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Transparent Pricing

At Carle, we are committed to helping you make informed choices about your care. That includes helping you know how much you will be charged for services and goods and what to expect on your bill.

Beginning January 1, 2019, the U.S. Department of Health & Human Services and the Centers for Medicare & Medicaid Services requires hospitals and health systems to post their "current, standard charges." You can view these at the links here.

When patients have the opportunity to shop for medical services, they should contact their insurance carrier to understand which services and goods will be covered and which will be the patient's responsibility.

Hospital charges are the amount a hospital bills for a service. Because of varying reimbursements for hospitals, patients most often pay far less than the amount listed. For charges that show up as zero dollars or blanks, the prices are determined on an individual basis, and as a result the price cannot be listed in the charge master but is determined only and if the particular charge is used.

In addition, the Centers for Medicare & Medicaid Services requires hospitals and health systems to post the average amount charged for diagnosis-related groups (DRG).

For questions about your insurance coverage, please call the telephone number on your member ID card.

Please be prepared to provide the following:

  • Description of service
  • Procedure code(s) which you can get from your physician's office

Most Requested
Estimates

For your convenience, below is a short list of most frequently provided services and their estimated charges. If you have any questions about this information, please give us a call.

Office Visits and Hospital Charges
description of service procedure codes* professional charge** facility charge** total charges
New Patient Visit 99201-99205 $155 - $540 $275 - $540 $430 - $1080
Established Patient Visit 99212-99215 $135 - $395 $290 - $540 $425 - $935
Physician/Advance Practice Provider Telephone Evaluation99441-99443
$115 - $350
N/A$115 - $350
Initial Hospital Admission99221-99223
$355 - $630
N/A
$355 - $630
Subsequent Hospital
99231-99233
$165 - $365
N/A$165 - $365
Emergency Exam99281-99285
$235 - $1230
$2300 - $3350
$2535 - $4580
Hospital Discharge
99238-99239 
$255 - $340
N/A$255 - $340
Laboratory and Radiology Services

The charges listed below have a draw fee associated with them called a venipuncture. The charge amount for a venipuncture is $42.00. It is billed as a facility charge.

description of service procedure codes* professional charge** facility charge** total charges
Complete Blood Count (CBC) 85025 N/A $252 $252
Complete Metabolic Panel (CMP) 80053 N/A $426 $426
Lipid Panel 80061 N/A $404 $404
Tuberculosis Test Cell Immune Measure (TB) 86480 N/A $348 $348
Hemoglobin; glycosylated (A1C) 83036 N/A $268 $268
Chest X-ray
71045-71046
$105 - $125
$390 - $510
$515 - $615
EKG93010
$84$360$444
COVID-19 Test87635
N/A$200$200
Mammograms
description of service procedure codes* professional charge** facility charge** total charges
Bilateral Screening - Digital 77067, with 3D Tomography 77063 $890 $1290 $2180
Bilateral Diagnostic - Digital 77066, with 3D Tomography G0279 $950 $1370 $2320
Colonoscopy
description of service procedure codes* professional charge** facility charge** total charges
Diagnostic Outpatient 45378 $2470 $2680 $5150
Magnetic Resonance Imaging (MRI)
description of service procedure codes* professional charge** facility charge** total charges
Head - without contrast 70551 $1720 $4380 $6100
Head - imaging performed no contrast followed by with contrast 70553 $2340 $6440 $8780

*Each service has a unique procedure code that is associated with the description and cost of the service or procedure performed. These codes are used nationally and help ensure consistency in the billing and reimbursement process. The codes are used to communicate to insurance companies.

The charges listed above are reflective of our most common services provided and are predominantly provided in a hospital provider based setting. In most instances, there will be a bill from Carle Physician Group for "professional charges" as well as a bill from Carle Foundation Hospital for "facility charges". Provider Based Billing is an established nationally-recognized billing model for hospitals and clinics that complies with Medicare regulations. Most insurance companies are familiar with provider based bills and pay claims accordingly.