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Patient Price Information List |
| In compliance with state law, The Bellevue 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 01/01/08.Your
charges may vary dependent on what your physician requests. |
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| Room and Board -- Per Day Charges |
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Charges |
| Intensive care |
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1,153.50 |
| Routine care |
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637.75 |
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Birthing
Room |
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804.65 |
| Nursery |
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418.40 |
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| Labor and Delivery Charges |
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| 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. |
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Charges |
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Normal Delivery Mom |
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6,000.00 - 7,000.00 |
Average cost |
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Cesarean Section Delivery Mom |
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8,100.00 - 9,000.00 |
Average cost |
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Normal Delivery Baby |
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1,300.00 - 1,600.00 |
Average cost |
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Cesarean Section Delivery Baby |
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1,600.00 - 1,800.00 |
Average cost |
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Amniocentesis |
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546.05 |
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Fetal Monitor Non Stress |
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226.95 |
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Fetal Monitor Stress |
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412.65 |
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Fetal Monitor Labor |
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244.55 |
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| Emergency Department Charges |
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| 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. |
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Charges |
Physician Charge |
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Level 1 |
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178.05 |
57.55 |
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Level 2 |
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178.08 |
89.85 |
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Level 3 |
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317.70 |
119.10 |
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Level 4 |
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541.00 |
236.30 |
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Level 5 |
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541.00 |
362.25 |
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Critical care |
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1225.55 |
543.55 |
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| Operating Room Charges |
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| Operating Room charges are based on the complexity level, with level 1
being the most basic, for a particular operation This time is charged
per minute. |
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Charge per minute |
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Special Procedure |
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30.40 |
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Operating Room |
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55.50 |
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| Physical Therapy Charges |
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| The following charges reflect the most common services offered by our
Physical Therapy department. Patients may have additional charges,
depending on the services performed. |
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Elec Stim with pack |
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124.45 |
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Eval 21-40 minutes |
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116.30 |
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Exercise |
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62.40 |
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Gait Training |
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34.95 |
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Hydrotherapy 15 minutes |
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64.55 |
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Manual Exercise |
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49.20 |
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Ultrasound |
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62.40 |
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Eval - 20 minutes |
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58.25 |
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| Occupational Therapy Charges |
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| The following charges reflect the most common services offered by our
Occupational Therapy department. Patients may have additional charges,
depending on the services performed. |
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Evaluation 21-40 minutes |
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116.30 |
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FCE |
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96.85 |
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Paraffin bath |
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61.05 |
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Self care home maint. 15min |
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61.05 |
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Theraputic Procedure |
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61.05 |
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Ultrasound |
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61.05 |
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| Pulmonary Therapy Charges |
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| The following charges reflect the most common services offered by our
Pulmonary Therapy department. Patients may have additional charges,
depending on the services performed. |
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CPT subsq |
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40.30 |
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Hand held nebulizer initial |
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37.80 |
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Hand held nebulizer subsq |
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40.30 |
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SP O2 Proc Pulse Ox |
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12.60 |
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IPPB Sub |
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40.30 |
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| X-Ray and Radiological Charges |
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| The following charges reflect the hospital's 30 most common x-ray and
radiological procedures. There is an additional cost for contrast
material that is used for certain procedures. |
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CT Abd w contrast |
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1,199.75 |
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CT Abd w/wo contrast |
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1,347.80 |
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CT abd wo contrast |
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1,026.70 |
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CT Head wo contrast |
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1,136.65 |
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CT Maxofacial wo contrast |
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970.35 |
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CT Pelvis w contrast |
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1,194.45 |
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CT pelvis wo contrast |
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1,021.40 |
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MRI Brain w wo contrast |
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3,021.45 |
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MRI L spine wo contrast |
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2,320.70 |
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Nuclear Medicine Cardiac Tomog Spectm |
1,692.80 |
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Nuclear Medicine Myocardial per/eject |
673.75 |
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Nuclear Medicine Myocardial perf/w MOT |
673.75 |
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Radiology Abd Flat upright chest |
301.70 |
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Radiology Ankle Min 3 view |
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184.25 |
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Radiology bilat mamm diag w CAD |
218.20 |
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Radiology bilat mamm screen w CAD |
150.55 |
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Radiology Chest 1 view |
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96.00 |
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Radiology Chest 2 view |
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165.20 |
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Radiology Cineradiograph |
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420.00 |
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Radiology Dexa Bone Density |
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270.65 |
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Radiology Foot Min 3 view Lt |
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185.05 |
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Radiology Foreign body eye |
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96.85 |
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Radiology Hand min 3 view Rt |
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185.05 |
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Radiology KUB 1 view |
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96.00 |
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Radiology L spine/min 4 views |
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308.50 |
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Ultrasound Breast |
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458.35 |
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Ultrasound Carotid Arteries Bil |
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977.70 |
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Ultrasound Gallbladder |
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472.75 |
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Ultrasound Pelvis |
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472.75 |
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Ultrasound Pelvis Transvaginal |
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427.85 |
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| Laboratory Charges |
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| The following charges reflect the hospital's 30 most common laboratory
procedures. |
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Amylase |
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55.95 |
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BNP |
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101.40 |
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BUN |
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21.00 |
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CBC auto diff |
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58.65 |
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CBC W manual diff |
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58.65 |
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CKMB |
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147.60 |
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CPK |
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49.45 |
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Creatinine |
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21.00 |
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Culture urine |
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39.50 |
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Differential manual |
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10.25 |
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Direct LDL |
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50.50 |
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Electrolytes |
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84.00 |
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Free T3 |
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99.15 |
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Free T4 |
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85.30 |
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Glucose blood |
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21.00 |
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Glycohemoglobin |
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113.55 |
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Hemogram H&H |
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56.40 |
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Lipid Profile |
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92.95 |
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Liver Profile |
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160.05 |
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Myoglobin |
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85.40 |
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Profile 14 |
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307.05 |
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Profile 8 |
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168.00 |
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Protime |
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45.05 |
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PTT |
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45.50 |
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Sedrate westergate |
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38.00 |
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Troponin |
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85.40 |
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TSH |
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87.10 |
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Urinalysis C&S if indicated |
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27.05 |
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Urinalysis micro |
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10.25 |
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Urinalysis w/o micro |
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27.05 |
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| Hospital Billing Policies |
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The
Bellevue Hospital is a community based, non-profit hospital. We are
committed to providing the best quality care to our community at the
lowest possible price regardless of ability to pay. Our charges are
the same for all patient's, but your responsibility may vary,
depending on payment plans negotiated with individual health
insurers. The hospital will bill your insurance company directly for
your services. The Bellevue Hospital does not charge interest on
patient accounts. If you are uninsured or underinsured, please
contact our Patient Accounting staff at 418-483-4040, extension 4237
to determine if you qualify for discounts or extended payment
arrangements.
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| 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 at
www.ohanet.org/portal. |
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