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

1,100.00

Telemetry Room Rate

1,550.00

3. Labor and Delivery Charges

Charges

Labor and Delivery

$ 1,500.00

Cesarean Section Delivery

See 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

Initial

Addt’l 15

Half Hr

Min Chrg

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

Addt’l Home Ins-Ast Development 15 MIN

$

85.00

Develope Cognitive Skill 15 MIN

65.00

Fluidotherapy

57.00

Orthotic Fitting & Training 15 MIN

92.00

OT Evaluation

206.00

Paraffin Bath

26.00

Physical Capacity 15 MIN

80.00

Therapeutic Activity 15 MIN

85.00

Therapeutic Exercise 15 MIN

79.00

Work Condition Exrcs/Job Stimulation 1 hr

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

Neuromuscle Facilitation 15 MIN

83.00

PT Evaluation

183.00

PT Evaluation Vestibula (Balance)

183.00

TENS – Transcutaneous Elect Nerve Stim

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 Ex 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 Mem

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 saline0

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: W/O contrast

560.00

CT Abdomen: with contrast

1060.00

CT Brain: W/O contrast

560.00

CT Chest: with contrast

1060.00

CT Pelvis: with contrast

950.00

CT Abdomen Pelvis W/O contrast

1000.00

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: W/ & W/O contrast

1,810.00

MRI Brain: W/O contrast

1,070.00

MRI Cervical Spine: W/O contrast

1,070.00

MRI Low Extrm W JT: W/O contrast

1,070.00

MRI Lumbar Spine: W/O contrast

1,070.00

MRI Up Extrm W JT: W/O contrast

1,070.00

Nuclear Med Bone Scan: Complete

1,330.00

Nuc Med Cardolite Treadmill Stress

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

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 ‘Patient Services’ tab, and ‘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.