Summa Barberton Hospital Patient Price Report - Summa Health ...

Summa Barberton Hospital
Usual and Customary Charges for Selected Procedures
Patient Price List
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 http://summahealth.org/patientvisitor/InsuranceandBilling/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 a financial counselor at 330-615-4064 or 330-615-
3234. Financial assistance forms are available at www.myhospitalservices.com/barberton
These prices are correct as of January 1, 2013.
Room and Board per Day Charges
Medical/Surgical Semi-Private or Private $1,938.00
CCU/ICU Semi-Private 1,938.00
CCU/ICU Private 4,449.00
Family Centered Maternity Care Daily 1,795.00
Nursery Daily (Routine) 1,014.00
Nursery Daily (Boarder) 1,105.00
Psychiatric Daily 1,479.00
Skilled Nursing Daily 550.00
Labor and Delivery Charges
Cesarean Section 4,457.00
Fetal Monitor hourly 55.00
Fetal Non-Stress Test 485.00
Vaginal Delivery 3,187.00
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 1 462.00
Level 2 619.00
Level 3 1,091.00
Level 4 1,976.00
Level 5 2,676.00
Immunization Admin A vaccine 293.00
Injection IM SC 323.00
IV Therapy 1 st Hour 347.00
Minor Procedures 563.00
Page 1 of 5

Summa Barberton Hospital
Usual and Customary Charges for Selected Procedures
Patient Price List
Operating Room Charges
Level 1 Basic 1,967.00
Level 2 Basic 4,038.00
Level 3 Basic 6,168.00
Level 4 Basic 9,777.00
Level 1 per minute 26.00
Level 2 per minute 38.00
Level 3 per minute 45.00
Level 4 per minute 55.00
Lens Intra-Ocular 1,085.00
Stapler Surgical Clip s/m/l 604.00
Anesthesia Supplies General 1,282.00
Anesthesia Supplies MAC 538.00
Page 2 of 5

Summa Barberton Hospital
Usual and Customary Charges for Selected Procedures
Patient Price List
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 537.00
CT ABD with Contrast 3,057.00
CT ABD without Contrast 2,310.00
CT Chest with Contrast 3,187.00
CT Head without Contrast 1,820.00
CT Pelvis with Contrast 3,160.00
CT Pelvis without Contrast 2,974.00
Fluoro Inj Procedure Additional 1,381.00
Mammogram Diagnostic 406.00
Mammogram Screening 312.00
MRI Lumbar without Contrast 5,216.00
Ultrasound ABD Complete 1,678.00
Ultrasound Renal Limited 1,169.00
Ultrasound Transvaginal 1,062.00
XR ABD Acute 833.00
XR ABD Multiple 462.00
XR ABD Single 386.00
XR Ankle 3V 390.00
XR Chest PA & Lateral 453.00
XR Chest PA 311.00
XR Foot 3 V 390.00
XR Hand 3 V 390.00
XR Hip 293.00
XR Knee Complete 325.00
XR Pelvis AP 338.00
XR Shoulder 390.00
XR Spine Cervical Complete 653.00
XR Spine Lumbar Anterior/Posterior & Lateral 512.00
Page 3 of 5

Summa Barberton Hospital
Usual and Customary Charges for Selected Procedures
Patient Price List
Laboratory
The following charges reflect the hospital’s 30 most common laboratory procedures (in alphabetical order).
ABG with cal O2 Sat 265.00
ABO type 103.00
Aerobic Organism ID 58.00
Basic Metabolic Panel 213.00
Bilirubin Total 81.00
CBC Platelet Auto Differential 107.00
CBC No Differential 107.00
CK-MB 265.00
Comprehensive Metabolic Panel 329.00
Creatine Kinase (CK, CPK) 73.00
Culture Blood 379.00
Culture with Presumptive ID 191.00
Glucose Blood Meter 97.00
Gram Stain 58.00
Lipase 195.00
Lipid Panel 254.00
Magnesium 81.00
PAP TCSC NORSC PHINT TH 79.00
Partial Thromboplastin Time (PTT) 171.00
Pro Time 110.00
RH type 87.00
Surgical Path Level 3 166.00
Surgical Path Level 4 244.00
Susceptibility – Mic 79.00
Thyroid Stimulating Hormone (TSH) 174.00
Troponin Quantitative 228.00
Urinalysis with Micro Auto 129.00
Venipuncture 36.00
Page 4 of 5

Summa Barberton Hospital
Usual and Customary Charges for Selected Procedures
Patient Price List
Occupational or Physical Therapy
OT Com/Wrk Int per 15 Min 137.00
OT Evaluation 300.00
PT Evaluation 300.00
PT Gait Training per 15 Min 112.00
OT Group Therapy 189.00
PT Massage per 15 Min 126.00
OT Massage per 15 Min 126.00
PT Neuromusc Re-Ed per 15 Min 130.00
OT Ortho Fit/Training per 15 Min 158.00
OT Re-Eval 205.00
PT Re-Eval 205.00
OT Self-Care Training per 15 Min 137.00
PT Therapeutic Activity per 15 Min 137.00
OT Therapeutic Exercise per 15 Min 137.00
PT Ultrasound per 15 Min 98.00
PT Wheelchair per 15 Min 118.00
PT Whirlpool 106.00
Respiratory Therapy
Arterial Puncture 78.00
Daily Oxygen 324.00
Inhalation Initial Treatment 103.00
Noninvasive Ear or Pulse 90.00
Vent Mgmt Subsequent 1,184.00
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.
You may also find helpful consumer information at http://www.ohiohealthcareguide.org/.
Page 5 of 5