Patient Price Information List

In compliance with state law, Wilson 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 January 1, 2011.

Room and Board, Per Day Charges
			Charges
Critical Care Unit			$1,147.00
Medical/Surgical
	Telemetry Semi-Private/Private		$819.00
	Med/Surg Semi-Private/Private		$625.00
Pediatrics
	Semi-Private		$543.00
	Private		$581.00
Birth Center
	Obstetrics		$660.00
	Nursery		$531.00
	Neonatal		$1,100.00
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.
			Charges
Normal Delivery			$2,958.00
Cesarean Section Delivery			$4,980.35

Emergency Department Charges
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. The patient can expect to receive a separate bill from the Emergency department physician.
			Charges
Level 1			$133.00
Level 2			$220.00
Level 3			$370.00
Level 4			$585.00
Level 5			$865.00
Level 6			$1,175.00

Operating Room Charges
Operating Room Services are charged based on each procedure performed. Listed below are the top 30 procedures and their price. The folowing list does not include anesthetic material, drugs or supplies required for a particular Operating Room procedure. The patient can expect to receive a separate bill from the Anesthesiologist, Pathologist, and Surgeon in relation to the surgery.
				Charges
Colonoscopy				$2,200.00
Upper GI Endoscopy				$2,200.00
Hysteroscopy, Biopsy				$3,810.00
Endometrial Ablation, Thermal				$6,275.00
Laparoscopic Cholecystectomy				$7,895.00
Knee Arthroscopy				$5,045.00
Laparoscopy, Tubal Block				$7,895.00
Repair of Wound or Lesion				$750.00
Laparoscopic Appendectomy				$7,895.00
Care of Miscarriage				$3,380.00
Total Knee Replacement				$20,168.00
Carpal Tunnel				$3,155.00
Bilateral Tubal Occlusion with Filshie Clip				$3,435.00
Laparoscopic Supracervical Hysterectomy				$12,295.00
After Cataract Surgery				$895.00
Shoulder Arthroscopy				$5,045.00
Arthroscopic Shoulder Acromioplasty				$8,230.00
Excision of Skin Lesion - Face - 1.1-2.0 cm				$1,385.00
Excision of Benign Lesion - 1.1-2.0 cm				$740.00
Lysis of Adhesions				$2,970.00
Skin Tissue Rearrangement				$2,710.00
Hysteroscopy, Diagnostic, Separate Procedure				$3,810.00
Laparoscopy, Excise Lesions				$7,895.00
Laparoscopic Assisted Vaginal Hysterectomy				$12,295.00
Diagnostic Laparoscopy				$6,415.00
Laparoscopy, Remove Adnexa				$7,895.00
Repair Bladder Defect				$7,585.00
Insertion of Tunneled Central Venous Device				$5,130.00
Inguinal Hernia Repair				$5,390.00
Closed Biopsy of Bronchus				$3,825.00

Physical Therapy 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.
		Charges			Charges
Therapeutic Exercises - 15 mins.		$80.00	Massage - 15 mins.		$80.00
Ultrasound - 15 mins.		$80.00	Gait Training - 15 mins.		$80.00
Therapeutic Activities - 15 mins.		$80.00	Manual Therapy Techniques - 15 mins.		$80.00
Aquatic Therapy - 15 mins.		$80.00	Electrical Stimulation (Unattended)		$80.00
Initial Evaluation		$180.00	Traction		$80.00
Work / Physical Conditioning		$300.00

Occupational Therapy Charges
The following charges reflect the most common services offered by our Occpational Therapy department. Patients may have additional charges, depending on the services performed.
				Charges
Initial Evaluation				$180.00
Therapeutic Procedure - 15 min.				$80.00
Ultrasound- 15 mins.				$80.00
Self Care/Home Mgmt Training				$80.00
Therapeutic Exercise - 15 mins.				$80.00

Speech Therapy Charges
The following charges reflect the most common services offered by our Speech Therapy department. Patients may have additional charges, depending on the services performed.
				Charges
Speech Therapy				$205.00
Dysphagia Therapy				$205.00
Modified Barium Swallow				$305.00
Dysphagia Clinical Evaluation				$305.00
Evaluation - Speech/Language/Voice				$310.00

Cardiopumonary Charges
The following charges reflect the most common services offered by our Cardiopulmonary department. Patients may have additional charges, depending on the services performed.
		Charges			Charges
Medicated Dose Inhaler Subsequent		$28.00	Initial Respiratory Treatment Education		$131.00
Medicated Nebulizer Subsequent		$60.05	EKG		$150.00
Oxygen Charge for 12 Hours		$54.65	Oximetry Single Determination		$34.90
Arterial Puncture Collection		$47.40	Aterial Blood Gases		$113.35
Cardio Stress Test - Treadmill		$630.00

X-Ray and Imaging Charges
The following charges reflect the hospital's 30 most common x-ray and radiological procedures. Fees for physician interpretation services are not reflected, and will be billed separately by your physician.
		Charges			Charges
Chest Two View		$227.00	Abdomen, CT With Contrast		$1,300.00
Mammogram Screening (including CAD reading)		$194.00	Pelvis, CT With Contrast		$1,300.00
Chest, Portable 1 View		$152.00	Dexa Bone Density		$378.00
Head, CT Without Contrast		$1,100.00	Abdomen, KUB Flat Plate 1 View		$168.00
Echo, 2-D (including Color Dopplar Mapping and Pulse Wave)		$1,294.00	Abdomen, CT Without Contrast		$1,100.00
Knee X-Ray, 3 views		$171.00	Shoulder X-Ray		$179.00
Ultrasound, Pelvis (including Transvaginal Ultrasound other than OB)		$940.00	Ultrasound, Venous Duplex Unilateral		$356.00
Hand X-Ray		$179.00	Pelvis, CT Without Contrast		$1,100.00
Acute Abdomen Series		$324.00	Mammogram Diagnostic, Bilateral (including CAD reading)		$282.00
Cardiac Stress/Rest (including Myocardial Wall Motion and Ejection Fraction)		$2,100.00	Ultrasound, Carotid Bilateral		$765.00
Ultrasound, Abdominal Aorta		$542.00	Wrist X-Ray		$179.00
Foot X-Ray		$179.00	Lumbar Spine, 2 or 3 views		$258.00
Ankle X-Ray		$179.00	Abdomen, CT With and Without Contrast		$1,500.00
Chest, CT With Contrast		$1,300.00	Ultrasound, Breast		$412.00
Mammogram Unilateral (Including CAD reading)		$209.00	MRI Lumbar Spine Without Contrast		$2,000.00

Laboratory Charges
The following charges reflect the hospital's 30 most common laboratory procedures.
Complete blood count (CBC)		$64.00	Glucose		$32.00
Comprehensive metabolic profile		$175.00	Surgical Pathology Level 4		$187.00
Basic metabolic profile		$100.00	Electrolytes Panel		$53.00
Prothrombin Time		$33.00	Free Thyroxine		$74.00
Lipid Panel		$128.00	CKMB Z		$75.00
Urinalysis		$20.00	Urine Pregnancy Test		$84.00
TSH		$137.00	Biochemical Profile Negative Organism		$66.00
Magnesium		$48.00	Blood Culture		$85.00
Troponin		$81.00	Sedimentation Rate		$29.00
Creatinine		$42.00	Hemoglobin		$20.00
Urine Microscopic		$45.00	Lipase		$57.00
Partial Thromboplastin Time		$49.00	Hematocrit		$20.00
Urine Culture		$66.00	Amylase		$53.00
Hepatic Function Panel		$94.00	Creatine Kinase (CK)		$54.00
Hemoglobin A1C		$80.00	Urea Nitrogen		$33.00

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.ohiohealthcareguide.org/.

Patient Price Information List

Room and Board, Per Day Charges

Emergency Department Charges

Operating Room Charges

Physical Therapy Charges

Occupational Therapy Charges

Speech Therapy Charges

Cardiopumonary Charges

X-Ray and Imaging Charges

Laboratory Charges