EA ADL 20 SQ CM

11045

$407.00

DEBRIDEMENT WOUND 1ST 20 SQ CM OR LESS

97597

$280.00

DEBRIDEMENT WOUND EA ADL 20 SQ CM

97598

$219.00

HYPERBARIC OXYGEN THERAPY 30 MIN

G0277

$407.00

SMALL BURN DRESSING  /DEBRIDEMENT PARTIAL THICKNESS

16020

$280.00



PAV URGENT CARE

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment.  They also do not include physician’s fees whose services will be billed separately.

OUTPATIENT VISIT LEVEL

$163.00

I AND D ABCESS SIMPLE OR SINGLE

10060

$338.00

REMOVE IMPACTED EAR WAX UNI

69209

$90.00

REMOVE IMPACTED CERUMEN 1 OR BOTH EARS

69210

$90.00

SIMPLE WOUND REPAIR 2.5CM OR LESS

12001

$280.00

APPLICATION OF FINGER SPLINT

29130

$90.00

APPLICATION OF SHORT ARM SPLINT

29125

$195.00

CARDIOLOGY

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment.  They also do not include physician’s fees whose services will be billed separately.

CARDIAC DOPPLER COMPLETE

93320

$328.00

CARDIAC DOPPLER FU OR LIMITED STUDY

93321

$194.00

ECHO 2 D M MODE FU OR LIMITED STUDY

93308

$373.00

ECHO STRESS W CARD STRESS COMPLETE

93351

$880.00

DOPPLER COLOR FLOW VELOCITY MAPPING

93325

$572.00

HOLTER MONITOR RECORD UP TO 48 HRS

93225

$260.00

CARDIO EVENT REC HOOKUP REC DISCONN

93270

$208.00

TREDMIL PHARM STRESS TST TRAC ONLY

93017

$655.00

TTE W DOPPLER COMPLETE

93306 /C8929

$1,450.00

EKG TRACING ONLY 12 LEAD HOSPITAL

93005

$203.00

SLEEP LAB / EEG

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment.  They also do not include physician’s fees whose services will be billed separately.

EEG

95816/ 95819 / 95822

$400.00

POLYSOMNOGRAPHY

95810

$2,181.00

POLYSOMNOGRAPHY W CPAP

95811

$2,544.00

SLEEP STDY UNATT RESP EFFORT (HOME SLEEP TEST)

G0399

$465.00

BLOOD BANK

PLASMA FRZ BTWN 8 24HR PROCESSING

P9059

$199.00

LEUKOCYTE REDUCED RBC PROCESSING

P9016

$493.00

BLOOD ADMINISTRATION LEVEL 1

36430

$750.00

TYPE AND CROSS / SCREEN RBC

$484.00

NEWBORN CORD BLOOD

$557.00

ZIMM SPIN CROSSMATCH PER UNIT

86920

$310.00

IV THERAPY

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment. 

IV HYDRATION INITIAL HOUR

96360

$295.00

IV HYDRATION EACH ADDITIONAL HOUR

96361

$60.00

IV MED INFUSION INITIAL HOUR

96365

$295.00

IV MED INFUSION EA ADDITIONAL HOUR

96366

$60.00

IV CHEMO INFUSION UP TO 1 HR

96413

$457.00

IV CHEMO INFUSION EA ADDITIONAL HOUR

96415

$95.00

IV MED PUSH INITIAL

96374

$295.00

INJECTION IM OR SUBSQ

96372

$95.00

INJECTION CHEMO SUBQ OR IM

96401 / 96402

$160.00

IRRIGATION IMPLANTED VENOUS ACCESS DEVICE

96523

$117.00

COLLECT BLOOD FROM IMPL VEN DEVICE

36591

$170.00

REHAB THERAPY SERVICES

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment. 

PT EVAL LOW COMPLEX 20 MIN

97161

$205.00

PT EVAL MOD COMPLEX 30 MIN

97162

$276.00

PT EVAL HIGH COMPLEX 45 MIN

97163

$414.00

OT EVAL LOW COMPLEX 30 MIN

97165

$220.00

OT EVAL MOD COMPLEX 45 MIN

97166

$309.00

OT EVAL HIGH COMPLEX 60 MIN

97167

$415.00

THERAPEUTIC ACTIVITIES EACH 15 MIN

97530

$96.00

ACTIVITIES OF DAILY LIVING 15 MIN

97535

$85.00

AQUATIC THERAPY EA 15 MIN

97113

$103.00

MANUAL THERAPY EACH 15 MIN

97140

$74.00

THERAPEUTIC PROCEDURE EACH 15 MIN

97110

$93.00

NEUROMUSCULAR REEDUCATION EA 15 MIN

97112

$84.00

ELECTRICAL STIMULATION UNATTENDED

G0283

$37.00

ICE HOT PACKS APPLICATION

97010

$16.00

OP CARDIAC REHAB PH II W ECG MONITOR

93798

$239.00

INDIVIDUAL TX SPEECH HEARING

92507

$195.00

EVALUATION OF LANGUAGE COMPREHENSION AND EXPRESSSION

92523

$476.00

TREATMENT OF SWALLOWING DISFUNCTION

92526

$211.00

BEDSIDE EVAL OF SWALLOWING

92610

$249.00

EVAL SWALLOWING MBS

92611

$444.00

RESPIRATORY THERAPY SERVICES

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment. 

ARTERIAL PUNCTURE FOR DIAGNOSIS

36600

$195.00

CARBOXYHEMOGLOBIN QUANT

82375

$111.00

BLOOD GAS MIXED WO O2 SAT 82803

82803

$148.00

VENTILATION MGMNT INPT OPT DAY 1

94002

$800.00

VENT MGMNT INPT OPT SUBSEQ DAY

94003

$800.00

SPIROMETRY PRE POST BRONCH

94060

$400.00

PULMONARY STRESS TESTING

94618

$195.00

MINI NEB AIRWAY INHALATION TREATMENT

94640

$305.00

BIPAP CPAP INITIATION MANAGEMENT

94660

$424.00

MECHANICAL CHEST WALL OSCILLATION

94669

$305.00

PULM FUNCT TST PLETHYSMOGRAP

94726

$400.00

CARBON MONOXIDE DIFF DLCO

94729

$142.00


CATH LAB SERVICES

The following charges do not include fees for drugs, supplies, or additional procedures that may be required during treatment. 

INS NEW REP PERM PM W TRNSV LDS ART VENT

33208

$17,482.00

PTCA SINGLE VESSEL

92920

$7,795.00

IVUS CORONARY INIT VES

92978

$4,784.00

COR ART CATH W ANGIO S I

93454

$5,481.00

COR ART CATH W ANGIO LIMA VBG S I

93455

$5,675.00

LT HEART CATH W COR ANGIO VENT S I

93458

$5,617.00

LT HEART CATH W ART GRFT ANGIO S I

93459

$5,842.00

INTRAVAS DOPP COR FLOW MS INIT VESS

93571

$1,585.00

DRUG ELUDING STENT W WO ANGIOPLASTY SGL VESSEL

C9600

$16,110.00

PTCA W DRUG ELUD STENT W ACUTE MI SNGL VES

C9606

$24,556.00

LABORATORY SERVICES

The following list reflects the hospital's 30 most common laboratory tests performed in hospital. Pricing for labs sent to outside laboratories will vary depending on outside lab charge for procedure so are not listed.

BASIC METABOLIC PANEL

80048

$106.00

COMPREHENSIVE METABOLIC PANEL

80053

$185.00

LIPID PROFILE

80061

$50.00

RENAL FUNCTION PANEL

80069

$132.00

DRUG SCREEN EMERGENCY IN HOUSE

80306

$121.00

URINALYSIS AUTO WITH MICROSCOPY

81001

$41.00

URINALYSIS AUTO WITHOUT MICROSCOPY POC (office)

81003

$19.00

PREG URINE

81025

$59.00

VITAMIN D 25 HYDROXY

82306

$94.00

VITAMIN B12

82607

$136.00

HEMOGLOBIN A1C

83036

$70.00

LACTIC ACID

83605

$45.00

LIPASE

83690

$42.00

MAGNESIUM

83735

$71.00

BNP

83880

$143.00

T4 FREE THYROXINE

84439

$87.00

THYROID STIMULATING HORMONE

84443

$128.00

TROPONIN I

84484

$81.00

HEMATOLOGY DIFF

85007

$41.00

CBC W DIFF

85025

$94.00

CBC NO DIFF

85027

$44.00

PROTHROMBIN TIME POC (office)

85610

$16.00

PROTHROMBIN TIME

85610

$38.00

PTT ACTIVATED

85730

$47.00

CULTURE BLOOD

87040

$100.00

CULTURE URINE

87086

$42.00

URINE ID AND ISOL

87088

$41.00

SENSITIVITY

87186

$63.00

INFLUENZA DNA AMP PROBE

87502

$292.00

STREP A AMPLIF NA PROBE

87651

$121.00

RADIOLOGY SERVICES

The following list reflects the hospital's 30 most common radiological procedures and does not include the price of contrast if used.

CT HEAD WITHOUT CONTRAST

70450

$1,564.00

MRI BRAIN WITHOUT CONTRAST

70551

$2,200.00

MRI BRAIN WITH AND WITHOUT CONTRAST

70553

$4,500.00

XRAY CHEST 1 VIEW

71045

$178.00

XRAY CHEST 2 VIEWS

71046

$258.00

CT CHEST WITHOUT CONTRAST

71250

$1,651.00

CT CHEST WITH CONTRAST

71260

$1,969.00

CTA CHEST NONCORONARY

71275

$1,969.00

XRAY L SPINE 2 VIEW

72100

$299.00

XRAY LUMBAR SPINE C OBLIQUE

72110

$497.00

CT CERVICAL SPINE WITHOUT CONTRAST

72125

$1,646.00

MRI LUMBAR SPINE WITHOUT CONTRAST

72148

$2,701.00

X-RAY EXAM OF SHOULDER 2+ VIEWS

73030

$234.00

X-RAY EXAM OF FOOT; 3+ VIEWS

73630

$234.00

XRAY ABDOMEN 1 VIEW

74018

$225.00

XRAY ABDOMEN 2 VIEWS

74019

$308.00

XRAY ACUTE ABDOMEN WITH CHEST

74022

$552.00

CT ABD PELVIS WITHOUT CONTRAST

74176

$3,937.00

CT ABD PELVIS WITH CONTRAST

74177

$3,937.00

US ABDOMEN LIMITED SINGLE ORGAN

76705

$755.00

US RENAL COMPLETE

76770

$943.00

US LESS THAN 14WKS PREG TRANSABD

76801

$245.00

US GREATER THAN 14WKS PREG TRANSABD

76805

$356.00

US OB FOLLOW UP PER FETUS

76816

$290.00

FETAL BIOPHYSICAL PROFILE W NON STRESS TEST

76818

$199.00

US TRANSVAGINAL NON OB COMPLETE

76830

$755.00

MAMMOGRAM 3D BILATERAL

77063

$75.00

SCREENING MAMMOGRAM BILATERAL

77067

$279.00

MYOCARDIAL PERFUSION IMAGING

78452

$3,700.00

US VENOUS DOPPLER EXTREMITY VEINS UNILATERAL

93971

$710.00