Summa Akron City, St. Thomas and Barberton Hospitals Usual and Customary Charges for Selected Procedures Patient Price List
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1 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your Room and Board per Day Charges MEDICAL/SURGICAL SEMI-PRIVATE 2, CHEMICAL DEPENDENCY/DETOX/PSYCHIATRY 2, ONCOLOGY 2, MEDICAL/SURGICAL PRIVATE 2, NURSERY 2, PERINATAL 4, TELEMETRY 5, ICU STEP DOWN 9, CORONARY/INTENSIVE CARE 13, 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. LABOR ROOM FIRST HR LABOR ROOM EA ADD HR LABOR/DELIVERY UNIT BIRTHING ROOM FIRST HR 5, BIRTH RM HIGH RISK 1ST 30 MIN 5, BIRTH RM HIGH RISK EA ADD 15 MIN DELIVERY RM 1ST 30 MIN 5, DELIVERY RM EA ADD 15 MIN OB OR LEVEL 1: 1ST 30 MIN 2, OB OR LEVEL 2: 1ST 30 MIN 5, OB OR LEVEL 3: 1ST 30 MIN 7, OB OR LEVEL 1 or 2: EA ADD 15M OB OR LEVEL 3: EA ADD 15M OB PACU - 1ST 30 MIN OB PACU - ADD 15 MIN CIRCUMCISION W/REGIONL BLOCK FETAL NON-STRESS TEST
2 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your 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.). s provided by Emergency physicians will be billed by the physicians. LEVEL 1 EMERGENCY EXAM LEVEL 2 EMERGENCY EXAM LEVEL 3 EMERGENCY EXAM 1, LEVEL 4 EMERGENCY EXAM 2, LEVEL 5 EMERGENCY EXAM 3, CRITICAL CARE 1ST HOUR 5, CRITICAL CARE ADDL 30 MIN 1, PRE-NOTIFY TRAUMA EVAL W/CC 7, PRE-NOTIFY TRAUMA ACT W/CC 12, Operating Room Charges LEVEL 1 ROOM OPEN 2, LEVEL 2 ROOM OPEN 4, LEVEL 3 ROOM OPEN 5, LEVEL 4 ROOM OPEN 12, LEVEL 1 PER MINUTE LEVEL 2 PER MINUTE LEVEL 3 PER MINUTE LEVEL 4 PER MINUTE 87.00
3 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your Anesthesia Charges Anesthesia charges are a function of the type of anesthesia and the level of risk for the patient based on the patient's overall health and risk for complications. Fees for anesthesia administration are not reflected and will be billed separately by your physician. ANES-EPIDURAL ASA 1-1ST 30M ANES-EPIDURAL ASA 2-1ST 30M ANES-EPIDURAL ASA 3-1ST 30M ANES-EPIDURAL ASA 4-1ST 30M 1, ANES-EPIDURAL ASA 5-1ST 30M 1, ANES-GENERAL ASA 1-1ST 30 MN 1, ANES-GENERAL ASA 2-1ST 30 MN 1, ANES-GENERAL ASA 3-1ST 30 MN 1, ANES-GENERAL ASA 4-1ST 30 MN 1, ANES-GENERAL ASA 5-1ST 30 MN 1, ANES-MAC ASA 1 - FIRST 30 MIN ANES-MAC ASA 2 - FIRST 30 MIN ANES-MAC ASA 3 - FIRST 30 MIN ANES-MAC ASA 4 - FIRST 30 MIN ANES-MAC ASA 5 - FIRST 30 MIN ANES-REGIONAL ASA 1-1ST 30MN ANES-REGIONAL ASA 2-1ST 30MN ANES-REGIONAL ASA 3-1ST 30MN ANES-REGIONAL ASA 4-1ST 30MN ANES-REGIONAL ASA 5-1ST 30MN ANES-SPINAL ASA 1-1ST 30M ANES-SPINAL ASA 2-1ST 30M ANES-SPINAL ASA 3-1ST 30M ANES-SPINAL ASA 4-1ST 30M ANES-SPINAL ASA 5-1ST 30M ANES-EA ADD 15M 68.50
4 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your X-Ray and Radiological Charges The following charges reflect some of the hospital s most common x-ray and radiological procedures. BNE AND OR JT IMAG WHOLE BODY 3, CT ABD/PELV W CONT 3, CT ABD/PELV WO CONT 3, CT CERV SPINE WO CONT 2, CT HEAD/BRAIN WO CONT 2, CT THORAX W CONT 2, CTA CHEST W/WO CONT 4, DX MAMMO INCL CAD UNI DXA BONE DEN 1+ SITES AXIAL 1, ECG STRESS 2, FLUORO GUIDE NEEDLE PLCMT 1, HEPATOBILI DUCT IMAG INCL GB 3, MRA HEAD WO CONT 3, MRI ANY JT LOW EXT W/CONT 4, MRI BRAIN W/WO CONT 6, SCR MAMMO BI INCL CAD MYOCARD PERF IMAG SPECT MX 6, PET CT SKULL THIGH 8, US ABD W IMAGE DOC COMPLT 2, US ABD W IMAGE DOC LTD 1, US BREAST LIMITED US GUID NDL PLCMT IMAG S/I 1, US PELVIC W/DOCUMN COMPLT 1, US PREG 1ST TRIM TA APP SING US PREG TRANSVAGINAL 1, ULTRASOUND TRANSVAGINAL 1, ABDOMEN 1 VIEW ABDOMEN 2 VIEWS ABDOMEN 3+ VIEWS 1, X-RAY CHEST 1 VIEW X-RAY CHEST 2 VIEWS X-RAY CHEST 3 VIEWS 1, X-RAY CHEST 4 OR MORE VIEWS 1,319.75
5 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your Laboratory The following charges reflect some of the hospital s most common laboratory procedures. ALLERG SP-IGE QUAN OR SEMIQUAN APTT AUTOM URINALYSIS WO MICRO BACT CULT-URINE QUAN COUNT BASIC METABOLIC PANEL BLOOD TYPING- ABO BLOOD TYPING-RH D CHLAM TRACH AMP PROBE COMPL AUTOM CBC W PLT COMPL CBC W PLT W AUTOM DIFF DRUG SCRN QUANT ALCOHOLS COMPREHENSIVE MET PANEL FERRITIN GLUCOSE; BLD BY MONITOR DEVICE HEMOGLOBIN A-1-C HEPATIC FUNCTION IRON LIPASE LIPID PANEL MAGNESIUM NEISSERIA AMPLIF NA PROBE PROTHROMBIN TIME RBC AB SCRN EA TECHIQ SURG PATH LEVEL IV TROPONIN QUANT TSH URINALYSIS COMPLETE URINALYSIS MICROSCOPIC ONLY URINE PREGNANCY VISUAL COLOR VITAMIN B-12 LEVEL
6 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your Occupational or Physical Therapy The following charges reflect the most common services offered by our Occupational Therapy and Physical Therapy departments. Patients may have additional charges, depending on the services performed. APPLY FINGER SPLINT-STATIC APP SHRT ARM SPLINT STATIC OT EVAL LOW COMPLEX 30 MIN OT RE-EVAL EST PLAN CARE OT TX MAN THER TECH Q OT TX PROC Q OT WHIRLPOOL THERAPY PT E STIM UNAT PT EVAL LOW COMPLEX 20 MIN PT RE-EVAL EST PLAN CARE PT TX ACTIVE FUNCT Q PT TX MAN THER TECH Q PT TX PROC NEURO Q PT TX PROC Q PT TRACT MECH PT US Q
7 Patient List Programs. For information contact Patient Financial s at pay the amount you owe in full, please contact Patient Financial s at the phone number noted on your Pulmonary Therapy The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services provided. ARTERIAL PUNCTURE BLOOD FOR DX 1, BEHAV CHNG SMOKING 3-10 MIN BEHAV CHNG SMOKING >10 MIN BLOOD GAS MIXED WO O2 SAT BRONCHOPROVOCATION 4, BRONCHOSPASM-PRE & POST BD CHEST PT; SUBSEQUENT C0 DIFFUSE CAPACITY CO EXPIRED GAS BY IR EVALUATE PT USE OF INHALER HAST W/REPORT INTUBATION EMERG PROC 2, POS AIRWAY PRESSURE CPAP 1, POTASSIUM PULM FUNCT TST BY GAS FRC/RV 1, PULM FUNCT TST PLETH FRC/RV 1, PULSE OX; MULT DET W/EX PULSE OX SGL W/PROCEDURE ONLY SPIROMETRY VENT MGMT INPT/OBS 1ST DAY-INV 3, VENT MGMT INPT/OBS SUBQ DAY-INV 2,183.25
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