Summa Akron City and St. Thomas Hospitals Usual and Customary ...

Summa Akron City and St. Thomas Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
In compliance with state law, Summa Akron City and St. Thomas Hospitals 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 http://summahealth.org/home/patientvisirot/patientpricereports.
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 Patient Financial
Services at 330.996.8505.
These prices are correct as of January 1, 2012.
Room and Board per Day Charges
Medical/Surgical Semi-Private $1,869.00 Nursery 1,430.50
Chemical Dependency/Detox/Psychiatry 1,869.00 Perinatal 2,728.25
Oncology 1,899.25 Step Down 4,047.00
Medical/Surgical Private 1,933.50 Coronary/Intensive Care 9,242.75
Labor and Delivery Charges
Labor Room First Hr 450.75 OB OR Level 1: First 30 Min 1,876.00
Labor Room each additional Hr 225.50 OB OR Level 2: First 30 Min 3,643.75
Labor/Delivery Unit 384.75 OB OR Level 3: First 30 Min 5,377.25
Birthing Room First Hr 3,972.75 OB OR Level 1 or 2: each additional 15 Min 190.75
Birthing Room each additional Hr 338.50 OB OR Level 3: each additional 15 Min 296.00
Birthing Room High Risk First 30 Min 4,448.75 OB PACU First 30 Min 338.50
Birthing Room High Risk each additional 15 Min 87.75 OB PACU each additional 15 Min 75.25
Delivery Room First 30 Min 4,198.00 Circumcision Newborn 313.25
Delivery Room each additional 15 Min 87.75 Fetal Non-Stress 430.25
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 1 333.50 Critical Care Initial 4,101.25
Level 2 481.75 Critical Care Additional 1,305.00
Level 3 848.75 Stroke Team 4,101.25
Level 4 1,487.25 Trauma Team Activation with CC 6,600.25
Level 5 2,195.75
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Summa Akron City and St. Thomas Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
Operating Room Charges
Operating Room charges are based on the number of staff in the room for each 15 minutes of operating room time and are billed
in surgical resource units. For example 4 operating room staff members for a one hour surgery = 16 surgical resource units (4
people x 60 minutes / 15 minutes = 16).
Fees for the services of a surgeon are not reflected and will be billed separately by your physician.
Surgical Resource Unit $ 365.25
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.
General ASA 1 First 30 Min 706.00 Spinal ASA 4 First 30 Min 600.00
General ASA 2 First 30 Min 776.25 Spinal ASA 5 First 30 Min 660.25
General ASA 3 First 30 Min 854.25 Regional ASA 1 First 30 Min 368.25
General ASA 4 First 30 Min 939.75 Regional ASA 2 First 30 Min 405.00
General ASA 5 First 30 Min 1,033.50 Regional ASA 3 First 30 Min 445.25
Epidural ASA 1 First 30 Min 562.25 Regional ASA 4 First 30 Min 490.00
Epidural ASA 2 First 30 Min 618.50 Regional ASA 5 First 30 Min 538.75
Epidural ASA 3 First 30 Min 680.75 MAC ASA 1 First 30 Min 248.25
Epidural ASA 4 First 30 Min 748.50 MAC ASA 2 First 30 Min 273.00
Epidural ASA 5 First 30 Min 823.50 MAC ASA 3 First 30 Min 300.75
Spinal ASA 1 First 30 Min 450.75 MAC ASA 4 First 30 Min 330.50
Spinal ASA 2 First 30 Min 495.50 MAC ASA 5 First 30 Min 363.50
Spinal ASA 3 First 30 Min 545.50 each additional 15 Min all anesthesia 46.50
X-Ray and Radiological Charges
The following charges reflect the hospital’s 30 most common x-ray and radiological procedures (in alphabetical order).
CAD Diagnostic Mammography 72.75 Ultrasound Abdomen Limited with image docum 833.25
CAD Screening Mammography 72.75 Ultrasound Guidance for Needle Placement 1,042.25
CT Abdomen Pelvis with Contrast 3,780.00 Ultrasound Retroperitoneal Limited 877.50
CT Abdomen Pelvis without Contrast 3,240.00 XR Abdomen Acute Series 651.75
CT Cerv Spine without Contrast 2,366.25 XR Abdomen Complete incl Decubitus 651.75
CT Head Brain without Contrast 2,366.25 XR Abdomen Single AP View 315.00
CT Thorax with Contrast 2,695.50 XR Ankle 3+ Views 665.25
CT Thorax without Contrast 2,366.25 XR Chest 1 View Front 370.50
CT Thorax with/without Contrast 3,953.75 XR Chest PA & Lateral 438.50
Diagnostic Mammogram Bilateral w/digital image 447.75 XR Foot 3+ Views 665.25
ECHO Brst(s) with image 589.00 XR Hand 3+ Views 443.50
MRA Head without Contrast 3,373.75 XR Knee Complete 4+ Views 762.50
MRI Brain with/without Contrast 5,828.25 XR Shoulder 2+ Views 407.75
MRI Brain without Contrast 4,023.75 XR Spine L-S (2-3 Views) 643.50
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Summa Akron City and St. Thomas Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
Screening Mammogram Bilateral w/digital image 283.25 XR Swallowing Function with video 1,133.50
Laboratory Charges
The following charges reflect the hospital’s 30 most common laboratory procedures (in alphabetical order).
Albumin 97.75 Hemoblobin A-1-C 157.00
Antibody Screen 205.50 Hemogram w/Auto Diff 102.75
Antimicrobial Susceptability 126.25 Hemogram Plt Auto 102.75
AST (SGOT) 85.75 Hepatic Function Panel 157.00
Basic Metabolic Panel 159.75 Lipase 165.75
Blood Gas Arterial 320.00 Lipid Panel 193.25
Blood Typing ABO 101.00 Magnesium 92.25
Blood Typing RH 95.00 Phosphorus 72.50
Comprehensive Metabolic Panel 216.75 ProTime 75.50
Crossmatch 180.75 Partial Thromboplastin Time (PTT) 108.50
Culture Blood 370.25 Surgical Pathology Level IV 313.50
Culture Urine 181.00 Thyroid Stimulating Hormone(TSH) 146.25
Glucose by Meter 90.25 Troponin I, Quantitative 227.75
Hematocrit 51.25 Urinalysis Routine (Macroscopic) 66.75
Hemoglobin 51.25 Urinalysis Routine (Microscopic) 28.25
Occupational or Physical Therapy
Check Pros/Ort per 15 Min 147.75 Therapeutic Exercise per 15 Min 196.25
Cognitive Training per 15 Min 125.75 Therapeutic Manipulative Therapy per 15 Min 163.25
Evaluation and Report 355.25 Therapeutic Procedure Neuro per 15 Min 154.00
Gait Training per 15 Min 147.50 Therapeutic Procedure per 15 Min 170.00
Re-evaluation 295.25 Wheelchair Management per 15 Min 125.75
Self/Home Management per 15 Min 137.50
Pulmonary Therapy
ABG Analysis 320.00 O2 Uptake; Indirect/Rest 822.50
Art Pun Withdraw Blood Dx 663.75 O2 Uptake; with CO2 and Exercise 816.75
Bronchoprovocation 2,215.00 Office visit established patient Level 1 119.00
Determine Resistance to Airflow 445.25 Plethysmog Trace Only 553.00
Evaluation Bronchospasm 706.00 Pulse OX; Mult Det with Exercise 130.25
Function Residual Capacity 505.75 Pulse OX; Single Determin 213.50
Maldisribution of vent 445.25 Spirogram 450.00
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.
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Summa Akron City and St. Thomas Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
You may also find helpful consumer information at http://www.ohiohealthcareguide.org/.
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