Charges for Select Hospital Services

Charges effective January 1, 2016

Room and Board - Per Day Charges

Med/Surg Semi Private $1,756
Med/Surg Private $1,789
ICU $3,881

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 $284
Level 2 $452
Level 3 $746
Level 4 $1,222
Level 5 $1,974
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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 $2,130 Level 1 - each additional 15 mins $899
Level 2 - 30 mins $2,600 Level 2 - each additional 15 mins $1,036
Level 3 - 30 mins $3,001 Level 3 - each additional 15 mins $1,175
Level 4 - 30 mins $3,272 Level 4 - each additional 15 mins $1,313
    
Recovery Phase I - 30 mins

$554

 Phase I - each additional 15 mins

$210
Recovery Phase II - 30 mins

$346 Phase II - each additional 15 mins

$141

Observation Status

Initial Hour $704
Each Additional Hour $44
R+B Oncology $2,696
R+B Detox $1,756
R+B Step Down $2,835

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 $272
Inhalation Treatment $325
Occupational Therapy Evaluation $427
Physical Therapy Evaluation $335
Physical Therapy - 15 mins $181
Gait Training - 15 mins $124

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 $1,724 Chest X-Ray 1 view $290
CT Head/Brain w & without contrast $2,623 Chest X-Ray 2 views $359
CT Sinuses/Facial $1,744 Lumbar Spine 1 view $288
CT Pelvis with contrast $2,210 Lumbar Spine 3 views $439
CT Thorax with contrast $1,769 Lumbar Spine-obliques $719
CT Abdomen with /contrast $2,517 Modified Barium Swallow $727
MRI Brain w & without contrast $6,440 Abdomen X-Ray-3 views $364
Thoracic Spine X-Ray 3 views $394 Abdomen X-Ray-Compl $593
Cervical Spine X-Ray 2-3 views $367 Bone Density Study $534
Cervical Spine X-Ray 4 view min. $485 Shoulder X-Ray $353
Screening Mammogram-bilateral $534 Elbow X-Ray-3 views $296
Diagnostic Mammogram-bilateral $651 Wrist X-RAY-3 views $377
Hand X-Ray $346 Hip X-Ray compl.-1 view $278
Finger X-Ray-2 views-one hand $205 Knee X-Ray compl-4 view $430
Ankle X-Ray-compl.-3 views $371 Foot X-Ray compl-3 view $319

Laboratory Charges

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

Basic Metabolic Panel $126 BUN $39
CBC $90 Creatine Kinase MB frac $99
CBC Platelet Auto Diff $99  
Comp Metabolic Panel $240 Creatine Kinase (CK) $77
Creatine Bld $49 Culture Blood $201
Culture Urine $77 Cyto PAP Smear $105
Hematocrit $33 Hemoglobin $32
Hemoglobin A1C $126 CBC Auto $90
Hepatic Panel $111 Lipid Panel $176
Lytes Panel $72 Magnesium $80
Myoglobin $208 Protime $51
PTT (Partial Prothrombin Time) $91 PSA $122
SED Rate Manual $47 Sensitivity Micro $87
Surgical Pathology Level 4 $416 Troponin Quant $174
TSH (Thyroid Stimulating Hormone) $192 Urinanalysis- with Micro $47
Urinalysis w/out Micro $30 Venipuncture $16

* 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.

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