In compliance with state law, Olean General Hospital is providing this price list containing our room and board, inpatient service, emergency room, operating room, physical therapy and other procedures. The hospital s charges are the same for all patients but total charges and patient s responsibility may vary based on severity, acuity, length of stay and the patient s individual health insurance coverage contract. Average payment is based on the average amount received from all insurers for the services listed. Uninsured or underinsured patients should consult with a hospital Financial Liaison to determine if they qualify for discounts. If you do not find the service you are looking for please contact our Financial Liaison at (716) 375-6080 or email us at billing@uahs.org. Effective July 1, 2018 Room and Board Per Day s Private Semi-Private Medical Surgical Room $ 745.00 $ 695.00 Labor & Delivery $ 798.00 $ 745.00 Nursery $ 500.00 Intensive Care Unit $1,655.00 Sub-Acute Rehabilitation Unit $ 530.00 Psychiatric $ 675.00 Observation Rates Private Semi-Private Medical Observation per hour $ 25.00 Telemetry Observation per hour $ 29.00 1
Inpatient Services The following list reflects the hospitals top 20 Inpatient services, determined by a patient s condition. Average charges include fees for drugs, supplies and additional ancillary services provided. They do not include fees for physicians who treat the patient, interpret radiology exams, pathology specimens or provide anesthesia services. Average Acute Myocardial Infarction $17,961.07 $9,104.10 Alcohol Abuse $4,925.07 $2,931.17 Bipolar Disorders $6,006.91 $3,994.82 Cardiac Arrhythmia $16,234.67 $7,150.79 Cardiac Catheter with Drug eluting stent $43,569.27 $13,339.54 Chronic Obstructive Pulmonary Disease with complication $13,796.93 $5,754.69 Chronic Obstructive Pulmonary Disease with major complication $15,036.66 $6,361.47 Esophagitis, Gastroenteritis without major complication $8,887.75 $4,208.08 Gastro Intestinal Hemorrhage with complication $11,485.77 $5,449.14 Heart Failure & Shock with comorbidity complication $11,430.44 $5,745.79 Heart Failure & Shock with major comorbidity complication $15,829.56 $8,595.90 2
Average Major Joint Replacement (Hip, Knee) $30,065.70 $11,673.91 Normal Newborn Weight >2499g with other problem(s) $2,291.37 $2,324.33 Pneumonia Simple with comorbidity complication(s) $11,064.84 $5,612.91 Pneumonia Simple with major Comorbidity Complication(s) $15,155.81 $7,660.56 Psychoses $7,744.03 $5,897.59 Renal Failure with comorbidity $8,861.04 $5,115.20 complication Septicemia & Disseminated Infections $14,984.49 $ 9,242.30 Septicemia, severe sepsis without Vent assist > 96 hours with major comorbidity Complication $19,958.76 $9,990.90 Septicemia, severe sepsis without Vent assist >96 hours without comorbidity complication $12,136.71 $ 5,816.95 Obstetric Services The following list reflects hospital charges only. Fees for physician services or anesthesia administration are not reflected, and will be billed separately. Cesarean Delivery without complication(s) $8,110.92 $5,414.11 Normal Newborn $1,438.10 $2,633.43 Vaginal Delivery without complication(s) $4,337.79 $3,918.48 3
Emergency Room Services 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 include and average fee for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services. Average Emergency Room Visit Level 1 $453.77 $183.93 Emergency Room Visit Level 2 $617.05 $226.55 Emergency Room Visit Level 3 $1,167.72 $314.34 Emergency Room Visit Level 4 $2,250.97 $533.44 Emergency Room Visit Level 5 $2,973.91 $683.98 Operating Room Services The following list includes averages charges for anesthesia, drugs, and supplies required for particular operating room procedures for our top 15 outpatient surgeries. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately. Average Appendectomy- Laparoscopy $10,153.68 $2,872.03 Catheter- Tunneled/Insertion (Mediport insert) $4,904.97 $2,321.35 Cholecystectomy- Laparoscopy $7,191.58 $2,584.26 Conization with/without D&C $3,015.66 $1,340.53 4
Cystoscopy with stent $5,844.54 $2,676.78 Cystourethroscopy w Lithro $7,238.93 $2,699.08 D&C $3,194.42 $1,358.26 Hemorrhoidectomy $4,101.99 $1,503.72 Hernia Repair (Inguinal-Initial) $5,987.27 $2,445.93 Hernia Repair (Ventral-Initial) $5,883.03 $2,619.39 Hernia Repair Umbilical $4,861.50 $2,127.14 Hysterectomy Laparoscopy (Total) $14,947.30 $ 2,788.18 Hysteroscopy with or without D&C $4,450.94 $1,884.25 Lithotripsy $8,697.43 $ 4,207.39 Tubal Laparoscopy $5,272.59 $2,083.02 Laboratory Services The following list reflects the hospital s 30 most common laboratory procedures: Average Basic Metabolic Panel/Chem 7 $48.50 $11.49 CBC Automated Diff $46.50 $14.50 Chlamydia Trachomatis $152.00 $51.27 Comp Metabolic Profile (CMP) $54.00 $17.85 Culture Aerobic Identify $31.00 $10.83 Culture Bacterial Other Spec $51.50 $13.77 Glycosylated HGB $58.00 $11.95 Hemogram CBC $46.50 $10.55 Lipid Panel $62.00 $21.31 Micro Albumin $35.50 $8.78 5
Average Microbe Susceptibility Studies Mic $23.00 $12.54 Neisseria Gonorrhoeae $152.00 $47.17 Protime $24.00 $6.56 Sedimentation Rate Automated $28.04 $4.95 Thyroid Stimulating Hormone TSH $100.00 $21.68 Thyroxine; Free T4 $54.00 $14.02 Thyroxine; Total $41.50 $10.65 Urinalysis Automated $13.50 $4.66 Urine Creatinine $41.50 $6.10 Urine Culture $48.50 $12.92 Urine Microscopic $13.50 $3.92 Venipuncture (Chg to draw blood) $10.50 $3.33 Vitamin B-12 $76.50 422.22 Vitamin D 25 Hydroxy $212.50 $51.89 HPV High Risk Types $ 119.40 $56.88 Alanine Amino SGPT $32.00 $5.26 Transferase; Aspartate Amino SGOT $31.00 $5.37 Magnesium $40.50 $10.19 Thyroid Hormone T3 Uptake $39.50 $7.89 Thyroglobulin Antibody $95.00 $21.19 Prostate Cancer Screening $78.00 $35.93 Radiology Services The following list reflects the hospital s 30 most common radiological procedures: MRI Brain with w/o Contrast $2,000.00 $504.20 Chest 2 views $155.50 $58.50 CT Thorax w Contrast $1,213.50 $248.10 Cervical Complete $227.25 $82.57 Lumbar Complete $227.25 $69.62 MRI Lumbar Spine w/o Contrast $1,342.50 $345.84 Shoulder 2 View $121.00 $45.98 MRI Any Joint Upper Extremity $1,342.50 $309.19 Knee 3 Views $121.00 $61.10 Ankle, Comp, Min 3 Views $173.00 $63.66 MRI Any Joint Lower Ext $1,342.50 $392.71 Abdomen 1 View AP $155.50 $42.22 CT ABD & Pelvis w/o Contrast $1,501.00 $294.25 6
CT Scan ABD & Pelvis w Contrast $1,715.50 $385.62 Ultrasound Abdominal Complete $713.00 $147.23 Echo Exam of Abdomen $303.30 $151.99 Pelvic/Non Obstetric $336.00 $129.53 Screening Mammogram Bilat with CAD $243.00 $58.03 DXA Bone Density Axial Skelet $287.50 $92.14 Ultrasound Breast Unilat;Complete $229.15 $111.48 US Limited Retroperitoneal $336.50 $95.05 Xray Hip Unilateral 2 Views $152.00 $40.12 Interlaminar Lumbar/Sac w/imag Guid $1,267.50 $420.29 Soft Tissue Head & Neck $336.50 $99.14 Duplex Scan Arteries $451.50 $173.76 CT Thorax w/o Contrast $884.00 Lumbar Complete w/flex min 6view $227.25 MRI Cervical Spine w/o cont $1,342.50 CT Scan Abd & Pelvis with & w/o cont $1,903.00 Pet/CT Tumor Skull-Thigh $3,216.00 Echo Cardio Services The following list reflects the hospital s most common echo cardiovascular procedures: Echocardiogram complete $1,068.18 $330.76 Echocardiogram complete w Contrast $1,137.00 $595.31 Cardiovascular stress test $407.00 $145.70 EKG $143.00 $38.52 Stress Test TEE with EKG Monitoring & Supervision $1,486.00 $444.18 Trans Esophageal Echocardiogram $1,486.03 $566.15 Echocardiogram Limited $626.68 $229.22 7
Respiratory Therapy Services The following charges reflect the most common services offered by our Respiratory Therapy department. Patients may have additional charges, depending on the services performed. Nebulizer Acute Initial treatment $156.50 $114.94 Oximetry Single $31.00 $10.53 Diffusing Capacity / Co2 $155.73 $57.60 Gas Dilution Deter Lung Volume $221.85 Pulmonary Function Test $129.40 $80.57 Physical Therapy Services The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed. Physical Therapy Evaluation Low-Complex $197.50 Gait Training $70.00 $25.21 Neuromuscular Reeducation $81.50 $40.34 Therapeutic Exercise 0-15 minutes $78.00 $41.88 Therapeutic Activities 0-15 minuets $86.00 $27.86 Electrical Stimulation (attended) $39.50 $22.54 15 minutes 8
Occupational Therapy Services The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed. Occupational Therapy Evaluation Low-Com $192.00 $ Therapeutic Activities 0-15 minutes $86.00 $27.86 Therapeutic Exercise 0-15 minutes $80.00 $41.88 ADL Training Self Care Management $86.00 $29.73 Manual Therapy Joint Mobilization $74.00 $23.84 15 minutes each Speech Therapy Services The following charges reflect the most common services offered by our Speech Therapy department. Patients may have additional charges, depending on the services performed. Speech Language Treatment $194.10 $78.06 Swallow Dysfunction Treatment $210.35 $74.48 Clinical Swallow Eval $245.00 $87.99 9