Summary of Charges
In compliance with state law, Aultman Orrville 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 financial counseling staff to determine whether they qualify for discounts by calling 330-684-4700 ext 317. These prices are effective as of 01/01/2012.
ROOM AND BOARD
The following list does not include charges for drugs, ancillary tests (i.e. x-rays, labs) ,physician fee, or any surgical procedures that may be required during your stay.
| ICU | 1422.23 |
| Med Surg | 590.91 |
| OB | 603.34 |
| Nursery | 444.84 |
LABORATORY
The following charges reflect the hospital’s most common outpatient laboratory procedures.
| Pregnancy Test, Urine | 50.35 |
| PSA Screen | 106.94 |
| Streptex | 70.17 |
| Blood Gas Profile | 102.18 |
| Sed Rate | 21.20 |
| CBC | 41.02 |
| Comprehensive Panel | 107.00 |
| Electrolyte Panel | 54.45 |
| Bilirubin Total | 22.18 |
| Creatinine | 26.29 |
| CPK | 35.19 |
| Glucose | 26.29 |
| LDH | 31.91 |
| Potassium | 21.73 |
| Urea Nitrogen | 23.85 |
| T-3 Up Take | 34.77 |
| T-4 | 39.64 |
| Digoxin | 73.03 |
| PTT | 59.25 |
| Prothrombin Time | 41.45 |
| RPR | 28.70 |
| Antibody Screen | 55.97 |
| ABO Group & RH | 21.48 |
| Urinalysis | 33.18 |
| Sensitivity Aerobe | 37.63 |
| Gram Stain | 43.46 |
| Urine Bacteria Culture | 39.22 |
| Lipid Panel | 128.29 |
| Hemoglobin | 24.49 |
| TSH | 119.25 |
| Hematocrit | 25.23 |
| EKG | 95.40 |
RADIOLOGY
The following charges reflect the hospital’s most common x-ray and radiological procedures. Contrast (a type of medication) is a separate charge. Physician fees are not included.
| Pelvic Ultrasound | 601.90 |
| O/B Initial Ultrasound | 625.35 |
| Skull (4-5 views) | 266.00 |
| Hip (2 views) | 226.82 |
| Knee (3-4 views) | 315.01 |
| Knee (2-views) | 195.11 |
| Tib-Fib (Lower Leg) | 214.05 |
| Ankle | 238.95 |
| Foot | 238.95 |
| Shoulder (2-3 views) | 236.67 |
| Forearm | 238.95 |
| Chest (2 views) | 265.49 |
| Chest (1 view) | 207.00 |
| Diagnostic Mammogram | 157.09 |
| Screening Mammogram | 157.09 |
| Pelvis | 195.11 |
| Femur | 229.42 |
| CT Brain | 1597.95 |
| Finger or Thumb | 164.70 |
| L-S Spine (4-5 views) | 404.62 |
| Cerv Spine (4-5 views) | 360.90 |
| Elbow | 144.47 |
| Wrist | 144.47 |
| Hand | 144.47 |
| Abdomen/KUB (1 view) | 214.98 |
| Uniribs w/PA Chest | 295.64 |
| Gallbladder Ultrasound | 612.17 |
| MRA Head without Contrast | 1752.18 |
| OB Ultrasound Detailed | 625.35 |
| OB Ultrasound Basic | 169.60 |
| CT Head/Brain w/o Contrast | 1159.00 |
| CT Head/Brain w/ Contrast | 1494.39 |
OPERATING ROOM
The following charges do not include fees for drugs, specialty supplies or additional ancillary (i.e. x-rays, labs) procedures that may be required for a particular surgical procedure. Additionally, this price does not include charges associated with your recovery after surgery. They also do not include fees for physicians, who will bill separately for their services.
| O.R. Level 1 - First Hour | 2637.69 |
| O.R. Level 1 - Additional 15 min. | 319.51 |
| O.R. Level 2 - First Hour | 4211.52 |
| O.R. Level 2 - Additional 15 min. | 388.50 |
| O.R. Level 3 - First Hour | 5437.31 |
| O.R. Level 3 - Additional 15 min. | 475.02 |
| O.R. Level 4 - First Hour | 6525.36 |
| O.R. Level 4 - Additional 15 min. | 604.20 |
| O.R. Level 5 - First Hour | 8458.80 |
| O.R. Level 5 - Additional 15 min. | 845.88 |
EMERGENCY ROOM
Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level I representing basic emergency care, reflect 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, or additional ancillary (i.e. x-rays, labs) procedures that may be required for a particular emergency treatment.
| Hospital – | Level I | 116.60 |
| Level II | 248.15 | |
| Level III | 417.22 | |
| Level IV | 503.50 | |
| Level V | 609.50 |
DELIVERY ROOM
The following does not include charges for anesthesia, drugs, or supplies required for the delivery room procedure. Additionally, this price does not include charges associated with your subsequent stay after delivery. Fees for physician services or anesthesia administration are also not reflected, and will be billed separately by the physician.
| Vaginal Delivery | 1260.13 |
RESPIRATORY THERAPY
The following charges reflect the most common services offered by our Respiratory Therapy department. Many of the charges are necessarily based on time increments. There may be additional charges depending on the services performed.
| Pulmonary Function Test | 215.94 |
| Pulmonary Function Test w/without Bronchial Dilator | 373.51 |
PHYSICAL THERAPY
The following charges reflect the most common services offered by our Physical Therapy department. Many of the charges are necessarily based on time increments. There may be additional charges depending on the services performed.
| Evaluation | 174.01 |
| Massage (15 minutes) | 50.09 |
| Therapeutic Exercise (15 minutes) | 62.81 |
| Ultra Sound (15 minutes) | 25.44 |
| Whirlpool | 40.55 |
| Electric Stimulation (unattended) | 26.24 |
OCCUPATIONAL THERAPY
The following charges reflect the most common services offered by our Physical Therapy department. Many of the charges are necessarily based on time increments. There may be additional charges depending on the services performed.
| Evaluation | 174.01 |
| Massage (15 minutes) | 50.09 |
| Therapeutic Exercise (15 minutes) | 62.81 |
| Ultra Sound (15 minutes) | 25.44 |
| Whirlpool | 40.55 |
| Electric Stimulation (unattended) | 26.24 |
You may contact the following physicians for their fee schedule.
PATHOLOGIST
Canton Pathology Associates, Inc.
2600 Sixth Street, S.W.
Canton, OH 44710
(330) 833-5530
ANESTHESIA
Aultman Orrville Anesthesia
830 South Main Street
Orrville, Ohio 44667
Medigistics (800) 282-0738, Ext. 3746
CARDIOLOGY
Stark Medical Specialties
323 Marion Avenue, N.W., Suite 200
Massillon, Ohio 44646
EMERGENCY ROOM PHYSICIAN
Comprehensive Medical Management
11821 Mason Montgomery Rd.
Cincinnati, OH 45249
(859) 291-4800
(800) 724-6966
SURGERY
Dunlap Surgical Associates
830 South Main Street
Orrville, OH 44667
(330) 684-4797
OB/GYN
Bob J. Bowden
Women's Health Services
185 Wadsworth Rd. Suite G
Wadsworth, OH 44281
(330) 334-5674