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.