Summa Wadsworth-Rittman Hospital Usual and Customary Charges ...
Summa Wadsworth-Rittman Hospital Usual and Customary Charges ...
Summa Wadsworth-Rittman Hospital Usual and Customary Charges ...
- No tags were found...
Create successful ePaper yourself
Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.
<strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong><strong>Usual</strong> <strong>and</strong> <strong>Customary</strong> <strong>Charges</strong> for Selected ProceduresPatient Price ListIn compliance with state law, <strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong> publishes charges for room <strong>and</strong> board, emergencydepartment, labor <strong>and</strong> delivery, operating room, lab, radiology <strong>and</strong> other procedures. This publication is available upon requestwhen visiting the hospital <strong>and</strong> may be found at http://summahealth.org/patientvisitor/Insurance<strong>and</strong>Billing/patientpricereports.The hospital charges are consistent for all patients. The patient’s responsibility may vary, however, depending on insurancecontracts with individual health insurers. <strong>Summa</strong> Health System offers financial assistance through the Ohio <strong>Hospital</strong> CareAssurance Program, <strong>Summa</strong>’s Charity <strong>and</strong> Uninsured Patient Charity Programs. For information contact Patient FinancialServices at 330-331-1551.These prices are correct as of January 1, 2013.Room <strong>and</strong> Board per Day <strong>Charges</strong>ICU/ER Telemetry $2,479.00Medical/Surgical Semi-Private 1,763.00Medical/Surgical Private 1,808.00Observation 1 st Hr 293.00Observation additional Hr 62.00Intensive Care 4,046.00Emergency Department <strong>Charges</strong>Emergency Department charges are based on the level of emergency care provided to patients. There may be other hospitalcharges related to the emergency room visit (drugs, ancillary services, testing, anesthesia, etc.) Services provided by Emergencyphysicians will be billed by the physicians.Critical Care 2,172.00EKG 12 Lead Cardio 130.00Level 1 347.00Level 2 389.00Level 3 772.00Level 4 1,272.00Level 5 1,618.60Operating Room <strong>Charges</strong>Surgery per minute 74.00Fees for anesthesia administration are not reflected <strong>and</strong> will be billed separately by your physician.General Anesthesia per 15 Min 523.00Block 234.00Local 234.00MAC 234.00Spinal 234.00PACU Recovery per Min 19.00Cardioversion 1,478.00Cardioversion Recover per Min 101.00Page 1 of 5
<strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong><strong>Usual</strong> <strong>and</strong> <strong>Customary</strong> <strong>Charges</strong> for Selected ProceduresPatient Price ListX-Ray <strong>and</strong> Radiological <strong>Charges</strong>The following charges reflect the hospital’s 30 most common x-ray <strong>and</strong> radiological procedures (in alphabetical order).Bone Densitometry 259.00CT ABD Pelvis without Contrast 4,895.00CT ABD Pelvis with Contrast 5,757.00CT Angio Chest with/without Contrast 4,098.00CT C Spine without Contrast 2,198.00CT Head Brain without Contrast 2,146.00Fluoro Guidance Needle 556.00Mammogram Diagnostic or Screening CAD 71.00Mammogram Screening Digital 236.00MRI Brain with/without Contrast 6,315.00MRI L Spine without Contrast 4,898.00XR Pelvis 1-2 V 274.00XR ABD Acute with PA Chest 573.00XR ABD KUB or Erect Decub 347.00XR Ankle 3V 279.00XR Chest 2V Frontal/Lateral 374.00XR Chest Single View 223.00XR C Spine 4-5 V 483.00XR Foot 3 V 279.00XR H<strong>and</strong> 3 V 279.00XR Hip 2 V 236.00XR Knee 4 V Min 357.00XR L Spine 2-3 V 302.00XR L Spine Min 4 V 579.00XR Shoulder Min 2 V 302.00Page 2 of 5
<strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong><strong>Usual</strong> <strong>and</strong> <strong>Customary</strong> <strong>Charges</strong> for Selected ProceduresPatient Price ListLaboratoryThe following charges reflect the hospital’s 30 most common laboratory procedures (in alphabetical order).Bacteria ID Aerobe 81.00Basic Metabolic Panel 201.00BB Crossmatch IS 52.00BNP NT PRO 335.00CBC No Differential 94.00CBC with Differential 114.00Comprehensive Metabolic Panel 278.00Culture Blood 197.00Culture Urine 99.00Gram Stain 58.00HCG Urine Qualitative 160.00Hemoglobin 51.00Hemoglobin A-1-C 148.00Hepatic Function Panel 184.00Lipase 112.00Lipid Profile 213.00Magnesium 91.00Partial Thromboplastin Time (PTT) 151.00Phosphorus 66.00Pro Time 94.00Renal Function Panel 252.00Sensitivity 137.00T4 Free 197.00Thyroid Stimulating Hormone (TSH) 184.00Urinalysis Complete 78.00Urinalysis Dipstick 50.00Vitamin B12 235.00Vitamin D, 25 Hydroxy 518.00Page 3 of 5
<strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong><strong>Usual</strong> <strong>and</strong> <strong>Customary</strong> <strong>Charges</strong> for Selected ProceduresPatient Price ListOccupational or Physical TherapyPT Aquatic Therapy per 15 Min 142.00PT Canalith Reposition 143.00PT Elec Stim Attended 142.00PT Elec Stim Unattended 98.00OT Evaluation 324.00PT Evaluation 324.00PT Func Retaining per 15 Min 158.00PT Gait Training per 15 Min 137.00OT Iontophoresis per 15 Min 138.00OT Manual Therapy per 15 Min 148.00PT Manual Therapy per 15 Min 148.00OT Neuromusc Re-Ed per 15 Min 150.00PT Neuromusc Re-Ed per 15 Min 150.00OT Ortho Check 137.00OT Ortho Mgmt/Training per 15 Min 154.00OT Paraffin 98.00OT Re-Eval 282.00PT Re-Eval 314.00OT Self-Care Training 158.00OT Therapeutic Activity 142.00OT Therapeutic Exercise 150.00PT Therapeutic Exercise 150.00PT Traction 142.00OT Vasopneumatic Devic 369.00OT Ultrasound per 15 Min 142.00PT Ultrasound per 15 Min 142.00OT Whirlpool 216.00PT Whirlpool 216.00Page 4 of 5
<strong>Summa</strong> <strong>Wadsworth</strong>-<strong>Rittman</strong> <strong>Hospital</strong><strong>Usual</strong> <strong>and</strong> <strong>Customary</strong> <strong>Charges</strong> for Selected ProceduresPatient Price ListRespiratory TherapyABG Collection 46.00Aerosol Initial Treatment 123.00Aerosol Subsequent Treatment 123.00CPAP/BIPAP Initial Day 692.00CPAP/BIPAP Subsequent 689.14ET Intubation Emergency 688.00MDI Treatment Initial 123.00MDI Subsequent Treatment 123.00Nocturn Desaturation 448.00Percussion Treatment 94.00PFT Pre/Post 583.00Pulse Oxygen Check 59.00Pulse Oxygen Continuous 448.00Vent Initial IP Only 720.00Vent Subsequent IP Only 617.00Pain Management1 st LVL Facet Bilateral 3,263.002 nd LVL Facet Inj 1,606.002 nd LVL Facet Bilateral 3,127.003 rd & Additional LVL Facet Bilateral 3,211.003 rd & Additional LVL Facet Injection 1,606.00Dest by Neuro Agent Other 1,633.00ESI Inj Cerv/Thoracic 1,632.00ESI Inj Lumbar/Sacral 1,632.00Inj Left Facet Lumbar/Sacral 1,632.00Inj Transfer Facet Lumbar/Sacral 1,331.00Office Visit Established Patient Level 2 272.00Office Visit Established Patient Level 3 313.00Office Visit Established Patient Level 4 442.50Office Visit Established Patient Level 5 586.25SI Block with Guidance 1,632.00<strong>Hospital</strong> Billing PoliciesYour insurance providers, including Medicare, Medicaid, other primary insurance providers <strong>and</strong> secondary insurance providersare billed by <strong>Summa</strong> hospitals before a bill is sent to you. Interest will not be charged on any balance due after insurancepayments are received. If you are not able to pay the amount you owe in full, please contact Patient Financial Services at thephone 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
Change language