Procedure/Treatment Pricing
In compliance with state law, Upper Valley Medical Center provides this price list containing our charges for room and board, emergency department, operating room, labor and 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 Business Office staff to determine whether they qualify for financial assistance. These prices are in effect as of 01/01/2012.
Room and Board – Per Day Charges
| |
Charges |
| Routine Care |
2,371.00 |
| Intensive Care |
4,646.00 |
| Physical Rehab |
2,371.00 |
| Nursery |
1,725.00 |
| Special Care Nursery (Level II) |
2,176.00 |
| Adult Mental Health - semi private room |
1,654.00 |
| Youth Services - semi private room |
1,722.00 |
Labor and Delivery Charges
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 |
8,500.00 |
| Cesarean Section Delivery |
11,125.00 |
| Recovery Services - OB |
648.00 |
| Amniocentesis |
300.00 |
| OB Level Visit 1 |
127.00 |
| OB Level Visit 2 |
255.00 |
| OB Level Visit 3 |
468.00 |
| OB Level Visit 4 |
632.00 |
| OB Level Visit 5 |
788.00 |
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. They also do not include fees for Emergency Department physicians, who will bill separately for their services.
| |
Charges |
| Level 1 |
258.00 |
| Level 2 |
515.00 |
| Level 3 |
893.00 |
| Level 4 |
1,785.00 |
| Level 5 |
2,756.00 |
| Critical Care |
6,143.00 |
Operating Room Charges
Operating Room charges are based on a level charge along with a level per minute charge. Anesthesia level charge does not include professional fee for administration of anesthesia. Please contact the appropriate anesthesia group office to obtain these prices.
| |
Charges |
| OR Base Level 1 |
2,000.00 |
| Per minute Level 1 |
65.00 |
| OR Base Level 2 |
3,500.00 |
| Per minute Level 2 |
85.00 |
| OR Base Level 3 |
5,500.00 |
| Per minute Level 3 |
105.00 |
| OR Base Level 4 |
7,500.00 |
| Per minute Level 4 |
160.00 |
| OR Base Level 5 |
15,000.00 |
| Per minute Level 5 |
220.00 |
| Anesthesia Level 1 |
400.00 |
| Anesthesia Level 2 |
550.00 |
| Anesthesia Level 3 |
1,100.00 |
| Anesthesia Level 4 |
2,250.00 |
| Anesthesia Level 5 |
3,500.00 |
| Recovery Room (90 Min) |
1,005.00 |
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 |
| PT Outpatient Evaluation (15 minutes) |
123.00 |
| Therapeutic Exercise (15 minutes) |
125.00 |
| Ultrasound (15 minutes) |
99.00 |
| Gait Training (15 minutes) |
110.00 |
| Whirlpool |
85.00 |
| Massage (15 minutes) |
99.00 |
Occupational Therapy Charges
The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.
| |
Charges |
| OT Evaluation (15 minutes) |
123.00 |
| Therapy Exercise (15 minutes) |
125.00 |
| Neuromuscular TX (15 minutes) |
125.00 |
| Cognitive Treatment (15 minutes) |
122.00 |
| Orthotic Fit/Training (15 minutes) |
125.00 |
Pulmonary Therapy Charges
The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges depending on the services performed.
| |
Charges |
| Arterial Blood Gases |
327.00 |
| Oxygen (In Use) Per Day |
208.00 |
| Ventilation Mgt. 1st Day |
638.00 |
| Ventilation Mgt. Subsequent Day |
350.00 |
| Aerosol Med Adminstration |
132.00 |
| MDI Demo/Eval |
148.00 |
X-Ray and Radiological Charges
The following charges reflect the hospital's 30 most common x-ray and radiological procedures.
| |
Charges |
| Abdomen Acute with Chest |
481.00 |
| Ankle - Routine |
383.00 |
| Chest - (1 view) |
292.00 |
| Chest PA and LAT |
336.00 |
| Cervical Spine (2 or 3 views) |
525.00 |
| Cervical Spine with Obliques |
633.00 |
| DXA Bone Density Study |
608.00 |
| Elbow |
365.00 |
| Foot |
383.00 |
| Hand |
275.00 |
| Knee with Obliques |
479.00 |
| Mammogram Bilateral |
340.00 |
| Shoulder |
438.00 |
| Wrist |
324.00 |
| IVP Nephrotomogram |
992.00 |
| KUB |
250.00 |
| Lumbar Sacral Spine and Obliques |
640.00 |
| Screening Mommography |
254.00 |
| Ultrasound - Cartoid Vessel Study |
1,554.00 |
| Ultrasound - Gallbladder |
779.00 |
| Ultrasound - Pelvic |
897.00 |
| CT - Abdomen with Contrast |
2,036.00 |
| CT - Abdomen without Contrast |
1,981.00 |
| CT - Chest with Contrast |
1,962.00 |
| CT - Head with and without Contrast |
1,884.00 |
| CT - Head without Contrast |
1,518.00 |
| CT - Pelvis with Contrast |
1,811.00 |
| CT - Pelvis without Contrast |
1,479.00 |
| MRI - Knee without Contrast |
3,018.00 |
| MRI - Brain without Contrast |
2,820.00 |
Laboratory Charges
The following charges reflect the hospital's 30 most common laboratory procedures.
| |
Charges |
| Amylase |
83.00 |
| Basic Metabolic Panel |
130.00 |
| BUN |
65.00 |
| CBC Minus Differential |
91.00 |
| CBC with Automated Differential |
118.00 |
| CBC with Manual Differential |
112.00 |
| CK-MB |
94.00 |
| Comprehensive Metabolic Panel |
176.00 |
| CPK |
65.00 |
| Creatinine |
65.00 |
| Culture, Blood |
155.00 |
| Digoxin |
93.00 |
| Electrolyte Panel |
102.00 |
| Glucose, Fasting/Random |
62.00 |
| Gram Negative Sensitivity |
126.00 |
| Gram Positive Sensitivity |
126.00 |
| Hemoglobin and Hematocrit |
102.00 |
| Hepatic Function Panel |
120.00 |
| Lipid Profile |
94.00 |
| Occult Blood |
51.00 |
| Pregnancy Test, Serum |
113.00 |
| Prostatic Specific Antigen (PSA) |
118.00 |
| Prothrombin Time |
78.00 |
| PTT (Part Thrombo Time) |
90.00 |
| Screening PSA |
118.00 |
| Thin Prep Pap, Screening |
107.00 |
| TSH |
118.00 |
| UCG - Urine Pregnancy |
108.00 |
| Urinalysis |
74.00 |
| Urine Culture |
113.00 |
Hospital Billing Policies
For billing questions, please call (937) 208-2777
Office Hours: Monday through Friday, 8:00 a.m. to 4:30 p.m.
Learn more about billing at UVMC.
Hospital Care Assurance Program
The Hospital Care Assurance Program (HCAP) is a program of the Ohio Department of Job & Family Services to assure hospital care to residents of Ohio. If you live in Ohio, have an income at or below the federal poverty guidelines, and do not receive Welfare/Medicare, you may be eligible for free care for basic medically necessary hospital services. You must submit an application to determine eligibility. If you believe you are eligible, contact us at (937) 208-2777.
Federal Poverty Guidelines
| Persons in Household |
Monthly Income |
Yearly Income |
| 1 |
$931 |
$11,170 |
| 2 |
$1,261 |
$15,130 |
| 3 |
$1,591 |
$19,090 |
| 4 |
$1,921 |
$23,050 |
| 5 |
$2,251 |
$27,010 |
| 6 |
$2,581 |
$30,970 |
| 7 |
$2,911 |
$34,930 |
| 8 |
$3,241 |
$38,890 |
For each additional person over seven add $3,960 yearly.
The hospital reserves the right to modify or cancel this program in accordance with the rules and regulations of the Ohio Department of Job and Family Services.
UVMC Financial Assistance
As a service to the community, UVMC provides financial assistance to qualified patients. If you do not have insurance or are not able to pay your balance, you may be eligible. Please contact our business office at (937) 208-2777 to see if you qualify.
Physician Phone Numbers
You may also receive statements for services provided by other health care professionals. These services could be for emergency, radiology, or anesthesiology physicians. Questions regarding these bills or services should be directed to the professional providing the services. These may include the following:
| Radiology |
Medical Imaging Physicians |
1-877-647-9729 |
| Emergency Room |
West Central Emergency Physicians |
1-800-875-7374 ext. 2077 |
| Anesthesiology |
Valley Anesthesia, Inc. |
1-800-351-1288 |
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 Consumer's Guide to Quality Health Care in Ohio
.
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