Effective July 1, 2016

Similar documents
Patient Price Information List

Patient Price Information List

Patient Price Information List As of October 1, 2013

On-Site Routine/STAT Laboratory Tests. This policy provides information regarding approved procedures performed at each site

Medical Schedule of Benefits (Effective July 01, June 30, 2019) Johns Hopkins Student Health Program

Budgeting a Clinical Trial

Medical Plan (Effective ) BENEFIT IN-NETWORK (PPO) OUT-OF-NETWORK (NON-PPO)

Medical Schedule of Benefits (Effective July 01, June 30, 2018) Johns Hopkins Student Health Program

Medical EPO Plan Schedule of Benefits (Effective January 01, 2019) Howard County General Hospital/TCAS Employees and Eligible Dependents

Medical EPO Plan Schedule of Benefits (Effective January 01, 2019) JHH/JHHSC Non-Union and Union Employees and Eligible Dependents

Medical Schedule of Benefits (Effective January 01, December 31, 2017) Johns Hopkins University Employees and Eligible Dependents

Medical PPO Plan Schedule of Benefits (Effective January 01, 2019) Bayview Non-Union and Union Employees and Eligible Dependents

Medical Schedule of Benefits (Effective January 01, 2016) Johns Hopkins Bayview Medical Center Non-Union and Union Employees and Eligible Dependents

Schedule of Benefits - HDHP $1500/$3000 Indemnity Group - MARSHFIELD CLINIC Benefit Year: April 1st through March 31st Effective Date: 04/01/2016

Schedule of Benefits - HDHP $3300/$6600 Indemnity Group - MARSHFIELD CLINIC Benefit Year: April 1st through March 31st Effective Date: 04/01/2016

HOSPITAL PRICING MOST COMMON ITEMS AS OF 06/18/18

PacifiCare SignatureElite SM Offered by PacifiCare Life Assurance Company Plan 155P 30/70-50/2500 PPO Schedule of Benefits

40% (Not subject to the Calendar-Year Deductible) CT scans, MRIs, MRAs, PET scans, and cardiac diagnostic

Standard Option Medical Schedule of Benefits (Effective January 01, 2017) Suburban Hospital Employees and Eligible Dependents

Standard Option Medical Schedule of Benefits (Effective January 01, 2018) Suburban Hospital Employees and Eligible Dependents

SUPRO: 2018 SCHEDULE OF BENEFITS - EMPLOYEE COST SHARING

Hip $4,000. Wrist or Elbow $1,100 $550. Toe or Finger $300 $150. (except toes/heel), Wrist,

SCHEDULE OF BENEFITS

SUBLUE AND SUORANGE: 2018 SCHEDULE OF BENEFITS -EMPLOYEE COST SHARING

In-Network Deductible: $3,000 per Member or $6,000 per family per calendar year.

$5,000 per individual. $6,000 per family. one family member meets the. $200 copayment per visit

and cardiac diagnostic procedures utilizing nuclear medicine) Bariatric surgery Not Covered Not Covered

Benefits Summary SelectHC IV

Standard Non-Discount Rate is a rate that will be used for research studies paying only fee for service.

SCHEDULE OF BENEFITS UNIVERSITY OF PITTSBURGH PPO PLAN - Applies to PA Child Welfare Resource Center

UNIVERSITY HOSPITALS SCHEDULE OF MEDICAL AND PRESCRIPTION DRUG BENEFITS

University of Pennsylvania Benefits Key Medical Plan Features (What You Pay) Aetna High Deductible Health Plan with HSA*

$5,000 per individual. $6,000 per family

Full PPO Combined Deductible /60 Benefit Summary (For groups of 101 and above) (Uniform Health Plan Benefits and Coverage Matrix)

Summary of Benefits Full PPO Savings Two-Tier Embedded Deductible 1500/2700/3000

Blue Cross Silver, a Multi-State Plan 94

Test Name CPT Price Note ABO TYPE $ ACETAMINOPHEN $ 61.25

Blue Cross Silver, a Multi-State Plan 87

In the U.S., the largest percentage of health care dollars are spent on:

G4S Secure Solutions (USA), Inc.: PanaBridge Advantage Coverage Period: 11/01/ /31/2017

Effective: July 1, Highlights: A description of the prescription drug coverage is provided separately. Participating Providers 1

OUT-OF-NETWORK MEMBER PAYS IN-NETWORK MEMBER PAYS. Contract Year Plan Deductibles. services and prescription drugs) Out-of-Pocket Maximum

FULL PAYMENT IN PAYMENTS. Computed Tomography (CT)

Full PPO Savings Two-Tier Embedded Deductible 2250/2700/4500 Effective January 1, 2019

SCHEDULE OF MEDICAL AND PHARMACY BENEFITS

CBC... $ Lipid panel... $ GGT... $ PTT... $ 37.00

ST. MARY S HEALTHCARE SYSTEM, INC.-CASE # GA6476 Blue Choice HI PPO Benefit Summary Effective: January 1, 2019

NATIONAL HEALTH INSURANCE

The following is a description of the fields that appear on the results page for the Procedure Code Search.

GC12 Limited Benefit Group Cancer Indemnity Insurance Region VIII TIPS EBC Group #13041

Blue Cross Select Silver 94 Blue Cross Preferred Silver 94

Cancer. About this Benefit AMERICAN PUBLIC LIFE YOUR BENEFITS DID YOU KNOW?

Your Responsibilities In network Out of network Deductible. $1,300 per individual. 40% of the next. $6,000 per individual $12,000 per family

Schedule of Benefits. Plan Information Participating Provider Non-Participating Provider. Deductible: $250 / $750 Rx: $10/$25/$40/$40 Coinsurance: 0%

Schedule of Benefits. Plan Information. Primary Care Provider: $10 Copayment per visit

Expatriate Health Insurance U.S. coverage. Care

IN-NETWORK MEMBER PAYS OUT-OF-NETWORK MEMBER PAYS. Calendar Year Plan Deductible. services and prescription drugs) Out-of-Pocket Maximum

UConn Co-op Plan II: Grandfathered Coverage Period: 1/1/14 12/31/14

CoventryOne is administered by Coventry Health Care of Delaware, Inc. and underwritten by Coventry Health and Life Insurance Company.

Summary of Benefits. Custom PPO Combined Deductible /60. City of Reedley Effective January 1, 2018 PPO Benefit Plan

CDPHP BASIC RX (HMO) CDPHP VALUE RX (HMO) CDPHP CHOICE (HMO) CDPHP CHOICE RX (HMO)

UnitedHealthcare Choice Plus. UnitedHealthcare Insurance Company. Certificate of Coverage

Benefit modifications for members with Full PPO /60

Signature Health Plan Option: Elite

Summary of Benefits Boone County

Summary of Benefits Custom HMO Zero Admit 10

2015 Summary of Benefits

UConn Co-op Plan I: Grandfathered Coverage Period: 1/1/14 12/31/14

SCHEDULE OF BENEFITS UPMC HEALTH PLAN PA CHILD WELFARE RESOURCE PPO

Central Health Medicare Plan (HMO)

C12D06(WY) OC R209 1 Level 2

Summary of Benefits. Y0027_16-092_EN CMS Accepted 08/30/2016

Health Net Health Plan of Oregon, Inc. BeneFacts: Family PPO Crystal High Deductible Health Plan Copayment and Coinsurance Schedule FHDHP10000/08

$15 copay $25 copay. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum

In-Network: $1,000 Ind / $2,000 Family Non-Network: $2,000 Ind / $4,000 Family. What is the overall deductible?

Everyone deserves a better Tomorrow.

UNIVERSITY OF NEBRASKA SYSTEM

Health Insurance Matrix 01/01/18-12/31/18

Benefit Comparison by Insurance Company (Reflects benefits for both HC and HC2; does not apply to HSA-Compatible Plans)

Calendar Year Medical Deductible Calendar Year Out-of-Pocket Maximum $2,000 per individual / $4,000 per family Lifetime Benefit Maximum

Financial Operating Summary for the Quarter Ending Sept. 30, 2017

Member Cost Sharing Participating Provider Non-Participating Provider Annual Deductible Individual $250 $750 Family $750 $2,250

IntegraGlobal. Health plans about you, Family health plans you can trust. PremierLife & PremierFamily Table of Benefits for the UAE

Important Contact Information for your Swisscare Expatriate Health Plan

You must pay all the costs up to the deductible amount before this plan begins What is the overall

2014 CDPHP Medicare Choices Group PPO Benefit Summary

SCHEDULE OF BENEFITS FOR BUSINESS BLUE SM HIGH DEDUCTIBLE. Benefit Period: December 1st through November 30th

Clergy Benefit Comparison Effective January 1, 2018

Anthem Blue Cross Your Plan: Premier HMO 15/100% Your Network: California Care HMO

Basic Accident Insurance

SCHEDULE OF BENEFITS ADVANTAGE PANTHER GOLD PLAN Enhanced Access HMO Applies to Oakland, Johnstown, and Titusville campuses

SCHEDULE OF BENEFITS UPMC HEALTH PLAN PANTHER PREMIER PPO

International Healthcare Comparison Plans Expat Standard, Comfort & Premium Plan 2013

CERTIFICATE OF INSURANCE

Emergency Department: $175 Copayment per visit Coinsurance: 0%

Schedule of Benefits. Plan Information Participating Provider Non-Participating Provider Benefit Period

COLORADO WEST HEALTHCARE SYSTEM dba COMMUNITY HOSPITAL EMPLOYEE BENEFIT PLAN SCHEDULE OF BENEFITS EFFECTIVE MAY 1, 2015

healthcare for the way we live

$15 copay $25 copay. in a specialist office. - Silver&Fit copays are not included in the Annual Out-Of- Pocket Maximum

Group Accident Insurance

Transcription:

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 $ 1,624.00 $ 1,548.00 Labor & Delivery $ 1,615.00 Psychiatric/Chemical Dependency $ 1,975.00 Stepdown - Medical/Surgical $ 3,653.00 Stepdown - Cardiac $ 3,910.00 Medical Intensive Care Unit (ICU) $ 8,203.00 Surgical Intensive Care Unit (ICU) $ 8,203.00 Cardiac Intensive Care Unit (ICU) $ 8,386.00 Burn Intensive Care Unit (ICU) $ 9,379.00 Neuroscience Intensive Care (ICU) $ 8,042.00 Trauma Intensive Care Unit (ICU) $ 9,637.00 Newborn - Normal $ 3,473.00 Newborn - Level 2 Continuing Care $ 3,337.00 Newborn - Intermediate $ 5,032.00 Newborn Intensive Care (ICU) $ 8,449.00 OBSERVATION RATES Private Semi- Private Observation Initial Hour $ 1,277.00 Observation - Each Additional Hour $ 81.00

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 $ 285.00 Emergency Unit (EU) - Level 2 $ 612.00 Emergency Unit (EU) - Level 3 $ 1,221.00 Emergency Unit (EU) - Level 4 $ 1,921.00 Emergency Unit (EU) - Level 5 $ 2,827.00 Emergency Unit (EU) - Critical Care $ 5,228.00 Emergency Unit (EU) - Trauma Consult $ 4,872.00 Emergency Unit (EU) - Trauma Response $ 6,479.00 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 $ 6,069.00 Operating Room-Major Procedure-1st Half Hour $ 7,255.00 Operating Room-Major Procedure-Each Additional Minute $ 159.00 Operating Room-Complex Procedure-1st Half Hour $ 7,621.00 Operating Room-Complex Procedure-Each Additional Minute $ 179.00 Operating Room-Trauma Procedure-1st Half Hour $ 9,639.00 Operating Room-Trauma Procedure-Each Additional Minute $ 194.00 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 $ 9,843.00 Vaginal Delivery $ 8,089.00

RADIOLOGY CHARGES The following list reflects the hospital's 30 most common radiological procedures. Diagnostic Outpatient Inpatient MRI - Head (with and without contrast) $ 3,486.00 $ 5,000.00 MRI - L Spine (without contrast) $ 2,420.00 $ 3,500.00 CT - Abdomen (without contrast) $ 1,784.00 $ 2,246.00 CT - Head (without contrast) $ 1,608.00 $ 1,846.00 CT - Abdomen (with contrast) $ 2,206.00 $ 2,778.00 CT - Pelvis (with contrast) $ 2,020.00 $ 2,642.00 CT - Chest (with contrast) $ 1,913.00 $ 2,407.00 CT - C Spine (without contrast) $ 1,854.00 $ 2,334.00 CT - L Spine (without contrast) $ 2,085.00 $ 2,625.00 US - Abdomen (complete) $ 932.00 $ 1,307.00 US - OB Re-Eval Abnormality $ 749.00 $ 749.00 US - Breast(s) $ 598.00 $ 839.00 US - Guide Needle Placement $ 783.00 $ 1,360.00 Mammography Screening Direct Digital $ 305.00 $ 366.00 Screening Mammography CAD $ 59.00 $ 72.00 Mammography Bilateral Diagnostic $ 345.00 $ 345.00 Abdomen - KUB & Erect $ 370.00 $ 478.00 Abdomen - Flat, Up/Decub & P $ 389.00 $ 561.00 Abdomen - Single view $ 297.00 $ 336.00 Ankle - Minimum 3 views $ 311.00 $ 445.00 C Spine - 2 or 3 views $ 335.00 $ 481.00 Chest - PA & Lateral $ 325.00 $ 392.00 Chest - PA or AP $ 283.00 $ 362.00 Fluoro up to 1 hour $ 494.00 $ 736.00 Foot - Minimum 3 views $ 305.00 $ 438.00 Hand - Minimum 3 views $ 329.00 $ 472.00 Knee - up to 2 views $ 277.00 $ 397.00 LS Spine - AP & Lateral $ 350.00 $ 501.00 Pelvis 1 or 2 view $ 300.00 $ 430.00 Shoulder - min 2 views $ 350.00 $ 501.00 Wrist - Minimum 3 views $ 305.00 $ 439.00 Bone Imaging Whole Body $ 1,984.00 $ 2,242.00 DXA Scan Axial Skelton $ 565.00 $ 813.00

LABORATORY CHARGES The following list reflects the hospital's 30 most common laboratory procedures. ABO Type $ 33.00 Antibody Screen, ea incubation $ 64.00 Basic Metabolic Panel $ 77.00 Bilirubin- Direct $ 40.00 Blood Gas $ 284.00 CK (CPK) $ 66.00 Complete Blood Count (CBC) - With differential, automated $ 82.00 Complete Blood Count (CBC) - Without differential $ 68.00 Comprehensive Metabolic Panel $ 111.00 Crossmatch, Electronic $ 64.00 Culture, Blood $ 137.00 Culture, Urine $ 90.00 Lactic Acid, Blood $ 107.00 Lipid Profile $ 133.00 Magnesium, Serum $ 59.00 Partial Thromboplastin Time (PTT) $ 64.00 Phosphorus, Serum $ 47.00 POC PC02 $ 192.00 POC Chloride $ 46.00 POC Creatinine $ 51.00 POC Glucose Monitoring $ - POC Glucose Quant Blood except reg strip $ 39.00 POC HCG- Qualitative, Urine $ 73.00 POC Potassium $ 46.00 POC Sodium $ 48.00 POC Urea Nitrogen, quant $ 39.00 POC Urinalysis $ 28.00 Prothrombin Time (PT) $ 41.00 Renal Function Panel $ 91.00 RH Factor $ 62.00 Surgical Pathology Level 4, Gross & Micro $ 187.00 Thyroid Stimulating Hormone $ 129.00 Troponin $ 99.00 Urinalysis- With Microscopic $ 37.00 Phlebotomy $ 26.00

PHYSICAL THERAPY CHARGES The following charges reflect the most common services offered by our Physical Therapy Physical Therapy Evaluation $ 352.00 Gait Training - 15 minutes $ 164.00 Neuromuscular Reeducation $ 164.00 Therapeutic Exercise - 15 minutes $ 164.00 Therapeutic Activities - 15 minutes $ 173.00 Electrical Stimulation (attended) - 15 minutes $ 150.00 OCCUPATIONAL THERAPY CHARGES The following charges reflect the most common services offered by our Occupational Therapy Therapeutic Activities - 15 minutes $ 173.00 Occupational Therapy Evaluation $ 352.00 Therapeutic Exercise - 15 minutes $ 164.00 Self Care / ADL 15 minutes $ 199.00 RESPIRATORY THERAPY The following charges reflect the most common services offered by our Respiratory Therapy Ventilator - Assist and Manage - Initial $ 1,456.00 Ventilator - Assist and Manage - Addt'l day $ 1,235.00 Oximetry - Continuous $ 414.00 Hand Held Nebulizer Treatment $ 210.00