Pursuant to Section 3727.12 of the Ohio Revised Code, you are entitled, upon request, to a list of our charges for room and board and a selected number of radiology, laboratory, emergency department, operating room, delivery room, physical therapy, occupational therapy and respiratory therapy services.
Trinity Health System, as part of our mission, provides charity care to patients who qualify under the charity guidelines. Uninsured or underinsured patients should consult with our Central Registration or Patient Accounting staff to determine if they qualify for charity programs or other discounts.
Hospital charges are the same for all patients, but a patient's responsibility may vary, depending on your individual insurance coverage. Your hospital bill will include separage charges for other services/items received during your stay, such as supplies and drugs. The charges listed below are only reflective of the charge for that specific item.
Hospital bills do not include the professional billing for Emergency Room Physicians, Hospital Pathologists, Anesthesiologists, or Radiologists. You will receive a separate bill from these physicians for their services.
| INPATIENT ROOM RATES: |
|
|
|
| Semi Private Med/Surg (60825500) |
$ 550 |
|
OPERATING ROOM: |
| Semi Private Telemetry (60821500) |
650 |
|
Major OR Room, 15 minutes (61000701) |
$ 1208 |
| Semi Private Pediatric (60601239) |
550 |
|
Major OR Room, 8 hrs or over (61000717) |
7718 |
| Semi Private Physical Rehab (60201100) |
510 |
|
Cardiac OR Room, 30 minutes (61051000) |
1607 |
| Semi Private Mental Health (61801212) |
680 |
|
Cardiac OR Room, 12 hrs or over(61051115) |
12542 |
| Semi Private Addiction Rec.Detox (61701212) |
700 |
|
|
|
| Semi Private Addiction Rec.Rehab (61702212) |
450 |
|
PHYSICAL THERAPY: |
| Semi Private Skilled Nursing Fac.(60801212) |
300 |
|
Aquatic Therapy, each 15 min. (70651335) |
$ 92 |
| Semi Private Nursing Facility (60901414) |
220 |
|
Debridement, each 15 min. (70651485) |
112 |
**If Patient requests a private room, an
additional $20.00 will be charge to patient.
|
|
Functional Activity each 15 mi (70651135) |
86 |
| |
Gait Training-each 15 mi (70651130) |
86 |
| |
Group Exercises 15 mi (70653012) |
86 |
| |
Orthotics Fitting & Train 15 (70653005) |
86 |
| Intensive Care Unit (60531600) |
900 |
|
Pt Evaluation (70651545) |
208 |
| Coronary Care Unit (60502105) |
900 |
|
Pt Re Evaluation (70651360) |
86 |
| Coronary Care Unit Post OP (60451000) |
2250 |
|
Ultrasound-ea 15 min (70651080) |
86 |
| Family Birth Center (60301123) |
550 |
|
Whirlpool (70651035) |
86 |
| Nursery Regular (60301714) |
500 |
|
|
|
| Nursery Intermediate (60302070) |
520 |
|
OCCUPATIONAL THERAPY: |
|
| Nursery Intensive (60302100) |
550 |
|
Debridement-each 15 min (70702550) |
$ 112 |
| |
|
|
Functional Activities ea 15m (70704025) |
65 |
| EMERGENCY DEPARTMENT: |
|
|
Functional Gait Training 15 m (70704035) |
86 |
| ED Level 1 (61203030) |
$ 63 |
|
Group Therapeutic Exercise (70704030) |
65 |
| ED Level 2 (61209930) |
124 |
|
Orthotics Fit/Training 15 mi (70702080) |
63 |
| ED Level 3 (61209931) |
256 |
|
OT Evaluation (70704150) |
208 |
| ED Level 4 (61209932) |
395 |
|
OT Re-evaluation (70704060) |
128 |
| ED Level 5 (61209933) |
545 |
|
Paraffin Bath (70702030) |
77 |
| Critical Care,1st 60 minutes (61204200) |
787 |
|
Ultrasound-each 15 min (70702095) |
65 |
| Critical Care,each addl 30mi (61204205) |
124 |
|
Whirlpool (70702035) |
86 |
| Nursery Intensive (60302100) |
|
|
|
|
| |
|
|
|
|
| RADIOLOGY: |
| GD-Chest-Standard Pa & Lat (70417001) |
$ 182 |
|
Incentive Spirometry (70809360) |
$ 134 |
| GD-Chest single view only (70417203) |
150 |
|
Arterial Blood Gas (70319345) |
174 |
| Mammograpy, screening (98500000) |
110 |
|
C-Pap Daily (70809570) |
232 |
| DTMC 11-19 MEV (704877540) |
569 |
|
IPPB/SA Sub/treat. (70809350) |
58 |
| CT-Head brain w/o Contrast (70420100) |
871 |
|
Pulse Oximetry Single (70809372) |
60 |
| DTM - Complex (704877410) |
634 |
|
Spirometry (70809332) |
83 |
| Abdominal series w/PA chest (70413130) |
330 |
|
Cardiac Rehab (70852007) |
120 |
| CT-Abdomen W & W/O Contrast (70420920) |
1401 |
|
Pulmonary Stress Test (70851014) |
317 |
| CT-Pelvis W & W/O Contrast (70421020) |
1401 |
|
Sleep Study, NPT protocol (70951025) |
1910 |
| PortFilm Inter & Verific (704877415) |
260 |
|
Sleep Study, Polysomnography (70951010) |
1739 |
| Device coplex (704877334) |
993 |
|
|
|
| GD-Spine/Lumber-Min 4 views (70417011) |
283 |
|
LAB: |
| FL-Reposit Feed Tube Up to 1 hr (70413855) |
316 |
|
CBC auto diff platelet (70358765) |
$ 64 |
| Mammography,Bilateral (98500045) |
273 |
|
Comprehensive metabolic (70319710) |
146 |
| Basic Calculation (704877300) |
349 |
|
T4 (70318911) |
64 |
| Continuing Phy Consult Weekly (704877336) |
289 |
|
Liver Profile (70319605) |
97 |
| GD-Spine-cervical min 4 views (70417014) |
248 |
|
Arterial Blood Gases (70319345) |
174 |
| CT-Pelvis w/o contrast (70421000) |
871 |
|
Magnesium (70318723) |
51 |
| CT-Abdomen w/o contrast (70420900) |
871 |
|
Electrolyte Panel (70319340) |
68 |
| US-Abdomen (70437069) |
594 |
|
HC-A1C (70318677) |
78 |
| CT-Thorax w & w/o contrast (70422095) |
1401 |
|
lipid Hcr Profile (70319257) |
80 |
| MR-Pituitary w & w/o contrast (70441155) |
2380 |
|
Hematocrit (HCT) (70358681) |
26 |
| GD-Knee right 4 or more views (70418075) |
234 |
|
Troponin I (70319595) |
119 |
| GD-Knee left 4 or move views (70418070) |
234 |
|
Hemoglobin (HGB) (70358669) |
26 |
| Echo for radiation Tx Fields (704876950) |
214 |
|
CKMB (70319365) |
96 |
| NM-MIBI Spect-Stress-Seq (70456080) |
2194 |
|
Blood Urea Nitrogen (70318744) |
58 |
| US-Pelvic (70437068) |
387 |
|
Creatinine-Serum (70318664) |
53 |
| US-Breasts-Bilateral (70437300) |
465 |
|
Cell Block-TC (70331020) |
57 |
| NM-Bone Scan Whole Body (70457121) |
1005 |
|
Glucose (70318726) |
53 |
| IM-Dxa Scan (central) (98500005) |
299 |
|
TSH (70318914) |
88 |
| |
|
|
Blood Culture (70368922) |
88 |
| |
|
|
Routine Culture (70368995) |
77 |
| |
|
|
Routine Urinalysis (70379025) |
51 |
| |
|
|
Microbe Susceptible,Mic (70369004) |
54 |
| |
|
|
Urine Ketone (70378918) |
29 |
| |
|
|
Cross Match (70398740) |
94 |
| |
|
|
(RCR) ABO typing (70392200) |
46 |
| |
|
|
Prothrombin (70386954) |
21 |
| |
|
|
Phosphorus (70318694) |
37 |
| |
|
|
APTT (70357010) |
52 |
| |
|
|
Culture Bacteria Aerobic (70361010) |
66 |
| |
|
|
Basic metabolic (70319236) |
79 |
