Summa Barberton Hospital Usual and Customary Charges for Selected Procedures Patient Price List

Transcription

1 In compliance with state law, Summa Barberton Hospital publishes charges for room and board, emergency department, labor and delivery, operating room, lab, radiology and other procedures. This publication is available upon request when visiting the hospital and may be found at The hospital charges are consistent for all patients. The patient s responsibility may vary, however, depending on insurance contracts with individual health insurers. Summa Health System offers financial assistance through the Ohio Hospital Care Assurance Program, Summa s Charity and Uninsured Patient Charity Programs. For information contact a financial counselor at or Financial assistance forms are available at These prices are correct as of January 1, Room and Board per Day Charges Medical/Surgical Semi-Private or Private $2, CCU/ICU Semi-Private 2, CCU/ICU Private 4, Family Centered Maternity Care Daily 1, Nursery Daily (Routine) 1, Nursery Daily (Boarder) 1, Psychiatric Daily 1, Skilled Nursing Daily NA Labor and Delivery Charges Cesarean Section 4, Fetal Monitor hourly Fetal Non-Stress Test Vaginal Delivery 3, Emergency Department Charges Emergency Department charges are based on the level of emergency care provided to patients. There may be other hospital charges related to the emergency room visit (drugs, ancillary services, testing, anesthesia, etc.) Services provided by Emergency physicians will be billed by the physicians. Level Level Level 3 1, Level 4 2, Level 5 2, Immunization Admin A vaccine Injection IM SC IV Therapy 1 st Hour Minor Procedures Page 1 of 5

2 Operating Room Charges Level 1 Basic Level 2 Basic 4, Level 3 Basic 6, Level 4 Basic 10, Level 1 per minute Level 2 per minute Level 3 per minute Level 4 per minute Lens Intra-Ocular 1, Stapler Surgical Clip s/m/l Anesthesia Supplies General 1, Anesthesia Supplies MAC Page 2 of 5

3 X-Ray and Radiological Charges The following charges reflect the hospital s 30 most common x-ray and radiological procedures (in alphabetical order). Bone Densitometry DXA Axial CT ABD with Contrast 3, CT ABD without Contrast 2, CT Chest with Contrast 3, CT Head without Contrast 1, CT Pelvis with Contrast 3, CT Pelvis without Contrast 3, Fluoro Inj Procedure Additional 1, Mammogram Diagnostic Mammogram Screening MRI Lumbar without Contrast 5, Ultrasound ABD Complete 1, Ultrasound Renal Limited 1, Ultrasound Transvaginal 1, XR ABD Acute XR ABD Multiple XR ABD Single XR Ankle 3V XR Chest PA & Lateral XR Chest PA XR Foot 3 V XR Hand 3 V XR Hip XR Knee Complete XR Pelvis AP XR Shoulder XR Spine Cervical Complete XR Spine Lumbar Anterior/Posterior & Lateral Page 3 of 5

4 Laboratory The following charges reflect the hospital s 30 most common laboratory procedures (in alphabetical order). ABG with cal O2 Sat ABO type Aerobic Organism ID Basic Metabolic Panel Bilirubin Total CBC Platelet Auto Differential CBC No Differential CK-MB Comprehensive Metabolic Panel Creatine Kinase (CK, CPK) Culture Blood Culture with Presumptive ID Glucose Blood Meter Gram Stain Lipase Lipid Panel Magnesium PAP TCSC NORSC PHINT TH Partial Thromboplastin Time (PTT) Pro Time RH type Surgical Path Level Surgical Path Level Susceptibility Mic Thyroid Stimulating Hormone (TSH) Troponin Quantitative Urinalysis with Micro Auto Venipuncture Page 4 of 5

5 Occupational or Physical Therapy OT Com/Wrk Int per 15 Min OT Evaluation PT Evaluation PT Gait Training per 15 Min OT Group Therapy PT Massage per 15 Min OT Massage per 15 Min PT Neuromusc Re-Ed per 15 Min OT Ortho Fit/Training per 15 Min OT Re-Eval PT Re-Eval OT Self-Care Training per 15 Min PT Therapeutic Activity per 15 Min OT Therapeutic Exercise per 15 Min PT Ultrasound per 15 Min PT Wheelchair per 15 Min PT Whirlpool Respiratory Therapy Arterial Puncture Daily Oxygen Inhalation Initial Treatment Noninvasive Ear or Pulse Vent Mgmt Subsequent 1, Hospital Billing Policies Your insurance providers, including Medicare, Medicaid, other primary insurance providers and secondary insurance providers are billed by Summa hospitals before a bill is sent to you. Interest will not be charged on any balance due after insurance payments are received. If you are not able to pay the amount you owe in full, please contact Patient Financial Services at the phone number noted on your bill to apply for financial assistance or arrange for a payment plan. Emergency services are neither delayed nor withheld on the basis of a patient s ability to pay. You may also find helpful consumer information at Page 5 of 5