Patient Price Information List

 

As of October 1, 2017

 

1. All charges noted do not include medications or supplies that may be used during your  stay at Community Hospitals and Wellness Centers.

1.1 Hospital based Pathology or Pathologist charges are included in the CHWC hospital bill.

1.2 Emergency Department Physician charges are not included in the CHWC hospital bills.

Information can be obtained by contacting:

For Bryan & Montpelier Emergency Departments:
Samaritan Emergency Physicians LLP
75 Remit Dr. – Suite 1056
Chicago, IL 60675-1056
866 703-3301

1.3 Radiologist, FWRadiology, services are not included in the CHWC hospital bills.

Information can be obtained by contacting:
FWRadiology
3707 New Vision Dr.
Fort Wayne, IN 46845
260-484-0850 or 800-758-0292

1.4 Non Hospital Based Anesthesia services provided by Anesthesia Associates of Fort Wayne

(AAFW) are not included in the CHWC hospital bills. Information can be obtained by contacting:
AAFW – CIPROMS
Suite 400, 3600 Woodview Trace
Indianapolis, IN 46268
888-802-6903

1.5 Pain Management Physician charges are not included in the CHWC hospital bills.

Information can be obtained by contacting:
For: Dr. Tom Kindl
Pain Management Specialists
1900 S Main Street
Findlay, OH 45840
419-423-5310

1.6 Radiation Oncology Physician charges are not included in the CHWC hospital bills.
Information can be obtained by contacting:
Toledo Radiation Oncology
3000 Regency Court, Suite 207
Toledo, OH 43623
419-473 2636 or 800-223-0311

1.7 University of Toledo Physicians LLC charges are not included in the CHWC hospital bills.
Information can be obtained by contacting:
University of Toledo Physicians
3355 Glendale Ave., 3rd Floor
Toledo, OH 43614
419-383-7100

2. Room and Board - Per Day Charges

 Charges
CAH swing bed room rate$1,600.00
Intensive care room rate$2,250.00
Medical/surgical room rate$1,250.00
Nursery room rate$650.00
OB room rate$1,100.00
Telemetry room rate$1,550.00

3. Labor and Delivery Charges

 Charges
Labor and delivery$1,500.00
Cesarean section deliverySee major surgery.

4. Emergency Department Charges

 Charges
Level 1$160.00
Level 2$280.00
Level 3$500.00
Level 4$830.00
Level 5$1,250.00

5. Operating Room Charges

 InitialAdditional 15 mins
Half hourMinimum charge
Minor surgery$1,500.00$350.00
Major surgery$1,900.00$400.00
Recovery room$813.00$84.00

6. Occupational Therapy Charges - most common services

 Charges
Additional home ins-ast development - 15 min$85.00
Develop cognitive skill - 15 min$65.00
Fluidotherapy$57.00
Orthotic fitting & training - 15 mins$92.00
OT evaluation$206.00
Paraffin bath$26.00
Physical capacity - 15 min$80.00
Therapeutic cctivity - 15 min$85.00
Therapeutic exercise - 15 min$79.00
Work condition exercises / job stimulation - 1 hour$118.00

7. Physical Therapy Charges - most common services

 Charges
Aquatic therapy - 15 min$104.00
Electrical stimulate - PT assisted$47.00
Electrical stimulate - unattended$34.00
Gait (Walking) training - 15 min$69.00
Infrared therapy$48.00
Iontophoresis - 15 min$53.00
Manual therapy tech - 15 min$73.00
Massage - 15 min$64.00
Neuromuscular facilitation - 15 min$83.00
PT evaluation$183.00
PT evaluation vestibular (balance)$183.00
TENS - transcutaneous electrical nerve stimulation$24.00
Therapeutic activity - 15 min$85.00
Therapeutic exercise - 15 min$79.00
Therapeutic exercise in a group$51.00
Traction mechanical$40.00
Ultrasound - 15 min$31.00
Vestibular exercise - 15 min$83.00

8. Pulmonary Therapy Charges - most common services

 Charges
Aerosol - all treatments after initial$75.00
Aerosol - initial treatment$190.00
Arterial blood gas$105.00
Atrovent with normal saline$12.00
Diffusion carbon dioxide across capilary membrane$200.00
Disposable incentive spirometry$157.00
Duoneb inhalation$9.00
EKG$96.00
PFT - spirometry brnch/dilt/ADM$581.00
Proventil - normal saline$7.00
Xopenex - 1.25 MG normal saline$12.00

9. X-Ray and Radiological Charges - 30 most common services

 Charges
Abdomen: AP, UP CXR - 3 views$450.00
Ankle: 3 views$240.00
Cervical spine: 2–3 views$450.00
Chest: AP/PA - 1 view$240.00
Chest with lateral: 2 views$240.00
CT abdomen: without contrast$560.00
CT abdomen: with contrast$1,060.00
CT brain: without contrast$560.00
CT chest: with contrast$1,060.00
CT pelvis: with contrast$950.00
CT abdomen pelvis: without contrast$1,000.00
CT abdomen pelvis: with contrast$1,400.00
Foot: min 3 views$240.00
Hand: min 3 views$240.00
K.U.B.: 1 view$240.00
Knee: 3 views$240.00
Lumbar spine: 2–3 views$450.00
Lumbar spine: 5 views$450.00
MRI brain: with & without contrast$1,810.00
MRI brain: without contrast$1,070.00
MRI cervical spine: without contrast$1,070.00
MRI lower extremity with joint: without contrast$1,070.00
MRI lumbar spine: without contrast$1,070.00
MRI upper extremity with joint: without contrast$1,070.00
Nuclear medicine bone scan: complete$1,330.00
Nuclear medicine Cardolite treadmill stress test$7,239.00
Shoulder: 2 views$240.00
ECHO - full study$1,800.00
Ultrasound - both carotid arteries$900.00
Ultrasound - pelvic$450.00

10. Laboratory Charges - 30 most common services

 Charges
ALT SGPT$28.00
Amylase$36.00
Basic profile$40.00
Blood culture$57.00
BNP$186.00
Urine culture$44.00
CBC with BC differential$43.00
CKMB$50.00
Comprehensive profile$58.00
CPK$36.00
Electrolyte profile$25.00
Hemoglobin A1C$53.00
Liver profile$35.00
Hemoglobin$13.00
Level IV gross & micro$159.00
Lipase$38.00
Lipid profile$70.00
Magnesium$32.00
Myoglobin$70.00
Organism ID$44.00
Phosphorus$26.00
PKU newborn screening$140.00
Protime$22.00
PTT$33.00
SED rate$19.00
Sensitivity$42.00
PSA screening or total$101.00
Troponin 1$54.00
TSH$92.00
Urinalysis$12.00

11. Hospital Billing Policy

All accounts with health insurance will be billed to the insurance. Secondary insurance plans are billed following completed processing of the claim by the primary insurance plan. The billing office will follow up with the health insurance until a payment is received or until the claim has completed processing by the insurance. The account will be held if a payment date is provided by the health insurance. If the insurance is holding the claim for additional information from the patient, a letter will be sent asking the policy holder to contact the insurance with the requested information and notify the hospital within 10 days. If no response is received, the first statement will be sent to the guarantor.

Under the Resources tab, and Financial Assistance, our financial assistance and financial collection policies is available for review of CHWC’s patient billing process and financial assistance options.