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Fees -As of 6 12 2019.Xls • Timed charges: Some charges such as anesthesia are based on a units of time, so the charges may vary based on the units charged. • Drugs and implants: Drugs, implants and supplies are priced individually based on the cost loaded into our information systems at the time of charging, so they do not have individual prices listed. The typical methodology will take the cost in place at the time, multiplied by a markup percentage. • Estimated Total Charges of Procedure/Stays/Visits etc can be obtained by contacting -AJ Karpinski at 218-546-2507. All charges are then subject to Insurance contract payer reductions. To get any accurate representation of patient final cost, I would strongly encourage contacting us to accurately predict final price -costs of services State Mandated Clinic Price Transparency – Average. Charge Medicare Medicaid Cuyuna Regional Medical Center - Clinic Commecial Reim. Office/outpatient visit new Level 1 $184 $76 $45 $34 Office/outpatient visit new Level 2 $379 $130 $75 $57 Office/outpatient visit new Level 3 $552 $186 $107 $82 Office/outpatient visit new Level 4 $679 $283 $163 $126 Office/outpatient visit est Level 1 $90 $36 $22 $16 Office/outpatient visit est Level 2 $180 $76 $44 $34 Office/outpatient visit est Level 3 $408 $127 $73 $56 Office/outpatient visit est Level 4 $528 $187 $108 $83 Office/outpatient visit est Level 5 $600 $245 $145 $112 Per pm reeval est pat infant $293 $176 Non-cov. $77 Prev visit est age 1-4 $334 $184 Non-cov. $82 Prev visit est age 18-39 $418 $205 Non-cov. $91 Prev visit est age 40-64 $391 $219 Non-cov. $97 Per pm reeval est pat 65+ yr $490 $236 Non-cov. $105 Init pm e/m new pat infant $329 $192 Non-cov. $85 Init pm e/m new pat 1-4 yrs $360 $201 Non-cov. $89 rev visit new age 18-39 $386 $229 Non-cov. $102 Prev visit new age 40-64 $451 $265 Non-cov. $118 Init pm e/m new pat 65+ yrs $494 $287 Non-cov. $128 VENIPUNCTURE/Lab Draw $44 $15 $3 $3 Seasonal Influenza $127 $39 $39 $53 Immunization admin $77 $28 $20 $16 Vaccine Admin $27 $25 $10 $16 PR SUBSEQUENT ANNUAL WELLNESS VISIT $278 $165 $117 $83 Transitional Care Management <14 days post dc. $487 $285 $165 $127 • ATTENTION: The amounts posted above DO NOT reflect the amount(s) each clinic patient will pay for • The Minnesota Legislature passed a law that requires certain clinics to report amounts for their 25 the services listed. For specific information about the amount you will owe for the services you receive, most frequent services that cost more than $25.00. The services listed here do not reflect all the services please contact your insurer. provided at this clinic. • Patients with government-sponsored health coverage, such as Medicare or Medical Assistance: The For more information, please contact AJ Karpinski, Director Managed Care Contracting, at 218- payment rates listed above reflect amounts set by Medicare or Medical Assistance, not by this clinic. 546-2507 These listed rates do not reflect the amount you might owe as a co-payment. NOTICE: Cuyuna Regional Medical Center - Crosby is a provider based facility. This clinic is a part of a • Patients covered by commercial health insurance or a Medicare Advantage plan: Your health insurance hospital and the patient may receive a separate charge or billing for the facility component of the service. company has likely negotiated a discount or contracted rate for each service. Your health insurance This may result in a higher out of pocket expense. company’s negotiated price might be higher or lower than the average commercial payment amount listed above. To learn more about your health insurance company’s negotiated price or how much you will owe under the term of your specific health policy, please contact your health insurance company. Fee Schedule Procedure Name UNIT_Charge CRNA PR INJ TRIGGER POINTS 3 OR > MUSCLES 44.00 CRNA PR VENIPUNC <3 YEARS FEMORAL JUGULAR MD SKILL 20.00 CRNA PR ANES NOSE SINUS SURGERY 20.00 CRNA PR ANES CORRECT HEART RHYTHM 20.00 CRNA PR ANES FAT LAYER REMOVAL PANNICULECTOMY 20.00 CRNA PR ANES ANORECTAL SURGERY 20.00 CRNA PR ANES XURETHRAL REMOVAL OF PROSTATE 20.00 CRNA PR ANES RADICAL REMOVE TESTIS INGUINAL 20.00 CRNA PR ANES HYSTEROSCOPY/VAG BX 20.00 CRNA PR ANES AMPUTATION LEG ABOVE KNEE 20.00 CRNA PR ANES TIB/FIB/PATELLA CLOSED PROCEDURE 20.00 CRNA PR ANES TIB/FIB/PATELLA OPEN PROCEDURE 20.00 CRNA PR ANES LOWER LEG OPEN PROCEDURE 20.00 CRNA PR ANES SHOULDER REPLACEMENT 20.00 CRNA PR ANES ELBOW AREA SURGERY 20.00 CRNA PR ANES FOREARM BONES CLOSED PROC 20.00 CRNA PR ANES CT/MRI OR RADIATION THERAPY 20.00 CRNA PR CATH PLCMT INJ/INFUSE EPI OR SUBA LUMB SACRAL WO GUIDE 204.00 CRNA PR ANES UPPER/LOWER GI ENDOSCOPY 20.00 CRNA PR VENIPUNCTURE > 3 MD SKILL DX OR TX PURP 62.00 CRNA PR INJ ANES AGENT SCIATIC NERVE CONT INF 127.00 CRNA PR ANES RECONSTRUCT EYELID 20.00 CRNA PR ANES TYMPANOTOMY 20.00 CRNA PR ANES FOR LENS SURGERY 20.00 CRNA PR ANES CHEST PROC CLOSED NOS 20.00 CRNA PR ANES CENTRL VASCULAR ACCESS 20.00 CRNA PR ANES XURETHRAL BLADDER TUMOR SURG 20.00 CRNA PR ANES TOTAL HIP ARTHROPLASTY 20.00 CRNA PR ANES OPEN PROC UPPER 2/3 FEMUR 20.00 CRNA PR ANES LOWER LEG BONE SURG 20.00 CRNA PR ANES ARTHROSCIC OPEN SHOULDER JOINT 20.00 CRNA PR ANES CES DEL FOL NEURAXIAL ANAL/ANES 354.00 CRNA PR INSERT NON TUNNEL CVCATH OVER 5 YRS 218.00 CRNA PR ULTRASOUND GUIDED NEEDLE PLCMT 64.00 CRNA PR INSERT CATH ART PERCUT SHORT TERM 126.00 CRNA PR INJ NERV BLOCK AXILLARY NERV 181.00 CRNA PR INJ ANES AGENT SCIATIC NERVE SINGLE 114.00 CRNA PR HEART/LUNG RESUSCITATION (CPR) 223.00 CRNA PR POS AIRWAY PRESSURE CPAP 293.00 CRNA PR ANES SURG CLAVICLE SCAPULA 20.00 CRNA PR ANES PACEMAKER INSERTION 20.00 CRNA PR ANES REPAIR OF CERVIX 20.00 CRNA PR ANES TOTAL KNEE ARTHROPLASTY 20.00 CRNA PR ANES ELBOW REPLACEMENT 20.00 CRNA PR ANES NERVE BLOCKS/INJ NOT PRONE 20.00 CRNA PR ANES PERC IMG TX SPINE PROC 20.00 CRNA PR TAP BLCK ABD PLN BLCK RECTUS BLCK UNI INJ W IMG GUID 312.00 CRNA PR ANES UPPER GI ENDOSCOPY 20.00 CRNA PR ANES LOWER GI ENDOSCOPY SCREENING COLONOSCOPY 20.00 CRNA PR ANES CRNA TIMED CUY ONLY 20.00 CRNA PR INJ ANES AGENT BRACHIAL PLEXUS CONT INF 152.00 CRNA PR INJ NERV BLOCK INTERCOST MULTPL 132.00 CRNA PR INJ FORAMEN L/S 1 LEVEL WITH FLUORO OR CT 302.00 CRNA PR ANES SKIN SURG HEAD/NECK 20.00 CRNA PR ANES GASTRIC RESTRICT MORBID OBESITY 20.00 CRNA PR ANES TUBAL LIGATION/TRANSECTION 20.00 CRNA PR ANES LOWER 1/3 FEMUR OPEN PROC 20.00 CRNA PR ANES RADICAL LEG RESECTION 20.00 CRNA PR ANES SURGERY OF SHOULDER 20.00 CRNA PR US GUIDED VASCULAR ACCESS 58.00 CRNA PR INJ TRIGGER POINT 1 OR 2 MUSCLES 43.00 CRNA PR INJ ANES AGENT BRACHIAL PLEXUS SINGLE 211.00 CRNA PR INJ NERV BLOCK INTERCOSTAL ONE 96.00 CRNA PR INJ ANES AGENT FEMORAL NERVE SINGLE 54.00 CRNA PR ANES PROCEDURES ON EYE 20.00 CRNA PR ANES TRACHBRONCHI INTRATHOR SURG 20.00 CRNA PR ANES SURG LOWER IP ABDOMEN 20.00 CRNA PR ANES COLPOVAGINECT COLPORRURETH PROC 20.00 CRNA PR ANES REVISE TOTAL HIP ARTHROPLASTY 20.00 CRNA PR ANES UPPER LEG SURG 20.00 CRNA PR ANES UPPER LEG VEINS SURG 20.00 CRNA PR ANES KNEE JOINT CLOSED PROCEDURE 20.00 CRNA PR ANES DX ARTHROSCOPIC PROC KNEE JOINT 20.00 CRNA PR ANES FOR INCOMPLETE OR MISSED ABORTION 20.00 CRNA PR TAP BLCK ABD PLN BLCK RECTUS BLCK BIL BY INJ W IMG GUID 377.00 CRNA HCHG MODERATE SED SAME PROVIDER > 5 YRS 1ST 15 MINUTES 202.00 CRNA PR INJ EPIDUR INTERLAM SUBA LUMB SACRAL WO GUIDE 281.00 CRNA PR ANES UPPER GI ENDOSCOPY W RETROGRADE 20.00 CRNA PR SPINAL PUNCTURE THERAPEUTIC DRAINAGE 143.00 CRNA PR INJ ANES AGENT FEMORAL NERVE CONT INF 174.00 CRNA PR INJ NERV BLOCK OTHR PERIPH NERV 101.00 CRNA PR ECHO HEART TRANSESOPHAGEAL COMPLETE 20.00 CRNA PR CRITICAL CARE 30-74 MINUTES 821.00 CRNA PR ANES CHEST DRAINAGE 20.00 CRNA PR ANES REPAIR UPPER ABD HERNIA NOS 20.00 CRNA PR ANES REPAIR LO ABD HERNIA NOS 20.00 CRNA PR ANES VAGINAL PROCEDURES 20.00 CRNA PR ANES BONE MARROW ASP/BX ILIAC CRST 20.00 CRNA PR ANES HIP JOINT SURGERY OPEN 20.00 CRNA PR ANES ARTHROSCOPIC OPEN KNEE JOINT 20.00 CRNA PR ANES LOWER LEG VEIN SURG NOS 20.00 CRNA PR ANES LOWER ARM SURGERY 20.00 CRNA PR NEURAXIAL LABOR ANAL/ANES PLAN VAG DEL 354.00 CRNA PR FLUOROSCOPIC GUIDE FOR NEEDLE PLACEMENT 488.00 CRNA PR NEWBORN RESUSCITATION 361.00 CRNA HCHG MODERATE SED SAME PROVIDER EACH ADDL 15 MINUTES 23.00 CRNA PR INSERT EMERGENCY ENDOTRACH AIRWAY 79.00 CRNA PR ANES RADICAL FACIAL BONE SURGERY 20.00 CRNA PR ANES NECK ORG PROC NOS AGE 1 YR/OLD 20.00 CRNA PR ANES NECK VESSEL SURG SIMPL LIGAT 20.00 CRNA PR ANES THORACOTOMY PROC W/1 LUNG VENT 20.00 CRNA PR ANES REPAIR LO HERNIA VENTR/INCIS 20.00 CRNA PR ANES SURG LOW ABDEXTRAPERINTONEAL 20.00 CRNA PR ANES KID STONE DESTRUCT 20.00 CRNA PR ANES URETERAL STONE REMOVAL 20.00 CRNA PR ANES MALE GENITALIA SURGERY 20.00 CRNA PR ANES VAGINAL HYSTERECTOMY 20.00 CRNA PR ANES LOWER 1/3 FEMUR CLOSED PROC 20.00 CRNA PR ANES OPEN OR ARTHROSCOPIC LOWER ARM SURGERY 20.00 CRNA PR INSERT NON TUNNEL CVCATH UNDER 5 YRS 234.00 CRNA PR INJ NERV BLOCK LMBR PLEX CONTIN INF 198.00 CRNA PR VENT MGMT INPAT SUBQ DAY 187.00 CRNA PR ANES LOWER GI ENDOSCOPY 20.00 CRNA PR WITHDRAWAL OF ARTERIAL BLOOD 104.00 CRNA PR LUMBAR PUNCTURE DIAGNOSTIC 391.00 CRNA PR INJ LUMBAR EPIDUR BLOOD/CLOT PATCH 556.00 CRNA PR INJ NERV BLOCK ILIOINGU/ILIOHYP 324.00 CRNA PR CRITICAL CARE EA ADDL 30 MIN 388.00 CRNA PR ANES CORNEAL TRANSPLANT 20.00 CRNA PR ANES INTRAORAL PROCEDURE NOS 20.00 CRNA PR ANES SKIN SURG THORAX EXTR 20.00 CRNA PR ANES SURG BREAST RAD MASTEC 20.00 CRNA PR ANES REPAIR UP HERNIA LUMBAR/VENTR 20.00 CRNA PR ANES SURG UPPER IP ABDOMEN 20.00 CRNA PR ANES TRANSURETHRAL SURG NOS 20.00 CRNA PR ANES CLOSED PROC UPPER
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