Patient Price Information List

[Pages:5]Patient Price Information List

In compliance with state law, Wooster Community Hospital is providing this price list conatining our charges for room and board, emergency department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our registration and billing staff to determine whether they qualify for discounts. These prices are correct as of 1/1/2020

Progressive Care Unit telemetry rate

Intensive care ICU ICU Step down ICU Telemetry

Womens Pavillion Standard

Nursery Med/Surg (MS2/MS3)

Standard telemetry rate Pediatrics Standard Inpatient Rehab Standard

Room and Board -- Per Day Charges

Charges

$ 1,130.00

$ 2,270.00 $ 1,690.00 $ 1,130.00

$ 1,060.00 $ 850.00

$ 880.00 $ 1,130.00

$ 960.00

$ 1,110.00

Labor and Delivery Charges

The following list does not include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Charges for Normal Delivery are an average for a vaginal delivery, 2 day stay. Charges for CSection are an average for a C-section with a 4 day stay. Your charges may be higher or lower, and will reflect the services you actually receive. Fees for physician services or anestehsia administration are also not reflected,

and will be billed separately by your physician.

Normal Delivery Cesearean Section Delivery Fetal Monitor per hour Labor Room per hour Recovery Care Non-Stress test (Scheduled) Epidural Anesthetic

Charges Call 330-263-8418 Call 330-263-8418 $ 106.76 $ 262.20 $ 436.68 $ 405.61 $ 247.52

Emergency Department Charges

Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel

resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures (such as imaging services) that may be required

for a particular emergency treatment. They also do not include fees for Emergency Department physicians, or other ancillary physicians (such as Radiologists) who will bill seperately for their services.

Level 1 Level 2 Level 3 Level 4 Level 5 Critical care Simple Suture (stitches) Complex Suture

Charges $ 251.03 $ 358.63 $ 502.08 $ 609.66 $ 932.43 $ 1,427.34 $ 295.63 $ 349.70

Spinal Fluid Tap, diagnostic Foley catheterization Closed reduction, Arm Splint, lower leg

$ 868.48 $ 177.41 $ 387.34 $ 250.21

Operating Room Charges

Operating Room charges are based on the complexity level, with level 1 being the most basic, for a particular operation There is an initial, set-up charge as well as an additional charge for each minute while the operation is being performed. This list does not include supplies, anesthesia, medications, pre-admission testing, or any professional services (physician charges). This list is informational only. For

an estimate of a specific procedure, please call 330-263-8418.

Class I Class II Class III Class IV Class V Class VI Class VII Class VIII Class IX Class X

Set-Up Charge

$

884.33

$

1,037.15

$

1,360.68

$

2,008.03

$

2,655.23

$

3,319.19

$

3,980.81

$

4,527.58

$

6,340.16

$

9,466.74

Additional per minute charge

$

25.59

$

26.90

$

28.79

$

37.95

$

41.57

$

42.97

$

44.93

$

46.29

$

47.59

$

50.30

Physical Therapy Charges

The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Ultrasound, 1/4 hour Massage, 1/4 hour Gait training, 1/4 hour Electronic Stimulation (unattended) Whirlpool standard Therapeutic Exercise, 1/4 hour Physical/Perf Test, 1/4 hour Evaluation - Low Evaluation - Mod Evaluation - High

Charges

$

60.00

$

60.00

$

75.00

$

60.00

$

45.00

$ 115.00

$

95.00

$ 165.00

$ 185.00

$ 185.00

Occupational Therapy Charges

The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Evaluation - Low Evaluation - Mod Evaluation - High Orthotics, 1/4 hour Comm/Work Reintegration, 1/4 hour Cognitive Function Intervention, 1st 15 min Cognitive Function Intervention, ea add 15 Re-Evaluation Neuromuscular Reeducation Gait Training, 1/4 hour

Charges

$ 165.00

$ 185.00

$ 205.00

$ 115.00

$

95.00

$

60.00

$

60.00

$ 100.00

$

95.00

$

50.00

Speech Therapy Charges

The following charges reflect the most common services offered by our Speech Therapy department. Patients may have additional charges, depending on the services performed.

Treatment Swallowing Evaluation Swallowing Treatment, 1/2 hour Evaluation Aphasia Assessment/Hour

$ 265.00 $ 400.00 $ 265.00 $ 270.00 $ 295.00

Pulmonary Therapy Charges

The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Aerosol treatment Aerosol treatment, subsequent Cool Mist/half day Short Term Oxygen Oxygen Therapy/Day Ventilator/Day EEG MDI charge Deep Suction Pulse Oximeter Overnight Sleep Study (does not include physician interpretatipohny)sician interpretation) Overnight Sleep Study with CPAP (does not include physician interpretatipohny)sician interpretation)

Charges

$ 185.97

$ 185.97

$ 122.15

$

80.06

$ 120.83

$ 976.09

$ 481.48

$ 195.43

$ 195.43

$

43.35

$ 4,987.80

$ 4,987.80

Cardiovascular Services Charges

The following charges reflect the most common services offered by our Cardiovascular Services department. Patients may have additional charges, depending on the services performed. Some services require medication

to complete, and the dosages vary, which will cause the pricing to vary. Your charges may be higher or lower. The charges listed below do not include physician interpretation. For physician interpretation fees, please contact

the ordering physician for the name of the interpreting physician requested.

EKG

$ 131.31

24 Hour Holter Monitor

$ 297.48

Nuclear Stress Test (charges vary depending on drug dosage $ 4,496.70

Exercise Stress Test

$ 1,473.27

Echocardiogram complete

$ 1,448.79

Transesophageal Echo (TEE)

$ 1,981.65

Pediatric Echocardiogram

$ 1,448.79

X-Ray/Imaging Charges

The following charges reflect the hospital's most common x-ray and radiological procedures. The charges do not include the radiologist's reading fee. For information on the radiologist's fee, please contact Radiology Services

of Canton at 888-300-3794

Radiology Abdomen, Single View Abdomen, Multiview Chest & Lateral Ankle Upper GI Series Pyelogram Cervical Spine w/Oblique Chest, PA Shoulder, 2 views Lumbar - Sacral Spine/Oblique Foot Hand Knee w/ tunnel View Bone Density Study

Ultrasound Initial OB > 14 weeks gestation Pelvic Abdomen, Limited Gallbladder Ultrasound

Nuclear Medicine Three Phase Bone Scan Myocardial Perf Spect

Cat Scan Brain, without contrast Brain, with and without contrast Abdomen, with and without contrast Pelvis, with contrast

Charges $ 221.28 $ 227.47 $ 213.82 $ 309.66 $ 780.57 $ 761.60 $ 535.95 $ 157.06 $ 303.57 $ 424.88 $ 373.75 $ 373.75 $ 370.96 $ 303.32

$ 502.74 $ 675.05 $ 614.17 $ 614.17

$ 1,687.38 $ 2,272.68

$ 1,050.55 $ 2,689.87 $ 1,726.38 $ 1,623.65

Lumbar Spine, without contrast Mammography

Mammogram, bilateral, digital Mammography, unilateral, digital Screening mammography, digital MRI Brain, without contrast Brain, with and without contrast Lumbar spine

$ 1,404.32

$ 272.56 $ 264.30 $ 272.56

$ 2,264.38 $ 4,442.19 $ 3,044.28

Laboratory Charges

The following charges reflect the hospital's 30 most common laboratory procedures. The laboratory charges do not include fees for the pathologist's service. For fee information, please contact Regional Pathology Associates

at 440-329-7656

Type & Screen Electrolyte Panel Drawing Fee Blood Culture CBC w/ auto diff Blood Typing RH D Urinalysis, complete Protime PTT Arterial Blood Gases Surgical Specimen Level IV CBC, PLT Auto Creatine Kinase Total Blood Grouping ABO Basic Metabolic Profile Comprehensive Metabolic Profile Prenatal Panel Glucose, Random Profile, Liver Thyroid Stimulating Hormone Gram Stain Direct Antiglobulin Coomb T-4 Thyroxine Dixogxin Pap Smear Red Cells, Packed Lipid Profile Urine Culture HB, A1C Glucose Tolerance Test 2 hour

Charges

$ 230.82

$

60.75

$

17.49

$

62.15

$

45.89

$

76.94

$

27.12

$

23.34

$

28.61

$

40.88

$

35.40

$

76.94

$

55.58

$ 121.24

$

96.40

$

31.04

$

81.45

$

89.57

$

47.35

$

56.04

$

47.35

$

71.87

$

26.39

$ 314.85

$ 131.69

$

25.61

$

28.20

$

34.62

$ 164.29

$ 164.29

Hospital Billing Policies

Financial Assistance Financial assistance is available to patients who meet certain guidelines. For questions or an application regarding financial assistance, please call 330-263-8418. Applications are also available at all registration points.

Self pay discounts Discounts are extended to self pay patients (those without insurance) if accounts are paid in full within 30 days of the initial billing. For further information, please call 330-263-8160 or 330-263-8158.

Credit policy Payment in full is expected at the time of initial billing. However, Wooster Community Hospital realizes that payment in full is not always possible. Because of this, we offer the following credit terms:

Balances less than $400 - minimum monthly payment is $40.

Balances greater than $400 - minimum monthly payment is 10 % of the beginning patient balance.

Wooster Community Hospital does not charge interest on outstanding balances.

All payment plans must be set up in our business office. To make payment arrangements, please call 330-263-8160. We also accept Visa, Mastercard and Discover for your convenience.

Consumers can access a number of government and private Websites, which provide additional information on hospitals' charges and quality. For a complete listing of available online resources, please visit the Consumer's

Guide to Quality Health Care in Ohio at portal.

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