Other Testing and Treatment
2012 Pricing Disclosure
Pursuant to section 3727.12 of the Ohio revised Code, the public is entitled, upon request, to a list of the usual and customary charges for Room and Board, and a selected number of X-ray, Laboratory, Emergency Room, Operating Room, Delivery Room, Physical Therapy, Occupational Therapy, and Respiratory Care Services. This list is not intended to be all-inclusive.
X-ray/Radiology Services
|
Abdominal Series Complete
|
$426.00
|
Abdominal Single View
|
$334.00
|
Ankle, Right Or Left 2 Views
|
$419.00
|
Chest, Single
|
$282.00
|
Chest Pa And Lateral
|
$338.00
|
Dexa Bone Scan
|
$291.00
|
Ct Cervical Wo Cont
|
$1,752.00
|
Ct Head-Wo Cntrst
|
$1,568.00
|
Ct Lumbar Wo Contrast
|
$2,106.00
|
Ct,Abdomen-W Cntrst
|
$1,706.00
|
Ct,Abdomen-Wo Cntrst
|
$1,487.00
|
Ct,Maxillo Area-Wo Cntrst
|
$1,468.00
|
Ct,Pelvis-W Contrast
|
$1,662.00
|
Ct,Pelvis-Wo Contrast
|
$1,437.00
|
Ct-Chest Wo Contrast
|
$1,974.00
|
Daily Treatment Imrt Technique
|
$1,217.00
|
Hand, Right Or Left 2 Views
|
$162.00
|
Knee, Right Or Left (1 Or 2) Views
|
$452.00
|
Mammogram, Bilateral, Diag With Cad
|
$162.00
|
Mammogram, Screening With Cad
|
$134.00
|
Mri-Brain Wo/W Contrast
|
$3,950.00
|
Mri-Lumbar Spine Wo Contrast
|
$2,894.00
|
Us-Non Ob Pelvis Complete
|
$660.00
|
Us - Abdomen Complete
|
$807.00
|
Spine Lumbar Spine 2 0R 3 Views
|
$468.00
|
Thyroid Scan W/Sngl Uptk
|
$890.00
|
Lab Charges
|
Basic Metabolic Panel 2000
|
$206.00
|
Creatinine
|
$34.00
|
Cbc W/Differential
|
$76.00
|
Prothrombin Time
|
$67.00
|
Urinalysis
|
$74.00
|
Magnesium
|
$88.00
|
Sedimentation Rate
|
$55.00
|
Phosphorous
|
$34.00
|
Drug Screen, Ea Class Poct
|
$87.00
|
Cpk
|
$131.00
|
Comp Metabolic Panel
|
$389.00
|
Lipid Panel
|
$134.00
|
Blood Gas
|
$171.00
|
Hepatic Function Panel
|
$74.00
|
Hemoglobin
|
$34.00
|
Potassium K
|
$34.00
|
Hematocrit
|
$34.00
|
Ckmb Fraction
|
$133.00
|
Bilirubin Total
|
$42.00
|
Bilirubin Direct
|
$51.00
|
Tsh-Thyr. Stim. Hor. Serum
|
$169.00
|
N Gonorrhoeae Amp Probe
|
$130.00
|
Chlamydia Culture
|
$110.00
|
Glucose Tolerance 1St 3 Spec
|
$158.00
|
Gtt Ea Add'L Spect
|
$44.00
|
Emergency Room
|
HS Level 1
|
$266.00
|
HS Level 2
|
$526.00
|
HS Level 3
|
$905.00
|
HS Level 4
|
$1,808.00
|
HS Level 5
|
$2,785.00
|
HS Level 6
|
$6,192.00
|
ER Procedure Level 1
|
$195.00
|
ER Procedure Level 2
|
$283.00
|
ER Procedure Level 3
|
$440.00
|
ER Procedure Level 4
|
$685.00
|
ER Procedure Level 5
|
$773.00
|
ER Procedure Level 6
|
$1,403.00
|
ER Procedure Level 7
|
$1,753.00
|
Room and Care Charges
|
Semi-Private/Private Med Surg Room
|
$2,805.00
|
OB Bed/Private - Labor & Delivery
|
$4,193.00
|
OB Care-Semi private Family Birthing Center
|
$3,025.00
|
Nursery-L&D
|
$2,640.00
|
NICU
|
$4,400.00
|
Intensive Care Unit
|
$4,180.00
|
Advanced Care
|
$3,630.00
|
BMT
|
$5,661.00
|
Burn Unit, PRIVATE
|
$7,040.00
|
TelemetryCardiac Telemetry
|
$2,805.00
|
Bariatric
|
$2,805.00
|
Psych Semi-Private/Private
|
$3,850.00
|
Rehab Private/Semi Private
|
$2,805.00
|
Labor and Delivery Services
|
Labor Care 1St Hr Or Portion
|
$1,435.00
|
Labor Care Ea Add'L Hr
|
$1,086.00
|
Intensive Labor Services 1St Hr
|
$876.00
|
Intensive Labor Ea Add Hr
|
$603.00
|
Dilation And Curettage
|
$3,855.00
|
Post Delivery Enroute Services
|
$867.00
|
C-Section L&D With Fm
|
$8,413.00
|
C. Section Plus Hysterectomy
|
$11,488.00
|
Delivery-Post Partum Ligation
|
$3,877.00
|
Hysterectomy Post Delivery
|
$5,410.00
|
Delivery-Major Repair W Fm
|
$2,935.00
|
Evacuate Hematoma
|
$924.00
|
Post Partum Ligation
|
$2,877.00
|
Removal Of Mcdonald's In Delivery
|
$302.00
|
Recovery Rm 1St Hr Or Portion
|
$722.00
|
Recovery Rm Ea Aditional Hr
|
$428.00
|
Amniocentesis, Diag.
|
$690.00
|
Circumcision
|
$467.00
|
Laparotomy
|
$6,992.00
|
Fetal Monitor Setup Internal
|
$434.00
|
Birthing Charge W/Fm
|
$3,623.00
|
Physical and Occupational Therapy
|
PT Eval
|
$411.00
|
OT Assessment
|
$411.00
|
PT Re-eval
|
$194.00
|
Fluidotherapy
|
$176.00
|
Electrical Stim 15 min
|
$176.00
|
Ultrasound EA 15 MIN
|
$153.00
|
Gait Training EA 15 MIN
|
$176.00
|
Respiratory Charges
|
Adult Ventilator Inline Meds
|
$41.00
|
Ippb Initial Therapy
|
$90.00
|
Peak Flow Measurement
|
$117.00
|
Daily Oxygen Use
|
$134.00
|
Cpt/Pd Ped
|
$88.00
|
Bronchodilation Responsiveness, Spirometry
|
$151.00
|
Diffusion Capacity
|
$134.00
|
Ventilator Initial Hour
|
$1,154.00
|
Ventilator Each Additional Hour
|
$185.00
|
Ped Ventilator Initial Setup
|
$1,441.00
|
Ped Ventilator Per Hour
|
$335.00
|
Ped Cont O2 Nebulizer
|
$212.00
|
Surgery
|
Base Rate |
P/Min Rate |
Bundle Rate |
Abdominal Aortic Aneurysm
|
$12,167.00
|
$173.00
|
$561.00
|
Amputation-Above Knee
|
$4,834.00
|
$95.00
|
$256.00
|
Amputation-Toe
|
$4,834.00
|
$95.00
|
$272.00
|
Appendectomy
|
$4,834.00
|
$95.00
|
$233.00
|
Arthroplasty-Shoulder
|
$7,342.00
|
$161.00
|
$453.00
|
Arthroscopic ACL Repair
|
$7,342.00 |
$173.00
|
$517.00
|
Arthroscopy-Knee
|
$4,834.00
|
$161.00
|
$352.00
|
Arthroscopy-Shoulder
|
$4,834.00
|
$173.00
|
$447.00
|
A.V. Fistula
|
$4,834.00
|
$95.00
|
$271.00
|
Bariatric Open Procedure
|
$7,342.00
|
$95.00
|
$362.00
|
Breast Biopsy
|
$2,482.00
|
$161.00
|
$225.00
|
Biopsy-Lymph Node
|
$7,342.00
|
$161.00
|
$199.00
|
Blepharoplasty
|
$1,047.00
|
$95.00
|
$319.00
|
Bunionectomy
|
$4,834.00
|
$161.00
|
$272.00
|
Carotid Endarterectomy
|
$4,834.00
|
$95.00
|
$268.00
|
Femoral Pop Bypass
|
$12,167.00
|
$95.00
|
$315.00
|
Carpal Tunnel Release
|
$4,834.00
|
$161.00
|
$267.00
|
Cataract Extraction
|
$1,047.00
|
$97.00
|
$491.00
|
Cataract Extraction-Phaco
|
$1,047.00
|
$97.00
|
$541.00
|
Cholecystectomy
|
$4,834.00
|
$95.00
|
$282.00
|
Closed Reduction Nasal Fracture
|
$4,834.00 |
$95.00
|
$150.00
|
Colon Resection
|
$6,019.00
|
$95.00
|
$429.00
|
Colostomy
|
$4,834.00
|
$161.00
|
$435.00
|
Conization w/Laser
|
$5,344.00
|
$143.00
|
$155.00
|
Cervical Conization
|
$2,482.00
|
$161.00
|
$155.00
|
Craniotomy
|
$12,167.00
|
$173.00
|
$879.00
|
Cystoscopy
|
$7,342.00
|
$95.00
|
$124.00
|
Cysto-Ureteroscopy
|
$7,342.00
|
$95.00
|
$128.00
|
Cystoscopy-T.U.R. of Bladder Tumor
|
$7,342.00
|
$95.00
|
$212.00
|
D and C
|
$4,834.00
|
$97.00
|
$113.00
|
D and C-Suction
|
$4,834.00
|
$97.00
|
$129.00
|
Debridement-Skin and Subcutaneous Tissue
|
$2,482.00
|
$161.00
|
$292.00
|
Dental Extractions
|
$2,482.00
|
$95.00
|
$225.00
|
Dental Restoration
|
$2,482.00
|
$95.00
|
$225.00
|
Laminectomy, Discectomy
|
$9,135.00
|
$156.00
|
$389.00
|
Endarterectomy-Carotid Artery
|
$4,834.00
|
$95.00
|
$268.00
|
Endoscopic Sinus Surgery
|
$4,834.00
|
$161.00
|
$236.00
|
Ethmoidectomy
|
$6,518.00
|
$139.00
|
$219.00
|
Excision-Lesion-Eyelid
|
$1,223.00
|
$95.00
|
$298.00
|
Excision-Lesion-Rectal
|
$2,482.00
|
$95.00
|
$216.00
|
Excision-Lesion-Skin
|
$2,482.00
|
$95.00
|
$152.00
|
Excision-Nailbed
|
$1,920.00
|
$74.00
|
$144.00
|
Eye Muscle Surgery
|
$1,047.00
|
$97.00
|
$219.00
|
Spinal Fusion w/ Instrum
|
$9,135.00
|
$156.00
|
$437.00
|
Fusion-Lumbar
|
$9,135.00
|
$161.00
|
$416.00
|
Ganglion Excision
|
$4,834.00
|
$161.00
|
$252.00
|
Hemorrhoidectomy
|
$2,482.00
|
$95.00
|
$216.00
|
Hernia Repair-Inguinal
|
$2,482.00
|
$161.00
|
$233.00
|
Hernia Repair-Umbilical
|
$4,834.00
|
$161.00
|
$212.00
|
| Hernia Repair-Epigastric |
$4,834.00 |
$95.00 |
$233.00 |
Hip Prosthesis
|
$7,342.00
|
$95.00
|
$570.00
|
Hydrocelectomy
|
$2,482.00
|
$161.00
|
$191.00
|
Hysterectomy-Abdominal
|
$7,342.00
|
$137.00
|
$282.00
|
Hysterectomy-Vaginal
|
$4,834.00
|
$161.00
|
$274.00
|
Hysteroscopy
|
$7,342.00
|
$161.00
|
$216.00
|
IM Nailing - Tibia
|
$7,342.00
|
$95.00
|
$354.00
|
Inc. & Drainage
|
$2,482.00
|
$97.00
|
$215.00
|
Insertion: Groshong/Hickman/Permacath
|
$4,834.00
|
$74.00
|
$260.00
|
Laminectomy Discectomy
|
$9,135.00
|
$156.00
|
$389.00
|
Laparoscopic Cholecystectomy
|
$7,342.00
|
$137.00
|
$496.00
|
Laparoscopy Pelviscopy
|
$7,342.00
|
$161.00
|
$226.00
|
Laparoscopy Pelvisc w/Laser
|
$7,342.00
|
$161.00
|
$225.00
|
Tubal Ligation
|
$6,992.00
|
$90.00
|
$217.00
|
Laparotomy
|
$7,342.00
|
$95.00
|
$312.00
|
Laryngoscopy
|
$7,342.00 |
$161.00
|
$88.00
|
Lymphadenectomy-Simple
|
$7,342.00
|
$161.00
|
$283.00
|
Mastectomy-Modified-Radical
|
$4,834.00
|
$95.00
|
$267.00
|
Mastectomy-Simple
|
$4,834.00
|
$161.00
|
$253.00
|
Myomectomy
|
$7,342.00
|
$161.00
|
$313.00
|
Myringotomy
|
$4,834.00
|
$95.00
|
$62.00
|
Tympanoplasty
|
$4,834.00
|
$161.00
|
$359.00
|
Nephrectomy
|
$10,689.00
|
$95.00
|
$331.00
|
Nerve Repair
|
$7,342.00
|
$161.00
|
$243.00
|
Orchiectomy
|
$2,482.00
|
$95.00
|
$173.00
|
Ostectomy-Foot
|
$748.00
|
$81.00
|
$228.00
|
Osteotomy-Mandibular
|
$1,007.00
|
$109.00
|
$278.00
|
O.R.I.F Humerus
|
$7,342.00
|
$95.00
|
$512.00
|
O.R.I.F. Acetabulum
|
$12,167.00
|
$156.00
|
$867.00
|
O.R.I.F. Hand
|
$7,342.00
|
$161.00
|
$318.00
|
O.R.I.F. Femur
|
$10,689.00
|
$156.00
|
$412.00
|
O.R.I.F. Hip
|
$7,342.00
|
$95.00
|
$322.00
|
O.R.I.F. Fingers
|
$7,342.00
|
$161.00
|
$286.00
|
O.R.I.F. Radius/Ulna
|
$7,342.00
|
$95.00
|
$293.00
|
O.R.I.F. Tibia/Fibula
|
$10,689.00
|
$156.00
|
$399.00
|
Palmer Fascietomy
|
$4,822.00
|
$65.00
|
$259.00
|
Parotidectomy
|
$4,834.00
|
$95.00
|
$240.00
|
Prostatectomy
|
$4,834.00
|
$95.00
|
$369.00
|
Release-Trigger Finger
|
$7,342.00
|
$161.00
|
$243.00
|
Removal-I.F.D.-Femur
|
$938.00
|
$101.00
|
$352.00
|
Removal-I.F.D.-Tibia/Fibula
|
$938.00
|
$101.00
|
$346.00
|
Repair-Rotator Cuff
|
$4,834.00
|
$161.00
|
$455.00
|
Repair-Tendon-Hand
|
$7,342.00
|
$161.00
|
$263.00
|
Repair-Tendons
|
$7,342.00
|
$161.00
|
$272.00
|
Replacement-Heart Valve
|
$12,167.00
|
$156.00
|
$2,793.00
|
Resection-Small Bowel
|
$7,342.00
|
$161.00
|
$437.00
|
Revision-Scar
|
$4,834.00
|
$161.00
|
$159.00
|
Salpingectomy
|
$5,432.00
|
$114.00
|
$292.00
|
Salpingo-Oophorectomy
|
$7,342.00
|
$161.00
|
$296.00
|
Septoplasty
|
$4,834.00
|
$161.00
|
$246.00
|
Splenectomy
|
$4,834.00
|
$161.00
|
$312.00
|
Split Thickness Skin Graft
|
$7,342.00
|
$95.00
|
$396.00
|
Thoracotomy
|
$12,167.00
|
$95.00
|
$516.00
|
Thyroid Parathy
|
$10,689.00
|
$95.00
|
$249.00
|
Tonsillectomy
|
$4,834.00
|
$95.00
|
$154.00
|
Total Hip Replacement
|
$7,342.00
|
$95.00
|
$620.00
|
Total Knee Replacement
|
$12,156.00
|
$156.00
|
$589.00
|
Tracheostomy
|
$4,834.00 |
$95.00
|
$160.00
|
Transplant-Cornea
|
$1,047.00
|
$97.00
|
$494.00
|
Transplant-Kidney
|
$12,167.00
|
$156.00
|
$318.00
|
VitrectomyPars Plana
|
$2,022.00
|
$90.00
|
$822.00
|
Vitrectomy Pars Plana w Laser
|
$2,780.00
|
$114.00
|
$958.00
|
Vulvectomy
|
$7,342.00
|
$95.00
|
$272.00
|
Wrist Fusion
|
$1,086.00
|
$84.00
|
$289.00
|
Important note about these charges
Radiology, Lab, Emergency Room, and Surgery charges do not include physician charges. Information relating to these charges can be obtained by writing to:
Radiology:
Radiology Physician, Inc.
1-866-684-1484
Lab:
CompuNet Clinical Laboratories
(937) 297-8230
Emergency:
Miami Valley Emergency Specialists
(800) 513-3044
Anesthesia:
Anesthesiology Services
(937) 208-7291
Pathology:
Valley Pathologists
(800) 554-2695