Patient Price Information List
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- Caroline Jenkins
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1 In compliance with state law, Olean General Hospital is providing this price list containing our room and board, inpatient service, emergency room, operating room, physical therapy and other procedures. The hospital s charges are the same for all patients but total charges and patient s responsibility may vary based on severity, acuity, length of stay and the patient s individual health insurance coverage contract. Average payment is based on the average amount received from all insurers for the services listed. Uninsured or underinsured patients should consult with a hospital Financial Liaison to determine if they qualify for discounts. If you do not find the service you are looking for please contact our Financial Liaison at (716) or us at billing@uahs.org. Effective April 1, 2015 Room and Board Per Day s Private Semi-Private Medical Surgical Room $ $ Labor & Delivery $ $ Nursery $ Intensive Care Unit $1, $ Sub-Acute Rehabilitation Unit $ Psychiatric $ Observation Rates Private Semi-Private Medical Observation per hour $ Telemetry Observation per hour $
2 Inpatient Services The following list reflects the hospitals top 20 Inpatient services, determined by a patient s condition. Average charges include fees for drugs, supplies and additional ancillary services provided. They do not include fees for physicians who treat the patient, interpret radiology exams, pathology specimens or provide anesthesia services. Average Acute Myocardial Infarction $18, $ 9, Alcohol Abuse $ 4, $ 2, Bipolar Disorders $ 5, $ 3, Cardiac Arrhythmia $14, $ 7, Cardiac Catheter with Drug eluting stent $37, $11, Chronic Obstructive Pulmonary Disease with complication $11, $ 5, Chronic Obstructive Pulmonary Disease with major complication $13, $ 6, Esophagitis, Gastroenteritis without major complication $ 9, $ 4, Gastro Intestinal Hemorrhage with complication $12, $ 5, Heart Failure & Shock with comorbidity complication $ 9, $ 5, Average Heart Failure & Shock with major comorbidity complication $13, $ 8,
3 Average Major Joint Replacement (Hip, Knee) $30, $12, Normal Newborn Weight >2499g with other problem(s) $ 2, $ 2, Pneumonia Simple with comorbidity complication(s) $10, $ 6, Pneumonia Simple with major Comorbidity Complication(s) $15, $ 7, Psychoses $ 7, $ 5, Renal Failure with comorbidity $ 9, $ 5, complication Septicemia & Disseminated Infections $19, $ 9, Septicemia, severe sepsis without Vent assist > 96 hours with major comorbidity Complication $17, $ 9, Septicemia, severe sepsis without Vent assist >96 hours without comorbidity complication $10, $ 5,
4 Obstetric Services The following list reflects hospital charges only. Fees for physician services or anesthesia administration are not reflected, and will be billed separately. Average Cesarean Delivery without complication(s) $ 8, $ 5, Normal Newborn $ 1, $ 1, Vaginal Delivery without complication(s) $ 4, $ 4, 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 include and average fee 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. Average Emergency Room Visit Level 1 $ $ Emergency Room Visit Level 2 $ $ Emergency Room Visit Level 3 $ $ Emergency Room Visit Level 4 $1, $ Emergency Room Visit Level 5 $2, $
5 Operating Room Services Patient Price Information List The following list includes averages charges for anesthesia, drugs, and supplies required for particular operating room procedures for our top 15 outpatient surgeries. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately. Average Appendectomy- Laparoscopy $ 9, $ 2, Catheter- Tunneled/Insertion (Mediport insert) $ 4, $ 1, Cholecystectomy- Laparoscopy $ 6, $ 2, Cystoscopy $ 4, $ 1, Cystoscopy with fulguration small bladder tumor $ 4, $ 1, Cystoscopy with stent $ 6, $ 2, Cystoscopy with ureter catheter $ 6, $ 2, Dialysis catheter (insertion) Arteriovenous upper arm $ 9, $ 2, Hernia Repair (Inguinal-Initial) $ 5, $ 2, Hemorrhoidectomy $ 4, $ 1, Hysterectomy Laparoscopy (Total) $14, $ 3, Hysteroscopy; Surgical with Biopsy, with or without D&C $ $ Lithotripsy $ 8, $ 4,
6 Average Pacemaker Generator (Remove/Replace) $17, $ 7, Tubal Laparoscopy $ 4, $ 1, Laboratory Services The following list reflects the hospital s 30 most common laboratory procedures: ANA Titer and Pattern $57.00 $12.47 Antinuclear Antibodies (ANA) $45.00 $13.34 Basic Metabolic Panel/Chem 7 $ $9.24 CBC Automated Diff $46.50 $8.48 Chlamydia Trachomatis $ $41.25 Comprehensive Metabolic Profile (CMP) $54.00 $12.91 Culture Aerobic Identify $31.00 $10.76 Folic Acid; Serum $ $18.57 Glycosylated HGB $58.00 $12.58 Hemogram CBC $46.50 $6.99 Hepatitis B Surface AG EIA $45.00 $13.32 Hepatitis Surface Antigen $72.50 $13.32 HIV-1, HIV-2 $47.13 $18.51 Lipid Panel $62.00 $14.89 Micro Albumin $35.50 $7.02 Microbe Susceptibility Studies Mic $23.00 $6.62 Neisseria Gonorrhea $ $41.25 Protime $24.00 $5.04 Sedimentation Rate Automated $28.04 $3.11 Single Drug Class $ $ Thyroid Stimulating Hormone TSH $16.30 $20.14 Thyroxine; Free T4 $54.00 $13.82 Thyroxine; Total $41.50 $9.40 Urinalysis Automated $13.50 $2.76 Urine Creatinine $41.50 $6.32 Urine Culture $48.50 $
7 Urine Microscopic $13.50 $3.61 Venipuncture (Chg. To Draw Blood) $10.50 $2.94 Vitamin B-12 $76.50 $14.87 Vitamin D 25 Hydroxy $ $48.21 Radiology Services The following list reflects the hospital s 30 most common radiological procedures: CT Abdomen & Pelvis W/O Contrast $1, $ CT Scan Abdomen & Pelvis W/Contrast $1, $ CT Thorax W/O Contrast $ $ CT Thorax With Contrast $1, $ Digitization Of Screening Mammogram Film $64.00 $14.46 Digitization Of Diagnostic Mammogram Film $64.00 $24.98 Duplex Scan Extremities Veins $ $ Mammogram, Screening $ $63.75 MRI Any Joint Of Lower Extremity $1, $ MRI Any Joint Of Upper Extremity $1, $ MRI Brain With & W/O Contrast $2, $ MRI Cervical Spine W/O Contrast $1, $ MRI Lumbar Spine W/O Contrast $1, $ Ultrasound Exam Of Abdomen $ $ Ultrasound Abdominal Complete $ $ Ultrasound Needle Guidance $ $60.65 Ultrasound Pelvic, Nonobstetric $ $ Ultrasound Thyroid $ $ X-Ray Abdomen 1 View Ap $ $ X-Ray Ankle, Comp, Min 3 Views $ $86.01 X-Ray Cervical Complete $ $ X-Ray Chest 2 Views $ $86.06 X-Ray Foot Complete $ $56.59 X-Ray Hand Min 3 Views $ $50.69 X-Ray Hip Min 2 Views $ $41.95 $ $
8 X-Ray Knee 3 Views X-Ray Knee Min 4 Views $ $27.91 X-Ray Lumbar Complete $ $ X-Ray Shoulder 2 View $ $49.59 X-Ray Wrist Comp Min 3 Views $ $55.46 Echo Cardio Services The following list reflects the hospital s most common echo cardiovascular procedures: Echocardiogram complete $1, $ Echocardiogram Limited $ $ Respiratory Therapy Cardiovascular stress test $ $ EKG $ $ 9.83 Stress Test TEE with EKG Monitoring & Supervision $1, $ Trans Esophageal Echocardiogram $1, $ Respiratory Therapy Services 8
9 The following charges reflect the most common services offered by our Respiratory Therapy department. Patients may have additional charges, depending on the services performed. Diffusing Capacity / Co2 $ $ Gas Dilution Deter Lung Volume $ $ Nebulizer Acute Initial treatment $ $ Oximetry Single $ $ 0.40 Pulmonary Function Test $ $ Physical Therapy Services The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed. Electrical Stimulation (attended) $ minutes Gait Training $ Neuromuscular Reeducation $ Physical Therapy Evaluation $ Therapeutic Exercise 0-15 minutes $ Therapeutic Activities 0-15 minuets $ Occupational Therapy Services 9
10 The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed. ADL Training Self Care Management $ Manual Therapy Joint Mobilization $ minutes each Occupational Therapy Evaluation $ Therapeutic Activities 0-15 minutes $ Therapeutic Exercise 0-15 minutes $ Speech Therapy Services The following charges reflect the most common services offered by our Speech Therapy department. Patients may have additional charges, depending on the services performed. Cognitive Treatment each 15 minutes $ Speech Language Treatment $ Swallow Dysfunction Treatment $
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