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

Radiation oncology professional charges are included with the CHWC hospital bill. (Effective 1/1/2020.)

– Medical oncology professional charges are included with the CHWC hospital bill.

Billing for interpretation of all imaging procedures are included with the CHWC hospital bill. (Effective 3/16/21.)

Hospital based anesthesia professional charges are included with the CHWC hospital bill. (Effective 6/1/20.)

 

Pain Management professional charges are not included with the CHWC hospital bill. Current physicians include Dr. Andrius Giedratitis and Dr. Darin Scribner. Billing information can be obtained by contacting:
Pain Management Specialists
1900 S Main Street
Findlay, OH 45840
419-423-5310

(Pain management professional charges for CNP Greg Durham are included with the CHWC hospital bills.)

– CHWC physician clinic professional charges for the following providers are not included with the CHWC hospital bills.

    • Dr. Michael Nosanov  –  ENT
    • Jennifer Rittenhouse, CNP  –  ENT
    • Dr. Jodi Tinkel  –  Cardiology
    • Dr. Khalid Minhas  –  Cardiology
    • Vaishali Patel, CNP  –  Cardiology
    • Dr. Hanan Bazzi  –  Women’s Clinic
    • Dr. Samar Hassouneh  –  Women’s Clinic
    • Nicole Pothast, CNM  –  Women’s Clinic
    • Dr. D. Matt Cooley  –  Gastroenterology
    • Dr. Monzur Haque  –  General Surgery

Billing information can be obtained by contacting:
CHWC Clinics
PO Box 5600
Fort Wayne, IN 46895
844-451-0002

(Payment for CHWC clinics billed through Fort Wayne can be paid at CHWC or on the CHWC website at www.chwchospital.org/payments.)

– Hospital based pathology and clinical professional charges are not included with the CHWC hospital bill. Billing information can be obtained by contacting:
Associated Pathologists, Inc.
5700 Southwyck BLVD
Toledo, OH 43614
419-861-7052

– Emergency Department physician charges are not included in the CHWC hospital bills. For Bryan & Montpelier Emergency Departments, information can be obtained by contacting:
Samaritan Emergency Physicians, LLP
75 Remit Dr. – Suite 1056
Chicago, IL 60675-1056
888-703-3301

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

Current University of Toledo physicians working clinics at CHWC include the following:

    • Dr. Daniel Murtagh  –  Urology
    • Dr. Ahmed El-Zawahry  –  Urology
    • Michelle Lajiness, CNP  –  Urology
    • Dr. Osama Elattar  –  Orthopedics    
    • Dr. Maged Hanna  –  Orthopedics
    • Dr. Chris Sanford  –  Orthopedics
    • Dr. Mina Tanios  –  Orthopedics
    • Dr. Ryan Hamilton  –  Orthopedics

 

 Parkview Physician Group charges are not included in the CHWC hospital bills. Information can be obtained by contacting:
Parkview Physicians Group
PO Box 10416
Des Moines, Iowa 50306
260-266-6700 or 855-814-0012

 

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

Room and Board - Per Day Charges

 Charges
CAH swing bed room rate$1,860.00
Intensive care room rate$ 2,690.00
Medical/surgical room rate$1,350.00
Nursery room rate$1,040.00
OB room rate$1,540.00
Telemetry room rate$2,170.00

Labor and Delivery Charges

 Charges
Labor and delivery$2,690.00
Cesarean section deliverySee major surgery.

Emergency Department Charges

 Charges
Level 1$180.00
Level 2$330.00
Level 3$580.00
Level 4$910.00
Level 5$1,400.00

Operating Room Charges

 InitialAdditional 15 mins
Half hourMinimum charge
Minor surgery$1,930.00$390.00
Major surgery$2,300.00$460.00
Recovery room$890.00$110.00

Occupational Therapy Charges - most common services

 Charges
Additional home ins-ast development - 15 min$80.00
Fluidotherapy$60.00
Orthotic fitting & training - 15 mins$130.00
OT evaluation$240.00
Paraffin bath$30.00
Physical capacity - 15 min$100.00
Therapeutic Activity - 15 min$100.00
Therapeutic exercise - 15 min$90.00
Work condition exercises / job stimulation - 1 hour$90.00

Physical Therapy Charges - most common services

 Charges
Aquatic therapy - 15 min$120.00
Electrical stimulate - PT assisted$60.00
Electrical stimulate - unattended$50.00
Gait (Walking) training - 15 min$100.00
Infrared therapy$50.00
Iontophoresis - 15 min$70.00
Manual therapy tech - 15 min$90.00
Massage - 15 min$90.00
Neuromuscular facilitation - 15 min$110.00
PT evaluation$230.00
TENS - transcutaneous electrical nerve stimulation$24.00
Therapeutic activity - 15 min$120.00
Therapeutic exercise - 15 min$90.00
Therapeutic exercise in a group$70.00
Traction mechanical$60.00
Ultrasound - 15 min$60.00
Vestibular exercise - 15 min$100.00

Pulmonary Therapy Charges - most common services

 Charges
Aerosol - all treatments after initial$480.00
Aerosol - initial treatment$480.00
Arterial blood gas$110.00
Atrovent with normal saline$12.00
Diffusion carbon dioxide across capilary membrane$140.00
Disposable incentive spirometry$150.00
EKG$140.00
PFT - spirometry brnch/dilt/ADM$350.00
Proventil - normal saline$7.00
Xopenex - 1.25 MG normal saline$12.00

X-Ray and Radiological Charges - 30 most common services

 Charges
Abdomen: AP, UP CXR - 3 views$480.00
Ankle: 3 views$280.00
Cervical spine: 2–3 views$280.00
Chest: AP/PA - 1 view$330.00
Chest with lateral: 2 views$330.00
CT abdomen: without contrast$560.00
CT abdomen: with contrast$880.00
CT brain: without contrast$660.00
CT chest: with contrast$860.00
CT pelvis: with contrast$880.00
CT abdomen pelvis: without contrast$1,200.00
CT abdomen pelvis: with contrast$1,940.00
Foot: min 3 views$350.00
Hand: min 3 views$350.00
K.U.B.: 1 view$350.00
Knee: 3 views$350.00
Lumbar spine: 2–3 views$480.00
Lumbar spine: 5 views$480.00
MRI brain: with & without contrast$1,780.00
MRI brain: without contrast$1,090.00
MRI cervical spine: without contrast$1,090.00
MRI lower extremity with joint: without contrast$1,100.00
MRI lumbar spine: without contrast$1,090.00
MRI upper extremity with joint: without contrast$1,100.00
Nuclear medicine bone scan: complete$1,660.00
Nuclear medicine Cardolite treadmill stress test$6,999.00
Shoulder: 2 views$350.00
ECHO - full study$1,940.00
Ultrasound - both carotid arteries$960.00
Ultrasound - pelvic$520.00

Laboratory Charges - 30 most common services

 Charges
ALT SGPT$30.00
Amylase$30.00
Basic profile$40.00
Blood culture50.00
BNP$160.00
Urine culture$40.00
CBC with BC differential$40.00
CKMB$50.00
Comprehensive profile$50.00
CPK$30.00
Electrolyte profile$30.00
Hemoglobin A1C$40.00
Liver profile$40.00
Hemoglobin$30.00
Level IV gross & micro$200.00
Lipase$30.00
Lipid profile$60.00
Magnesium$30.00
Myoglobin$60.00
Organism ID$40.00
Phosphorus$40.00
PKU newborn screening$160.00
Protime$20.00
PTT$30.00
SED rate$20.00
Sensitivity$40.00
PSA screening or total$80.00
Troponin 1$50.00
TSH$70.00
Urinalysis$10.00

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.