Patient Pricing and Hospital Charges for UH St. John Medical Center

In compliance with state law, University Hospitals St. John Medical Center is providing this list, which reflects selected charges for room and board, the emergency department, the operating and recovery room, labor and delivery, physical, occupational and respiratory therapy, lab and radiology services. The hospital’s charges are the same for all patients, however the patient’s financial responsibility will vary depending on the payment plans negotiated with individual health insurers. Uninsured or underinsured patients should consult with our financial counselors or billing staff to determine whether they qualify for a discount under the Financial Assistance Policy. The prices below are correct as of January 1, 2018.

Room and Board

Description Charge
Labor/Del/Rec 3,750.00
Medical Surgical 1,864.00
Med/Surg Ortho 1,864.00
Interm ICU – IMCU (Stepdown) 2,904.00
M S Tele 3NO 2,383.00
Surgical ICU 4,021.00
Medical ICU 4,021.00

Emergency Department Charges

Mnemonic Description MC HCPCS CPT Charge
Level 1 99281 99281 268.00
Level 2 99282 99282 548.00
Level 3 99283 99283 1,161.00
Level 4 99284 99284 1,310.00
Level 5 99285 99285 1,864.00

Operating Room Charges

Description Charge
First 30 Mins
Charge
per Addl 15 Mins
OR 1 2,460.00 746.00
OR 2 3,574.00 1,045.00
OR 3 4,468.00 1,045.00
OR 4 6,038.00 1,330.00
Post-Op 1 462.00 151.00
Post-Op 2 782.00 199.00
Post-Op 3 963.00 213.00

Physical, Occupational and Pulmonary Therapy Charges

Description MC HCPCS CPT Charge
Blood Gases 82803 82803 257.00
Inhalation Treatment – Acute Obstruction 94640 94640 313.00
Occupational Therapy Evaluation – Mod Complex 97166 97166 299.00
Physical Therapy Eval Low Complex 97161 97161 299.00
Physical Therapy Eval Mod Complex 97162 97162 299.00
Physical Therapy Eval High Complex 97163 97163 299.00
Pt Gait Training 15 Minutes 97116 97116 128.00

X-Ray and Radiological Charges

Description MC HCPCS CPT Charge
Head/Brain w/o Contrast 70450 70450 1,671.00
Head/Brain w & w/o Contrast 70470 70470 2,296.00
Sinuses/Facial w/o Contrast 70486 70486 2,160.00
Brain w & w/o Contrast 70553 70553 5,232.00
Chest Single View 71045 71045 304.00
X-ray Exam Chest Three Views 71047 71047 404.00
Thorax with Contrast 71260 71260 2,944.00
Lumbar Spine 1 View 72020 72020 412.00
Cervical Sp Ap & Lat or 2 Views 72040 72040 553.00
Cervical Spine with Obliques 72050 72050 790.00
Thoracic Spine 3 Views 72072 72072 755.00
Lumbar Spine 3 Views 72100 72100 631.00
Lumbar Spine with Obliques 72110 72110 960.00
Pelvis with Contrast 72193 72193 1,532.00
Shoulder Unilateral 73030 73030 512.00
Elbow Minimum 3 Views 73080 73080 488.00
Wrist Minimum 3 Views 73110 73110 502.00
Hand Complete Unilateral 73130 73130 440.00
Finger(s) 73140 73140 347.00
Hip Unilateral 2-3 Views 73502 73502 586.00
Knee Complete (4+ View) Unilateral 73564 73564 658.00
Ankle Complete Minimum 3 Views 73610 73610 502.00
Foot Minimum 3 Views 73630 73630 502.00
X-ray Exam Abdm 3+ Views 74021 74021 433.00
Complete Abdominal Series w/Chest 74022 74022 1,016.00
Abdomen with Contrast 74160 74160 2,979.00
Modified Barium Swallow 74230 74230 469.00
Dx Mammo Direct Uni All 77065 77065 424.00
Dx Diag with Scr Same Day Bi 77066 77066 501.00
Screen Mammo Direct Bi All 77067 77067 425.00
Bone Density Study 77080 77080 523.00

Laboratory Charges

Description MC HCPCS CPT Charge
Basic Metabolic Panel 80048 80048 68.00
Bun - Venous Sample 84520 84520 46.00
CBC Auto 85027 85027 66.00
CBC Platelet Auto Diff 85025 85025 74.00
CK MB (Creatine Kinase MB Fraction) 82553 82553 164.00
Complete Metabolic Panel 80053 80053 103.00
Creatine Kinase (CK) 82550 82550 66.00
Creatinine Bld 82565 82565 66.00
Culture Blood 87040 87040 180.00
Culture Urine W CC 87086 87086 90.00
Cyto Pap Tlp Man Scr G0123 88142 153.00
Hematocrit 85014 85014 26.00
Hemoglobin 85018 85018 26.00
Hemoglobin A1C Glycohgb 83036 83036 112.00
Hepatic Panel 80076 80076 68.00
Lipid Panel 80061 80061 144.00
Lytes Panel 80051 80051 56.00
Magnesium Bld 83735 83735 69.00
Myoglobin Bld 83874 83874 130.00
Prostate Specific Antigen (PSA) G0103 84153 149.00
Protime (Prothrombin Time) 85610 85610 44.00
PTT (Partial Thromboplastin Time) 85730 85730 68.00
Sedimentation Rate Manual 85651 85651 47.00
Sensitivity Micro 87186 87186 136.00
Surgical Pathology Level 4 88305 88305 587.00
Troponin Quant 84484 84484 101.00
TSH (Thyroid Stimulating Hormone) 84443 84443 136.00
Urinalysis With Micro Auto 81001 81001 43.00
Urinalysis w/o Micro Auto 81003 81003 37.00
Venipuncture 36415 36415 22.00

* In accordance with Ohio Revised Code, Section 3727.42
Professional fees are not billed by the hospital and are not included in these charges. Prices/charges may be updated at any time without notice. The patient/guarantor may be responsible for any amount different than those prices listed here.