Archbold Medical Center

121 Westfield Dr.
Archbold, OH 43502-1061
419-445-4415

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Bryan Hospital

433 W. High St.
Bryan, OH 43506-1690
419-636-1131

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Montpelier Hospital

909 E. Snyder Ave.
Montpelier, OH 43543-1251
419-485-3154

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You are here: Home > Pricing Disclosure

Federal Pricing Transparency: The information provided in this document is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital, also known as a chargemaster. It is not a helpful tool for patients to comparison-shop between hospitals or to estimate what healthcare services are going to cost them out of their own pocket. For more information about the cost of your care, please contact our hospital at 419-636-1131.

 

Patient Price Information List

In compliance with Ohio state law.
As of October 1, 2021

 

The following services and healthcare providers are included with CHWC hospital bills:

  • Interpretation of all imaging procedures
  • Hospital-based anesthesia
  • Jodi Tinkel  –  Cardiology
  • Khalid Minhas  –  Cardiology
  • Damoder Kesireddy  –  Cardiology
  • Vaishali Patel, CNP  –  Cardiology
  • Michael Nosanov  –  Ear, Nose & Throat
  • Jennifer Rittenhouse, CNP  –  Ear, Nose & Throat
  • D. Matt Cooley  –  Gastroenterology
  • Brooke Moore, CNP  –  Gastroenterology
  • Jose Parodi  –  General Surgery
  • Arunkumar Baskara  –  General Surgery
  • Greg Durham, CNP –  Pain Management
  • Mahmoud Afifi  –  Medical Oncology
  • Patricia Wise, PA-C –  Medical Oncology
  • Wainwright Jaggernauth –  Radiation Oncology
  • Scott Shie –  Urology
  • Nicholai Kiehl –  Urology
  • Brandi Alwine, PA-C –  Urology
  • Hanan Bazzi  –  Women’s Health
  • Lindsay Roose, CNM  –  Women’s Health
  • George Magill –  Wound Care

Billing information for the providers and services listed above can be obtained by contacting CHWC Patient Accounts: 419-630-2149, 433 W. High St., Bryan, OH 43506.

Payment can be made at CHWC or on the CHWC website at www.chwchospital.org/payments.

 

The following providers and services are not included with CHWC hospital bills:

  • Hospital-based pathology and clinical professional charges
    • Billing information for these charges can be obtained by contacting Associated Pathologists, Inc.: 419-861-7052, 5700 Southwyck Blvd., Toledo, OH 43614
  • Emergency Department physician charges
    • Billing information for Bryan Hospital and Montpelier Hospital Emergency Departments can be obtained by contacting Samaritan Emergency Physicians, LLP: 888-703-3301, 75 Remit Dr., Ste. 1056, Chicago, IL 60675-1056
  • Parkview Physicians Group
    • Billing information can be obtained by contacting Parkview Physicians Group: 260-266-6700or 855-814-0012, PO Box 10416, Des Moines, IA 50306
  • Andrius Giedraitis –  Pain Management
    • Billing information for these professional charges can be obtained by contacting Pain Management Specialists: 419-423-5310, 1900 S. Main St., Findlay, OH 45840
  • University of Toledo Physicians
    • Billing information can be obtained by contacting University of Toledo Physicians LLC: 419-383-7100, 3355 Glendale Ave., 3rd Floor, Toledo, OH 43614
      Current University of Toledo physicians working at CHWC include:

      • Ahmed El-Zawahry  –  Urology/Urogynecology
      • Osama Elattar  –  Orthopedics
      • Maged Hanna  –  Orthopedics
      • Chris Sanford  –  Orthopedics
      • Ryan Hamilton  –  Orthopedics

 

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

CHARGES:

Room and Board - Per Day Charges

 Charges
CAH swing bed room rate$2,000.00
Intensive care room rate$2,880.00
Medical/surgical room rate$1,450.00
Nursery room rate$1,120.00
OB room rate$1,650.00
Telemetry room rate$2,330.00

Labor and Delivery Charges

 Charges
Labor and delivery$2,890.00
Cesarean section deliverySee major surgery.

Emergency Department Charges

 Charges
Level 1$200.00
Level 2$360.00
Level 3$630.00
Level 4$980.00
Level 5$1,500.00

Operating Room Charges

 InitialAdditional 15 mins
Half hourMinimum charge
Minor surgery$2,070.00$420.00
Major surgery$2,470.00$500.00
Recovery room$960.00$120.00

Occupational Therapy Charges - most common services

 Charges
Additional home ins-ast development - 15 min$110.00
Fluidotherapy$70.00
Orthotic fitting & training - 15 mins$140.00
OT evaluation$260.00
Paraffin bath$40.00
Physical capacity - 15 min$110.00
Therapeutic Activity - 15 min$110.00
Therapeutic exercise - 15 min$100.00
Work condition exercises / job stimulation - 1 hour$170.00

Physical Therapy Charges - most common services

 Charges
Aquatic therapy - 15 min$130.00
Canalith Repositioning - 15 min$140.00
Electrical stimulate - PT assisted$70.00
Electrical stimulate - unattended$70.00
Gait (Walking) training - 15 min$110.00
Iontophoresis - 15 min$80.00
Manual therapy tech - 15 min$100.00
Massage - 15 min$100.00
Neuromuscular facilitation - 15 min$120.00
PT evaluation$250.00
Therapeutic activity - 15 min$130.00
Therapeutic exercise - 15 min$100.00
Therapeutic exercise in a group$80.00
Traction mechanical$70.00
Ultrasound - 15 min$70.00

Pulmonary Therapy Charges - most common services

 Charges
Aerosol - all treatments after initial$520.00
Aerosol - initial treatment$520.00
Arterial blood gas$700.00
Atrovent U/D 2.5ml$1.00
Diffusion carbon dioxide across capilary membrane$170.00
Disposable incentive spirometry$380.00
EKG$150.00
PFT - spirometry brnch/dilt/ADM$380.00
Atrovent U/D 2.5ml$1.00
Xopenex 1.25MG U/D 3ml$4.94

X-Ray and Radiological Charges - 30 most common services

 Charges
Abdomen: AP, UP CXR - 3 views$520.00
Ankle: 3 views$380.00
Cervical spine: 2–3 views$300.00
Chest: AP/PA - 1 view$360.00
Chest with lateral: 2 views$360.00
CT abdomen: without contrast$600.00
CT abdomen: with contrast$950.00
CT brain: without contrast$710.00
CT chest: with contrast$930.00
CT pelvis: with contrast$950.00
CT abdomen pelvis: without contrast$1,290.00
CT abdomen pelvis: with contrast$1,950.00
Foot: min 3 views$380.00
Hand: min 3 views$380.00
K.U.B.: 1 view$380.00
Knee: 3 views$380.00
Lumbar spine: 2–3 views$520.00
Lumbar spine: 5 views$530.00
MRI brain: with & without contrast$1,910.00
MRI brain: without contrast$1,170.00
MRI cervical spine: without contrast$1,170.00
MRI lower extremity with joint: without contrast$1,180.00
MRI lumbar spine: without contrast$1,170.00
MRI upper extremity with joint: without contrast$1,180.00
Nuclear medicine bone scan: complete$1,780.00
Nuclear medicine Cardolite treadmill stress test$6,650.00
Shoulder: 2 views$380.00
ECHO - full study$2,940.00
Ultrasound - both carotid arteries$1,030.00
Ultrasound - pelvic$560.00

Laboratory Charges - 30 most common services

 Charges
ALT SGPT$40.00
Amylase$40.00
Basic profile$50.00
Blood culture$60.00
BNP$180.00
Urine culture$50.00
CBC with BC differential$50.00
CKMB$60.00
Comprehensive profile$60.00
CPK$40.00
Electrolyte profile$40.00
Hemoglobin A1C$50.00
Liver profile$50.00
Hemoglobin$40.00
Level IV gross & micro$230.00
Lipase$40.00
Lipid profile$70.00
Magnesium$40.00
Myoglobin$70.00
Organism ID$50.00
Phosphorus$40.00
PKU newborn screening$180.00
Protime$30.00
PTT$40.00
SED rate$30.00
Sensitivity$50.00
PSA screening or total$90.00
Troponin 1$60.00
TSH$80.00
Urinalysis$30.00

Hospital Billing Policy

Insurance Accounts

All accounts with health insurance will be billed to the insurance. Secondary insurance plans will be 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 guarantor.

Under the ‘Resources’ tab, under ‘Financial Assistance’, the hospital ‘Financial Assistance Policy’ and the ‘Financial Collection Policy’ can be viewed to obtain information explaining CHWC’s patient billing process and financial assistance options.