Outpatient Pharmacy

Charges for Select Hospital Services

Charges effective January 1, 2013

Room and Board- Per Day Charges___________________

Med/Surg Semi Private $ 1,444
Med/Surg Private $ 1,470
ICU $ 3,192

 

Emergency Department Charges_____________________

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 Emergency Department physician fees, which are billed separately.

Level 1 $236
Level 2 $378
Level 3 $625
Level 4 $1,024
Level 5 $1,654

 

Operating Room Charges__________________________

Operating Room Charges are based on the complexity level, with Type 1 being the most basic. 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 by your physician.

Level 1 - 30 mins $1,785 Level 1 - each additional 15 mins $752
Level 2 - 30 mins $2,179 Level 2 - each additional 15 mins $868
Level 3 - 30 mins $2,515 Level 3 - each additional 15 mins $984
Level 4 - 30 mins $2,743 Level 4 - each additional 15 mins $1,100

 

Observation Status__________________________

Initial Hour $578
Each Additional Hour $35
R+B Oncology $2,216
R+B Detox $1,444
R+B Step Down $2,331

 

Physical, Occupational and Pulmonary Therapies________

The following charges reflect the most common services offered by our Physical Therapy, Occupational Therapy, and Pulmonary Therapy Departments. Patients may have additional charges, depending upon the services performed.

Blood Gas Study $228
Inhalation Treatment $138
Occupational Therapy Evaluation $368
Occupational Therapy - 15 mins $142
Physical Therapy Evaluation $289
Physical Therapy - 15 mins $142
Gait Training - 15 mins $103

 

X-Ray and Radiological Charges_____________________

The following charges reflect the hospital’s 30 most common x-ray and radiological procedures.

CT Head/Brain without contrast $1,445 Chest X-Ray 1 view $242
CT Head/Brain w & without contrast $2,198 Chest X-Ray 2 views $299
CT Sinuses/Facial $1,462 Lumbar Spine 1 view $240
CT Pelvis with contrast $1,851 Lumbar Spine 3 views $367
CT Thorax with contrast $1,885 Lumbar Spine-obliques $602
CT Abdomen with /contrast $1,979 Modified Barium Swallow $597
MRI Brain w & without contrast $5,400 Abdomen X-Ray-3 views $305
Thoracic Spine X-Ray 3 views $329 Abdomen X-Ray-Compl $496
Cervical Spine X-Ray 2-3 views $307 Bone Density Study $438
Cervical Spine X-Ray 4 view min. $405 Shoulder X-Ray $294
Screening Mammogram-bilateral $250 Elbow X-Ray-3 views $248
Diagnostic Mammogram-bilateral $350 Wrist X-RAY-3 views $315
Hand X-Ray $289 Hip X-Ray compl.-2 view $325
Finger X-Ray-2 views-one hand $171 Knee X-Ray compl-4 view $360
Ankle X-Ray-compl.-3 views $310 Foot X-Ray compl-3 view $267

 

Laboratory Charges______________________________

The following charges reflect the hospital’s 30 most common laboratory procedures.

Basic Metabolic Panel $105 BUN $31
CBC $82 Creatine Kinase MB frac $61
Comp Metabolic Panel $200 Creatinine Kinase (CK) $63
    Culture Blood $168
Culture Urine $63 Cyto PAP Smear $87
Hematocrit $26 Hemoglobin $26
Hemoglobin A1C $105 CBC Auto $74
Hepatic Panel $91 Lipid Panel $146
Lytes Panel $58 Magnesium $66
Myoglobin $172 Protime $41
PTT (Partial Prothrombin Time) $75 PSA $101
SED Rate Manual $38 Sensitivity Micro $72
Surgical Pathology Level 4 $347 Troponin Quant $145
TSH (Thyroid Stimulating Hormone) $160 Urinanalysis- with Micro $38
Urinalysis w/out Micro $24 Venipuncture $12

 

* In accordance with Ohio Revised Code, Section 3727.42
Professional fees are not billed by the hospital and are not included in these charges. Prices/charges may be updated at any time without notice. The patient/guarantor may be responsible for any amount different than those prices listed here.