Summa Wadsworth-Rittman Hospital Usual and Customary Charges ...

More documents

Recommendations

Info

Summa Wadsworth-Rittman HospitalUsual and Customary Charges 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
Summa Wadsworth-Rittman HospitalUsual and Customary Charges 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 1,632.00Hospital Billing PoliciesYour insurance providers, including Medicare, Medicaid, other primary insurance providers and secondary insurance providersare billed by Summa 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
Page 1 and 2: Summa Wadsworth-Rittman HospitalUsu
Page 3: Summa Wadsworth-Rittman HospitalUsu

Summa Wadsworth-Rittman Hospital Usual and Customary Charges ...

Create successful ePaper yourself

Delete template?

Save as template?