2011 SRMC Pricing Disclosure.xlsx

Operating Room Charges
Operating Room charges are based on the complexity level, with level 1 being the most basic, for a particular operation There is an initial, set-up charge as well as an
additional charge for each minute while the operation is being performed.
Charges
ACUITY LEVEL 1- INITIAL 30 MIN $3,730.27
ACUITY LEVEL 1- EACH ADDITIONAL 30 MIN $272.55
ACUITY LEVEL 3- INITIAL 30 MIN $4,874.45
ACUITY LEVEL 3- EACH ADDITIONAL 30 MIN $585.49
ACUITY LEVEL 4- INITIAL 30 MIN $6,069.40
ACUITY LEVEL 4- EACH ADDITIONAL 30 MIN $660.49
ACUITY LEVEL 5- INITIAL 30 MIN $7,675.46
ACUITY LEVEL 5- EACH ADDITIONAL 30 MIN $1,147.09
ACUITY LEVEL 6- INITIAL 30 MIN $9,082.40
ACUITY LEVEL 6- EACH ADDITIONAL 30 MIN $1,414.53
ACUITY LEVEL 7- INITIAL 30 MIN $9,561.31
ACUITY LEVEL 7- EACH ADDITIONAL 30 MIN $1,594.50
ACUITY LEVEL 8- INITIAL 30 MIN $9,260.16
ACUITY LEVEL 8- EACH ADDITIONAL 30 MIN $1,583.30
ACUITY LEVEL 9- INITIAL 30 MIN $18,360.56
ACUITY LEVEL 9- EACH ADDITIONAL 30 MIN $1,557.54
Physical Therapy Charges
The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services
performed.
Charges
EVAL BY PT (41-60 MIN) $192.05 97001
GROUP THERAPY PT 30 MIN $42.83 97150
THER EXER W/PT 15 MIN $84.79 97110
GAIT TRAINING 15 MIN $43.07 97116
NEURO EXER W/PT 15 MIN $92.86 97112
ULTRASOUND 15 MIN $82.10 97035
CPT
Occupational Therapy Charges
The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the
services performed.
Charges
EVAL BY OT (41-60 MIN) $295.91 97003
GROUP THERAPY, OT 30 MIN $42.83 97150
THER EXER W/OT 15 MIN $82.48 97110
ADL TRAINING 15 MIN $56.29 97535
AQUATIC THERAPY 15 MIN $88.83 97113
CPT