Patient Price Information List

Transcription

1 Patient Price Information List In compliance with state law, Aultman Hospital is providing this price list containing our charges for room and board, emergency department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our admitting and billing staff to determine whether they qualify for discounts. These prices are correct as of 1/1/2018. Room and Board -- Per Day Charges Medical - Surgical Private Regular $ Intensive Care Private 1:1 Nursing Care (within any ICU) $3, MICU, SICU, CCU, Cardiac SICU $2, ICU Stepdown (Mem 4E/Mem 4S) $1, CCU Stepdown (Mem 3E) $1, CSICU Stepdown $1, Pediatrics Private Pediatric Stepdown $1, Regular $ Obstetrics Private Obstetric ICU $2, Obstetric Stepdown $1, Regular $ Psychiatric Private ICU $1, Regular $ Level III Neonatal Intensive Care Private Acute $7, Intermediate $4, Convalescent $3, Newborn Care $ Transitional Care Private $1, Rehabilitation Private $1,863.00

2 Observation Status Per Hour Regular $42.00 Monitored $76.00 Labor and Delivery Charges The following list does not include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician. Caesarean Section $4, Circumcision $ Labor Induction $1, Tubal Ligation $4, Vaginal Delivery $3, Anesthesia Physician Fee information may be obtained from: Ohio Hospital Based Physicians 2600 Sixth Street S.W. Canton, Ohio 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 fees for Emergency Department physicians, who will bill separately for their services. Level 1 Services $ Level 2 Services $ Level 3 Services $ Level 4 Services $ Level 5 Services $1, Critical Care $1, Trauma Care $3, Emergency Physician fee information may be obtained from: Canton Aultman Emergency Physicians P.O. Box Cleveland, OH 44101

3 Operating Room Charges Operating Room charges are based on the complexity level, with level 1 being the most basic, for a particular operation There is an initial, set-up charge as well as an additional charge for each minute while the operation is being performed. MAIN OR Level 1 Initial Set-up $1, Level 1 Per Minute $28.00 Level 2 Initial Set-up $2, Level 2 Per Minute $32.00 Level 3 Initial Set-up $2, Level 3 Per Minute $41.00 Level 4 Initial Set-up $3, Level 4 Per Minute $43.00 Level 5 Initial Set-up $3, Level 5 Per Minute $53.00 Level 6 Initial Set-up $8, Level 6 Per Min $62.00 Level 7 Initial Set-up $10, Level 7 Per Min $76.00 HYBRID OR Level 2 Initial Set-up $2, Level 2 Per Minute $44.00 Level 3 Initial Set-up $3, Level 3 Per Minute $56.00 Level 4 Initial Set-up $4, Level 4 Per Minute $59.00 Level 5 Initial Set-up $5, Level 5 Per Minute $72.00 Level 6 Initial Set-up $11, Level 6 Per Min $84.00 Level 7 Initial Set-up $14, Level 7 Per Min $ Physical Therapy Charges The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed. Exercise $89.00 Evaluation High Complexity $ Evaluation Moderate Complexity $209.00

4 Evaluation Low Complexity $ Aquatic Therapy $96.00 Neuromuscular Re-education $70.00 Ultrasound $83.00 Manual Therapy per 15 min $96.00 Occupational Therapy Charges The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed. Manual Therapy per 15 min $96.00 Functional Activity $70.00 Exercise $89.00 Evaluation High Complexity $ Evaluation Moderate Complexity $ Evaluation Low Complexity $ Neuromuscular Re-education $70.00 Fluidotherapy $87.00 Pulmonary Therapy Charges The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed. Aerosol Broncho Treatment $ Oxygen Admin/Day $35.00 Metered Dose Inhaler Treatment $ Blood Gas Draw $65.00 Lung Physiotherapy $ X-Ray and Radiological Charges The following charges reflect the hospital's most common x-ray and radiological procedures. CT brain $ MRI brain $1, MRI brain w&w/o contrast $2, Chest x-ray 1 view $ Chest x-ray 2 views $ CT chest w/o contrast $1, CT chest with contrast $1, CTA chest w&w/o contrast $1, Lumbar spine x-ray 2/3 views $ CT cervial w/o contrast $1,005.00

5 Pelvis x-ray 1/2 views $ Foot x-ray complete RT $ Abdomen x-ray anteroposterior $ Abdomen x-ray $ CT abd/pelvis w/o contrast $1, CT abd/pelvis w/ contrast $2, US abdomen real time; complete $ Echo abdomen limited $ US retroperitoneal complete $ OB US <14 wks single fetus $ OB US >/= 14 wks, single fetus $ OB US follow up per fetus $ Echo transvaginal OB $ Fetal BPP w/o NST $ Echo transvaginal NON OB $ US pelvis NON OB complete $ Mammo screen bilateral digital with CAD $ Tomosynthesis Screen $74.00 Bone desnitometry skeletal $ Foot x-ray complete LT $ MRI lumbar spine $1, Radiologist fee information may be obtained from: Radiology Associates 4974 Higbee Avenue N.W. Canton, Ohio Laboratory Charges The following charges reflect the hospital's most common laboratory procedures. ABO Blood Typing $36.00 Antibody Screen $65.00 APTT (P. thrombin time) $45.00 Vitamin D Hydroxy $99.00 Lactic Acid $77.00 CBC-w differential $68.00 Lipase serum $51.00 Natriuretic peptide $ Culture blood $ Prostatic antigen $78.00 Glycosylated hemoglob $76.00 Hematocrit $21.00 Hemoglobin $20.00 Magnesium, serum $49.00

6 Sensitivity Antibiotic $83.00 Panel basic metabolic $78.00 Panel blood gas $ Panel comp metabolic $ Panel Lipid $83.00 Pap smear liquid based $94.00 Phosphorus, serum $36.00 Potassium, serum $33.00 Prothrombin time $31.00 RH type $37.00 C. trachomatis $ Sur path level 4 $ Troponin I $89.00 TSH thyroid stim $99.00 Urinalysis auto w/microscope $38.00 Urine culture $90.00 Pathologist fee information may be obtained from: Pathology Associates 2300 Wales Avenue Massillon, Ohio Hospital Billing Policies Patients may call for customer service. Financial counselors are on staff to help with availability of financial assistance, discounts, and interest free extended payment plans. Consumers can access a number of government and private Websites, which provide additional information on hospitals' charges and quality. For a complete listing of available online resources, please visit the Consumer's Guide to Quality Health Care in Ohio at