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: |
| Med/Surg (60825500) |
$ 650 |
OPERATING ROOM: |
| Telemetry (60821500) |
750 |
Major OR Room, 15 minutes (61000701) |
$ 1327 |
| Pediatric (60601239) |
650 |
Major OR Room, 8 hrs or over (61000717) |
8469 |
| Physical Rehab (60201100) |
650 |
Cardiac OR Room, 30 minutes (61051000) |
1764 |
| Mental Health (61801212) |
700 |
Cardiac OR Room, 12 hrs or over(61051115) |
13760 |
| Addiction Rec.Detox (61701212) |
700 | |
| Addiction Rec.Rehab (61702212) |
700 |
PHYSICAL THERAPY: |
| Skilled Nursing Fac.(60801212) |
350 |
Aquatic Therapy, each 15 min. (70651335) |
$ 96 |
| Nursing Facility (60901414) |
220 |
Debridement, each 15 min. (70651485) |
116 |
|
Functional Activity each 15 mi (70651135) |
90 |
|
Gait Training-each 15 mi (70651130) |
90 |
|
Group Exercises 15 mi (70653012) |
90 |
|
Orthotics Fitting & Train 15 (70653005) |
90 |
| Intensive Care Unit (60531600) |
975 |
Pt Evaluation (70651545) |
216 |
| Coronary Care Unit (60502105) |
975 |
Pt Re Evaluation (70651360) |
90 |
| Coronary Care Unit Post OP (60451000) |
2400 |
Ultrasound-ea 15 min (70651080) |
90 |
| Family Birth Center (60301123) |
650 |
Whirlpool (70651035) |
90 |
| Nursery Regular (60301714) |
560 |
|
|
| Nursery Intermediate (60302070) |
580 |
OCCUPATIONAL THERAPY: |
| Nursery Intensive (60302100) |
590 |
Debridement-each 15 min (70702550) |
$ 116 |
|
Functional Activities ea 15m (70704025) |
68 |
|
Functional Gait Training 15 m (70704035 |
90 |
|
Group Therapeutic Exercise (70704030) |
68 |
|
Orthotics Fit/Training 15 mi (70702080) |
66 |
|
OT Evaluation (70704150) |
216 |
|
OT Re-evaluation (70704060) |
133 |
|
Paraffin Bath (70702030) |
80 |
|
Ultrasound-each 15 min (70702095) |
68 |
|
Whirlpool (70702035) |
90 |
| |
|
|
PULMONARY/RESPIRATORY: |
| EMERGENCY DEPARTMENT: |
Incentive Spirometry (70809360) |
$ 148 |
| ED Level 1 (61203030) |
$ 70 |
Arterial Blood Gas (70319345) |
191 |
| ED Level 2 (61209930) |
137 |
C-Pap Daily (70809570) |
255 |
| ED Level 3 (61209931) |
281 |
IPPB/SA Sub/treat. (70809350) |
64 |
| ED Level 4 (61209932) |
434 |
Pulse Oximetry Single (70809372) |
66 |
| ED Level 5 (61209933) |
599 |
Spirometry (70809332) |
92 |
| Critical Care,1st 60 minutes (61204200) |
864 |
Cardiac Rehab (70852007) |
125 |
| Critical Care,each addl 30mi (61204205) |
137 |
Pulmonary Stress Test (70851014) |
329 |
| |
Sleep Study, NPT protocol (70951025) |
2096 |
| |
Sleep Study, Polysomnography (70951010) |
1908 |
| |
|
| RADIOLOGY: |
LAB: |
| GD-Chest-Standard Pa & Lat (70417001) |
$ 201 |
CBC auto diff platelet (70358765) |
$ 75 |
| GD-Chest single view only (70417203) |
166 |
Comprehensive metabolic (70319710) |
162 |
| Mammograpy, screening Digtal (98504000) |
182 |
T4 (70318911) |
72 |
| DTMC 11-19 MEV (704877540) |
607 |
Liver Profile (70319605) |
108 |
| CT-Head brain w/o Contrast (70420100) |
957 |
Arterial Blood Gases (70319345) |
191 |
| DTM - Complex (704877410) |
677 |
Magnesium (70318723) |
57 |
| Abdominal series w/PA chest (70413130) |
363 |
Electrolyte Panel (70319340) |
76 |
| CT-Abdomen W & W/O Contrast (70420920) |
1539 |
HC-A1C (70318677 |
86 |
| CT-Pelvis W & W/O Contrast (70421020) |
1539 |
lipid Hcr Profile (70319257) |
88 |
| PortFilm Inter & Verific (704877415) |
279 |
Hematocrit (HCT) (70358681) |
30 |
| Device coplex (704877334) |
1059 |
Troponin I (70319595) |
132 |
| GD-Spine/Lumber-Min 4 views (70417011) |
311 |
Hemoglobin (HGB) (70358669) |
30 |
| FL-Reposit Feed Tube Up to 1 hr (70413855) |
348 |
CKMB (70319365) |
106 |
| Mammography,Bilateral (98500045) |
283 |
Blood Urea Nitrogen (70318744) |
65 |
| Basic Calculation (704877300) |
373 |
Creatinine-Serum (70318664) |
59 |
| Continuing Phy Consult Weekly (704877336) |
309 |
Cell Block-TC (70331020) |
66 |
| GD-Spine-cervical min 4 views (70417014) |
273 |
Glucose (70318726) |
59 |
| CT-Pelvis w/o contrast (70421000) |
957 |
TSH (70318914) |
98 |
| CT-Abdomen w/o contrast (70420900) |
957 |
Blood Culture (70368922) |
102 |
| US-Abdomen (70437069) |
652 |
Routine Culture (70368995) |
88 |
| CT-Thorax w & w/o contrast (70422095) |
1539 |
Routine Urinalysis (70379025) |
59 |
| MR-Pituitary w & w/o contrast (70441155) |
2612 |
Microbe Susceptible,Mic (70369004) |
62 |
| GD-Knee right 4 or more views (70418075) |
258 |
Urine Ketone (70378918) |
35 |
| GD-Knee left 4 or move views (70418070) |
258 |
Cross Match (70398740) |
109 |
| Echo for radiation Tx Fields (704876950) |
229 |
(RCR) ABO typing (70392200) |
53 |
| NM-MIBI Spect-Stress-Seq (70456080) |
2408 |
Prothrombin (70386954) |
25 |
| US-Pelvic (70437068) |
426 |
Phosphorus (70318694) |
42 |
| US-Breasts-Bilateral (70437300) |
511 |
APTT (70357010) |
60 |
| NM-Bone Scan Whole Body (70457121) |
1104 |
Culture Bacteria Aerobic (70361010) |
77 |
| IM-Dxa Scan (central) (98500005) |
310 |
Basic metabolic (70319236) |
87 |
