Effective July 1, 2016
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- Aubrie Johns
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1 University of Cincinnati Medical Center Patient Price Information List In compliance with state law, UC Health is providing this price list containing our room and board, emergency room, operating room, delivery, physical therapy, observation 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 a hospital financial counselor to determine if they qualify for discounts. Effective July 1, 2016 ROOM and BOARD - Per Day Charges Private Semi- Private Medical/Surgical Room $ 1, $ 1, Labor & Delivery $ 1, Psychiatric/Chemical Dependency $ 1, Stepdown - Medical/Surgical $ 3, Stepdown - Cardiac $ 3, Medical Intensive Care Unit (ICU) $ 8, Surgical Intensive Care Unit (ICU) $ 8, Cardiac Intensive Care Unit (ICU) $ 8, Burn Intensive Care Unit (ICU) $ 9, Neuroscience Intensive Care (ICU) $ 8, Trauma Intensive Care Unit (ICU) $ 9, Newborn - Normal $ 3, Newborn - Level 2 Continuing Care $ 3, Newborn - Intermediate $ 5, Newborn Intensive Care (ICU) $ 8, OBSERVATION RATES Private Semi- Private Observation Initial Hour $ 1, Observation - Each Additional Hour $ 81.00
2 EMERGENCY ROOM SERVICES 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 Unit (EU) - Level 1 $ Emergency Unit (EU) - Level 2 $ Emergency Unit (EU) - Level 3 $ 1, Emergency Unit (EU) - Level 4 $ 1, Emergency Unit (EU) - Level 5 $ 2, Emergency Unit (EU) - Critical Care $ 5, Emergency Unit (EU) - Trauma Consult $ 4, Emergency Unit (EU) - Trauma Response $ 6, OPERATING ROOM SERVICES The following list does not include charges for anesthesia, drugs, or supplies required for a particular operating room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician. Operating Room-Minor Procedure-1st Half Hour $ 6, Operating Room-Major Procedure-1st Half Hour $ 7, Operating Room-Major Procedure-Each Additional Minute $ Operating Room-Complex Procedure-1st Half Hour $ 7, Operating Room-Complex Procedure-Each Additional Minute $ Operating Room-Trauma Procedure-1st Half Hour $ 9, Operating Room-Trauma Procedure-Each Additional Minute $ DELIVERY ROOM The following list does not include charges for anesthesia, drugs, or supplies required for a delivery room procedure. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by your physician. Cesarean Section Delivery $ 9, Vaginal Delivery $ 8,089.00
3 RADIOLOGY CHARGES The following list reflects the hospital's 30 most common radiological procedures. Diagnostic Outpatient Inpatient MRI - Head (with and without contrast) $ 3, $ 5, MRI - L Spine (without contrast) $ 2, $ 3, CT - Abdomen (without contrast) $ 1, $ 2, CT - Head (without contrast) $ 1, $ 1, CT - Abdomen (with contrast) $ 2, $ 2, CT - Pelvis (with contrast) $ 2, $ 2, CT - Chest (with contrast) $ 1, $ 2, CT - C Spine (without contrast) $ 1, $ 2, CT - L Spine (without contrast) $ 2, $ 2, US - Abdomen (complete) $ $ 1, US - OB Re-Eval Abnormality $ $ US - Breast(s) $ $ US - Guide Needle Placement $ $ 1, Mammography Screening Direct Digital $ $ Screening Mammography CAD $ $ Mammography Bilateral Diagnostic $ $ Abdomen - KUB & Erect $ $ Abdomen - Flat, Up/Decub & P $ $ Abdomen - Single view $ $ Ankle - Minimum 3 views $ $ C Spine - 2 or 3 views $ $ Chest - PA & Lateral $ $ Chest - PA or AP $ $ Fluoro up to 1 hour $ $ Foot - Minimum 3 views $ $ Hand - Minimum 3 views $ $ Knee - up to 2 views $ $ LS Spine - AP & Lateral $ $ Pelvis 1 or 2 view $ $ Shoulder - min 2 views $ $ Wrist - Minimum 3 views $ $ Bone Imaging Whole Body $ 1, $ 2, DXA Scan Axial Skelton $ $
4 LABORATORY CHARGES The following list reflects the hospital's 30 most common laboratory procedures. ABO Type $ Antibody Screen, ea incubation $ Basic Metabolic Panel $ Bilirubin- Direct $ Blood Gas $ CK (CPK) $ Complete Blood Count (CBC) - With differential, automated $ Complete Blood Count (CBC) - Without differential $ Comprehensive Metabolic Panel $ Crossmatch, Electronic $ Culture, Blood $ Culture, Urine $ Lactic Acid, Blood $ Lipid Profile $ Magnesium, Serum $ Partial Thromboplastin Time (PTT) $ Phosphorus, Serum $ POC PC02 $ POC Chloride $ POC Creatinine $ POC Glucose Monitoring $ - POC Glucose Quant Blood except reg strip $ POC HCG- Qualitative, Urine $ POC Potassium $ POC Sodium $ POC Urea Nitrogen, quant $ POC Urinalysis $ Prothrombin Time (PT) $ Renal Function Panel $ RH Factor $ Surgical Pathology Level 4, Gross & Micro $ Thyroid Stimulating Hormone $ Troponin $ Urinalysis- With Microscopic $ Phlebotomy $ 26.00
5 PHYSICAL THERAPY CHARGES The following charges reflect the most common services offered by our Physical Therapy Physical Therapy Evaluation $ Gait Training - 15 minutes $ Neuromuscular Reeducation $ Therapeutic Exercise - 15 minutes $ Therapeutic Activities - 15 minutes $ Electrical Stimulation (attended) - 15 minutes $ OCCUPATIONAL THERAPY CHARGES The following charges reflect the most common services offered by our Occupational Therapy Therapeutic Activities - 15 minutes $ Occupational Therapy Evaluation $ Therapeutic Exercise - 15 minutes $ Self Care / ADL 15 minutes $ RESPIRATORY THERAPY The following charges reflect the most common services offered by our Respiratory Therapy Ventilator - Assist and Manage - Initial $ 1, Ventilator - Assist and Manage - Addt'l day $ 1, Oximetry - Continuous $ Hand Held Nebulizer Treatment $
Patient Price Information List
Patient Price Information List In compliance with state law, The Christ Hospital is providing this price list containing our charges for room and board, emergency department, operating room, delivery,
Patient Price Information List
Patient Price Information List In compliance with state law, Trinity Hospital Twin City is providing this price list containing our charges for room and board, emergency department, operating room, physical
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum EHP Network Provider Out of Network Provider Individual $150 $150 Family $450 $450 Individual $3000 $3000 Family $9000 $9000 Unlimited Acupuncture
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum EHP Network Provider Out of Network Provider Individual $150 $150 Family $450 $450 Individual $3000 $3000 Family $9000 $9000 Unlimited Acupuncture
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum Hopkins Affiliated Facility Network (facility charges only) EHP Network Provider Individual $500 $500 Family $1000 $1000 Individual $3000 (combined
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum EHP Network Provider Out of Network Provider Individual $250 $500 Family $750 $1500 Individual $2000 $4000 Family $6000 $12000 Unlimited Acupuncture
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum Individual Family Individual Family Hopkins Preferred Network Provider EHP Network Provider Out of Network Provider $150 (under $50K) / $200
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Plan Year Deductible Out-of-Pocket Maximum Lifetime Maximum EHP Network Provider Out of Network Provider Hopkins Preferred Network Provider Individual $100 $750 $0 Family $200 $1500 $0 Individual $2000
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SCHEDULE OF BENEFITS ADVANTAGE PANTHER GOLD PLAN Enhanced Access HMO Applies to Oakland, Johnstown, and Titusville campuses This document is called a Schedule of Benefits. It is part of your Certificate
SCHEDULE OF BENEFITS UPMC HEALTH PLAN PANTHER PREMIER PPO
SCHEDULE OF BENEFITS UPMC HEALTH PLAN PANTHER PREMIER PPO This document is called a Schedule of Benefits. It is part of your Certificate of Coverage or your Summary Plan Description. Your Schedule of Benefits
International Healthcare Comparison Plans Expat Standard, Comfort & Premium Plan 2013
Epat Standard, Comfort & Premium Plan 2013 Epat Standard, Comfort & Premium Plan 2013 Maimum Lifetime Plan Benefit $USD $400,000,000,000,000,000 Annual Maimum Plan Benefit $USD $400,000,000,000 $2,000,000
CERTIFICATE OF INSURANCE
CERTIFICATE OF INSURANCE A complete explanation of Your plan Bronze 60 PPO 6300/75+Child Dental Important benefit information please read Dear Health Net Covered Person: Thank you for choosing Health
Emergency Department: $175 Copayment per visit Coinsurance: 0%
Schedule of Benefits UPMC Small Business Advantage Primary Care Provider: $25 Copayment per visit Gold PPO $1,000 $25/$50 - Premium Network Specialist: $50 Copayment per visit Deductible: $1,000 / $2,000
Schedule of Benefits. Plan Information Participating Provider Non-Participating Provider Benefit Period
Schedule of Benefits Duquesne University HSA PPO - Premium Network Deductible: $1,500 / $3,000 Coinsurance: 10% Total Annual Out-of-Pocket: $4,500 / $6,850 Primary Care Provider: 10% after Deductible Specialist:
COLORADO WEST HEALTHCARE SYSTEM dba COMMUNITY HOSPITAL EMPLOYEE BENEFIT PLAN SCHEDULE OF BENEFITS EFFECTIVE MAY 1, 2015
COLORADO WEST HEALTHCARE SYSTEM dba COMMUNITY HOSPITAL EMPLOYEE BENEFIT PLAN SCHEDULE OF BENEFITS EFFECTIVE MAY 1, 2015 Verification of Eligibility 1-800-426-7453 or 303-770-5710 Call this number to verify
healthcare for the way we live
healthcare for the way we live Enrollment Guide for Employees Aetna Anthem Blue Cross Health Net Kaiser Permanente Sharp Health Plan Western Health Advantage 1 CONTENTS Welcome to CaliforniaChoice... 3
$15 copay $25 copay. in a specialist office. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum
Prepared for Genesee Area Healthcare Plan Effective: 01/01/2019 Plan Feature Highlights Annual deductible None $250 Annual out-of-pocket maximum (medical services only, does not include prescription drugs)
Group Accident Insurance
Group Accident Insurance You can t predict when or where an accident will strike. But you can make sure you have a safety net of financial protection to help if an accidental injury occurs. Accidents can