In compliance with state law, Wayne 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 1/01/08.
Room and Board -- Per Day Charges
Charges
Intensive care
Level 1
$1,522.00
Birthing Suite (LDR)
$914.00
Nursery
$596.00
Routine care
$873.00
Private
$973.00
Ward
$529.00
Swing Bed Skilled
$311.00
Swing Bed Intermediate
$236.00
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
$2,258.25
Amniocentesis
$559.80
Fetal non-stress test
$234.55
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
$79.00
Level 2
$132.05
Level 3
$207.70
Level 4
$335.50
Level 5
$519.70
Critical Care
$647.50
ER Physician Charges
Charges
ER Physician Level 1
$52.00
ER Physician Level 2
$85.00
ER Physician Level 3
$146.00
ER Physician Level 4
$230.00
ER Physician Level 5
$350.00
ER Physician Level 6
$500.00
Operating Room Charges
Operating Room charges are based on the complexity level, with level 1 being the most basic, for a
particular operation There is an initial, set-up charge as well as an additional charge for each 15
minutes while the operation is being performed.
Set-Up Charge
Addtl 15 min.
Level 1
$829.65
$201.80
Level 2
$934.00
$244.95
Level 3
$1,361.05
$372.75
Level 4
$1,544.25
$426.00
Level 5
$1,815.85
$483.50
Level 6
$2,130.00
$532.50
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
Therapeutic Exercise
$64.05 (15 min)
Ultrasound
$64.05 (15 min)
Mobilization
$70.15 (15 min)
Aquatic Therapy
$65.30 (15 min)
Gait Training
$75.00 (15 min)
Massage
$65.30 (15 min)
Evaluation
$198.75
Therapeutic Activities
$70.15 (15 min)
Mechanical Traction
$65.30
Electrical Stimulation
$68.90 (15 min)
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
Therapeutic Exercise
$64.05
Therapeutic Activities
$60.45
Activity of Daily Living
$60.45
Evaluation
$235.05
Neuromuscular Re-education
$64.05
Orthotic Training
$65.30
Whirlpool
$100.40
Community/Work Reintegration
$60.45
Ultrasound
$64.05
Electrical Stimulation
$68.90
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
Respiratory Therapy
Arterial Blood Gas
$172.90
Acapella Device
$112.75
Deep breathing/chest percussion initial
$76.05
Deep breathing/chest percussion subq
$68.10
Bipap
$552.50
Carbon Monoxide Level
$35.05
Medication Nebulizer Initial
$61.65
Medication Nebulizer sub
$54.35
Incentive Spirometer
$16.40
Oxygen Per hour
$6.45
Oxygen set up
$16.85
Pulmonary Function Test/complete
$207.95
Pulmonary Function Test pre/post bronch
$83.45
Sleep Study
$1,945.85
Sleep Study w cpap trial
$2,335.30
Sleep Study mult/day and night
$2,854.10
Ventilator Management 1st day
$1,102.70
Ventilator Management subq
$913.95
EKG
Electrocardiogram (EKG)
$139.05
Cardiac monitor/2-4 week
$389.30
Holter Monitor 24/48 hour
$334.95
Electroencephalogram(EEG)
$442.50
Exercise stress test standard
$524.75
Cardic Ultrasound
Echocardiogram (ECHO)
$1007.10
Vascular Ultrasound
Carotid
$731.45
Venous bilateral
$483.60
Venous Unilateral
$379.60
Arterial
$344.60
Lower Arterial and abdomen
$621.45
X-Ray and Radiological Charges
The following charges reflect the hospital's 30 most common x-ray and radiological procedures.
Diagnostic
Chest 2 Views
$162.05
Chest PA
$147.50
Screening Mammogram
$66.00
Lumbar Spine
$207.95
Dexa Axial Skeleton
$186.15
Acute ABD w/PA Chest
$321.65
Ultrasound
R U Q
$469.15
Pelvis
$523.55
Breast
$422.00
Soft Tissue Head and Neck
$401.40
Abdomen Complete
$594.85
Scrotum
$386.85
Nuclear Medicine
Spect Cardiac
$1043.45
Bone/Whole Body
$781.05
Hepatobiliary
$724.25
Thyroid Uptake and Scan
$666.20
Bone Limited
$532.00
Vent-Perf Lung Scan
$1,284.05
CT
Head I
$820.95
Abdomen w/contrast
$996.30
Pelvis w/contrast
$996.30
Chest w/contrast
$996.30
Abdomen
$820.95
Pelvis
$820.95
MRI
Lumbar
$1,784.75
Any Joint/lower
$1,784.75
Brain
$1,784.75
Any Joint/upper
$1,784.75
Brain w/wo contrast
$2,013.10
Cervical
$1,784.75
Laboratory Charges
The following charges reflect the hospital's 30 most common laboratory procedures.
Charges
Complete Blood Count (CBC)
$38.65
Basic Metabolic Panel
$72.55
Protime
$25.40
Lipid Panel
$72.55
Urinalysis
$42.30
Manual Differential
$19.45
Comprehensive Metabolic Panel
$127.00
Hepatic Panel
$64.05
Thyroid Stimulating Hormone (TSH)
$75.00
Troponin
$65.30
Creatine Kinase (CK)
$44.75
Hemoglobin glycosylated (HGB A1C)
$38.65
Creatine Kinase MB fraction (CKMB)
$65.30
Magnesium
$48.35
Urine Culture
$26.60
Thyroxine total free (T4 free)
$65.30
Natriuretic Peptide (BNP)
$181.40
Amylase
$68.90
Thromboplastin time partial (APTT)
$43.55
PSA
$71.35
Lipase
$76.15
Transferase Alanine amino( ALT)
$14.10
Sedimentation Rate
$37.50
Bacteria ID
$56.85
MIC (Sensitivity)
$70.15
Transferase aspartate amino (AST)
$14.10
Rh Type
$35.05
Cross Match
$43.55
Leuko Reduced
$255.10
Hemoglobin
$15.55
Hospital Billing Policies
Financial Counseling 1-800-589-2963 Ext. 5707
Billing 1-800-589-2963 Ext. 5770
Deposits and Co-pays required
Payment plans, prompt pay discount, HCAP, Charity
No interest charged on unpaid balances
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.ohanet.org/portal.
