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).
Carle Foundation Hospital- Carle Hoopeston Regional Health Center
- Carle Richland Memorial Hospital
- Our Patient Financial Services representatives are available to help you understand charges and provide estimates Monday through Friday, 8 a.m. to 5 p.m. at (888) 71-CARLE or (888) 712-2753.
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 Evaluation | 99441-99443 | $115 - $350 | N/A | $115 - $350 |
| Initial Hospital Admission | 99221-99223 | $355 - $630 | N/A | $355 - $630 |
| Subsequent Hospital | 99231-99233 | $165 - $365 | N/A | $165 - $365 |
| Emergency Exam | 99281-99285 | $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 |
| EKG | 93010 | $84 | $360 | $444 |
| COVID-19 Test | 87635 | 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.