Patient Price Information | ProMedica Memorial Hospital
In compliance with state law, Memorial Hospital is providing this price list containing our charges for room and board, emergency department, operating room, delivery, physical therapy and other procedures. The hospital's charges are the same for all patients, but a patient's responsibility may vary, depending on payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our admitting and billing staff to determine whether they qualify for discounts. These prices are correct as of 01/01/2015. .
The following list does not include charges for anesthesia, drugs, or supplies required for a particular delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician.
|Labor and Delivery Charges|
|Cesarean Section Delivery||$12,208.00|
|Outpatient Evaluation, Simple (in Labor & Delivery)||$132.25|
|Room & Bed OB||$1019.00|
|Room and Board - Per Day Charges|
|Stepdown with telemtry||$1,700.00|
|Stepdown without telemetry||$1019.00|
|Pediatric Unit Isolation||$1133.00|
Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees for Emergency Department physicians, who will bill separately for their services.
|Emergency Department Charges|
|Low Level ER E/M||$148.50|
|Low/Mod Level ER E/M||$295.75|
|Mod Level ER E/M||$528.25|
|Mod High Level ER E/M||$613.75|
|High Level ER E/M||$886.50|
|Critical Care ER E/M||$1781.25|
Operating Room charges are based on the complexity level, with level 1 being the most basic, for a particular operation There is an initial, set-up charge as well as an additional charge for each 15 minutes while the operation is being performed.
|Operating Room Charges|
The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.
|Physical Therapy Charges|
|Electrical simulation - ea 15 min.||$59.75|
|Functional activities - ea 15 min.||$65.00|
|Gait training - ea 15 min.||$83.00|
|Comprehensive initial evaluation||$256.25|
|Massage - ea 15 min.||$56.75|
|Phoresor - ea 15 min.||$148.50|
|Ultrasound - ea 15 min.||$65.00|
The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.
|Occupational Therapy Charges|
|Activities of daily living/function activities training||$152.75|
|Neuromuscular facilitation training||$108.25|
|Ultrasound - ea 15 min.||$65.00|
The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.
|Pulmonary Therapy Charges|
|Arterial blood gas||$351.00|
|Metered dose inhaler trtmnt-initial||$53.75|
|Metered dose inhaler trtmnt-subseq.||$47.00|
|Nebulizer treatment initial||$105.25|
|Nebulizer treatment subsequent||$87.50|
The following charges reflect the hospital's 30 most common x-ray and radiological procedures.
|X-Ray and Radiological Charges|
|CT - Abdomen with/without contrast||$2,118.75|
|CT - Abdomen without contrast||$1,233.00|
|CT - Head without contrast||$1143.25|
|CT - Pelvis without contrast||$1,233.00|
|CT - Pelvis, with contrast||$1,942.50|
|CT - Thorax-pe study||$1,392.50|
|NM - Myocardial perf w/ wall motion||$328.75|
|NM - Myocardial perf w/ef||$328.75|
|NM - Spect cardiac imaging||$2,211.00|
|Rad - Abdomen single view||$220.00|
|Rad - Acute abd series abd2 chest 1||$501.75|
|Rad - Ankle complete||$215.25|
|Rad - Cervical spine, ap & lateral||$267.75|
|Rad - Chest, 1 view||$179.50|
|Rad - Chest, 2 views||$253.75|
|Rad - Dexa bone density study||$330.75|
|Rad - Foot||$200.75|
|Rad - Hand||$183.25|
|Rad - Hip||$235.25|
|Rad - Knee - ap, lat, obli||$166.50|
|Rad - Lumbar spine/oblique||$401.00|
|Rad - Mammogram - Digital Bilateral Screening||$190.00|
|Rad - Pelvis||$219.25|
|Rad - Shoulder||$213.50|
|Rad - Wrist||$201.50|
|US - Abdominal echogram - limited||$852.50|
|US - Pelvic echogram||$808.25|
|US -Complete pregnancy echogram||$820.75|
The following charges reflect the hospital's 30 most common laboratory procedures.
|Bld urea nitrogen (BUN)||$100.25|
|Blood group (abo)||$16.75|
|CBC complete bld cnt w/plate.||$78.50|
|Cf carrier screen 4||$8.50|
|Ck-mb cardiac series #1||$199.25|
|Collection-by lab personnel||$17.50|
|Comprehensive metabolic panel||$320.75|
|Hepatic function panel||$144.75|
|Myoglobin, serum quant||$199.00|
|PTT Correction Studies
|Prothrombin time (PT/INR)||$84.00|
|Thyroid stim hormone (TSH)||$119.75|
|Urinalysis non-auto with scope
Hospital Billing Notices
- While we do our best at Memorial Hospital to assist you any way that we can, it is important that you understand your specific coverage. Whether you have commercial insurance, Medicare, or Medicaid, we recommend that you contact your carrier in advance to clarify your benefits.
- It is important that you bring your insurance card, policy information, or government assistance program cards at the time of registration. We will verify your benefits for inpatient, outpatient observation and outpatient surgeries.
- Some insurance companies require patients to obtain pre-certification for other outpatient services (i.e., number of physical therapy visits, CT scans, MRIs, ER, etc,). This is the responsibility of the patient. Pre-certification phone numbers can often be found listed on your insurance card.
- We will bill the appropriate insurance company or agency on your behalf for all claims. The patient or guarantor is responsible for any portion not covered by insurance, Medicare, or Medicaid.
- Patient Account Representatives are available to discuss your account with you. If you have any questions about your hospital bill, or about our billing and credit policy, please feel free to call our Business Office at 419-334-6600.
Consumers can access a number of government and private Websites, which provide additional information on hospitals' charges and quality. For a complete listing of available online resources, please visit the Consumer's Guide to Quality Health Care in Ohio.