Outpatient Pharmacy

Charges for Select Hospital Services

Charges effective January 1, 2012

Room and Board- Per Day Charges___________________

Med/Surg Semi Private $ 1,375
Med/Surg Private $ 1,400
ICU $ 3,040

 

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 $225
Level 2 $360
Level 3 $595
Level 4 $975
Level 5 $1,575

 

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 $1700 Level 1 - each additional 15 mins $717
Level 2 - 30 mins $2075 Level 2 - each additional 15 mins $827
Level 3 - 30 mins $2395 Level 3 - each additional 15 mins $937
Level 4 - 30 mins $2612 Level 4 - each additional 15 mins $1047

 

Observation Status__________________________

Initial Hour $550
Each Additional Hour $33
R+B Oncology $2,110
R+B Detox $1,375
R+B Step Down $2,220

 

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 $217
Inhalation Treatment $131
Occupational Therapy Evaluation $350
Occupational Therapy - 15 mins $135
Physical Therapy Evaluation $275
Physical Therapy - 15 mins $135
Gait Training - 15 mins $98

 

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 $1,376 Chest X-Ray 1 view $230
CT Head/Brain w & without contrast $2,093 Chest X-Ray 2 views $285
CT Sinuses/Facial $1,392 Lumbar Spine 1 view $228
CT Pelvis with contrast $1,793 Lumbar Spine 3 views $349
CT Thorax with contrast $1,885 Lumbar Spine-obliques $573
CT Abdomen with /contrast $1,912 Modified Barium Swallow $569
MRI Brain w & without contrast $5,143 Abdomen X-Ray-3 views $290
Thoracic Spine X-Ray 3 views $313 Abdomen X-Ray-Compl $472
Cervical Spine X-Ray 2-3 views $292 Bone Density Study $417
Cervical Spine X-Ray 4 view min. $386 Shoulder X-Ray $280
Screening Mammogram-bilateral $250 Elbow X-Ray-3 views $236
Diagnostic Mammogram-bilateral $350 Wrist X-RAY-3 views $300
Hand X-Ray $275 Hip X-Ray compl.-2 view $310
Finger X-Ray-2 views-one hand $163 Knee X-Ray compl-4 view $343
Ankle X-Ray-compl.-3 views $295 Foot X-Ray compl-3 view $255

 

Laboratory Charges______________________________

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

Basic Metabolic Panel $100 BUN $30
CBC $78 Creatine Kinase MB frac $78
Comp Metabolic Panel $190 Creatinine Kinase (CK) $60
    Culture Blood $160
Culture Urine $60 Cyto PAP Smear $83
Hematocrit $25 Hemoglobin $25
Hemoglobin A1C $100 CBC Auto $70
Hepatic Panel $87 Lipid Panel $139
Lytes Panel $55 Magnesium $63
Myoglobin $164 Protime $39
PTT (Partial Prothrombin Time) $71 PSA $96
SED Rate Manual $36 Sensitivity Micro $68
Surgical Pathology Level 4 $331 Troponin Quant $138
TSH (Thyroid Stimulating Hormone) $152 Urinanalysis- with Micro $36
Urinalysis w/out Micro $23 Venipuncture $11

 

* 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.