Summa Akron City, St. Thomas and Barberton Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
In compliance with state law, Summa Akron City and St. Thomas Hospitals publishes charges for room and board, emergency
department, labor and delivery, operating room, lab, radiology and other procedures. This publication is available upon request
when visiting the hospital and may be found at http://summahealth.org/patientvisitor/InsuranceandBilling/patientpricereports.
The hospital charges are consistent for all patients. The patient’s responsibility may vary, however, depending on insurance
contracts with individual health insurers. Summa Health System offers financial assistance through the Ohio Hospital Care
Assurance Program, Summa’s Charity and Uninsured Patient Charity Programs. For information contact Patient Financial
Services at 234.312.5700.
These prices are correct as of January 1, 2016.
Room and Board per Day Charges
Medical/Surgical Semi-Private
Chemical Dependency/Detox/Psychiatry
Oncology
Medical/Surgical Private
$2,610.50
2,610.50
2,652.50
Nursery
Perinatal
Telemetry
ICU Step Down
Coronary/Intensive Care
2,700.00
1,997.75
3,810.50
5,651.75
9,105.75
12,907.25
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.
Labor Room First Hr
521.50
Labor Room each additional Hr
261.25
Labor/Delivery Unit
537.75
Birthing Room First Hr
4,591.50
Birthing Room High Risk First 30 Min
5,141.50
Birthing Room High Risk each additional 15 Min 102.00
Delivery Room First 30 Min
4,851.75
Delivery Room each additional 15 Min
102.00
OB OR Level 1: First 30 Min
OB OR Level 2: First 30 Min
OB OR Level 3: First 30 Min
OB OR Level 1 or 2: each additional 15 Min
OB OR Level 3: each additional 15 Min
OB PACU First 30 Min
OB PACU each additional 15 Min
Circumcision w/Regional Block
Fetal Non-Stress
2,620.00
5,088.25
7,509.25
266.75
413.75
473.00
105.50
435.00
597.75
Emergency Department Charges
Emergency Department charges are based on the level of emergency care provided to patients. There may be other hospital
charges related to the emergency room visit (drugs, ancillary services, testing, anesthesia, etc.) Services provided by Emergency
physicians will be billed by the physicians.
Level 1 Emergency Exam
Level 2 Emergency Exam
Level 3 Emergency Exam
Level 4 Emergency Exam
Level 5 Emergency Exam
401.25
579.50
1,138.00
1,788.00
2,640.00
Critical Care First Hour
Critical Care Addl 30 Min
Pre-Notify Trauma Eval w/CC
Pre-Notify Trauma Act w/CC
Page 1 of 5
4,930.25
1,569.00
6,051.75
9,738.75
Summa Akron City, St. Thomas and Barberton Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
Operating Room Charges
Operating Room
Level 1
Level 2
Level 3
Level 4
Room Open
1,961.00
4,319.50
5,618.00
12,031.00
Per Minute
41.25
43.50
51.00
82.75
Anesthesia charges are a function of the type of anesthesia and the level of risk for the patient based on the patient’s overall
health and risk for complications. Fees for anesthesia administration are not reflected and will be billed separately by your
physician.
Epidural ASA 1 First 30 Min
Epidural ASA 2 First 30 Min
Epidural ASA 3 First 30 Min
Epidural ASA 4 First 30 Min
Epidural ASA 5 First 30 Min
General ASA 1 First 30 Min
General ASA 2 First 30 Min
General ASA 3 First 30 Min
General ASA 4 First 30 Min
General ASA 5 First 30 Min
MAC ASA 1 First 30 Min
MAC ASA 2 First 30 Min
MAC ASA 3 First 30 Min
785.50
864.00
950.75
1,045.75
1,150.25
986.00
1,085.00
1,193.25
1,315.50
1,443.50
347.25
381.50
420.25
MAC ASA 4 First 30 Min
MAC ASA 5 First 30 Min
Regional ASA 1 First 30 Min
Regional ASA 2 First 30 Min
Regional ASA 3 First 30 Min
Regional ASA 4 First 30 Min
Regional ASA 5 First 30 Min
Spinal ASA 1 First 30 Min
Spinal ASA 2 First 30 Min
Spinal ASA 3 First 30 Min
Spinal ASA 4 First 30 Min
Spinal ASA 5 First 30 Min
each additional 15 Min all anesthesia
Page 2 of 5
461.75
507.75
514.25
565.75
622.00
684.50
752.50
630.00
692.25
762.00
838.00
922.25
65.25
Summa Akron City, St. Thomas and Barberton Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
X-Ray and Radiological Charges
The following charges reflect the hospital’s 30 most common Radiological procedures (in alphabetical order)
Bone and or Jt Imag Whole Body
2,876.75
Mammog Scr-Bil w/Dig Image
CT Abd/Pelv w cont
4,638.75
Myocard Perf Image Spect Mx
CT Abd/Pelv wo cont
3,744.50
PET CT Skull Thigh
CT Cerv Spine wo cont
2,735.00
Ultrasound ABD w Image Doc Complt
CT Head/Brain wo cont
2,735.00
Ultrasound ABD w Image Doc Ltd
CT Thorax w contr
3,115.50
Ultrasound Breast Limited
CTA Chest w/wo cont
4,569.50
Ultrasound Guid Needle Plcmt
Digital Diag Mammography
464.50
Ultrasound Pelvic w/Docum Complt
DXA Bone Density 1+ Sites Axial
1,183.25
Ultrasound Preg 1st Trim TA APP Sing
ECG Stress
1,633.00
Ultrasound Preg Transvaginal
Fluoro Guide Needle Plcmt
1,253.00
Ultrasound Transvaginal
Hepatobili Duct Image incl GB
2,715.00
XR Abd Complt Incl Decubitus
MRA Head wo cont
3,899.25
XR Abdomen Single AP View
MRI Any Jt Low Ext w cont
4,835.00
XR Chest 1 View Front
MRI Brain w/wo cont
6,735.75
XR Chest PA and Lateral
Page 3 of 5
373.25
5,223.50
9,006.00
1,732.00
1,229.50
633.00
1,538.25
869.50
763.00
1,168.00
1,326.50
962.00
465.00
547.00
647.25
Summa Akron City, St. Thomas and Barberton Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
Laboratory
The following charges reflect the hospital’s 30 most common laboratory procedures (in alphabetical order).
Alerg SP-IGE Quan or SemiQuan
APTT
Autom Urinalysis WO Micro
Bact Cult-Urine Quan Count
Basic Metabolic Panel
Blood Typing ABO
Blood Typing RH
Chlam Trach Amp Probe
Compl Autom CBC W Plt
Pl CBC W Plt W Autom Diff
Drug Screen Class List A
Comprehensive Metabolic Panel
Ferritin
Glucose by Meter
Hemoglobin A-1-C
28.75
125.75
74.00
209.50
185.25
117.25
110.25
241.00
119.25
119.25
251.00
348.00
218.50
104.75
182.00
Hepatic Function
Iron
Lipase
Lipid Panel
Magnesium
Neisseria Amplif NA Probe
Prothrombin Time
RBC AB Scrn Ea Techiq
Surgical Path Level IV
Troponin Quant
Thyroid Stimulating Hormone (TSH)
Urinalysis Complete
Urinalysis Microscopic Only
Urine Pregnancy Visual color
Vitamin B-12 Level
182.00
116.00
192.25
223.75
107.00
241.00
87.75
238.00
362.75
263.50
169.50
25.00
33.25
214.25
260.25
Occupational or Physical Therapy
The following charges reflect the most common services offered by our Occupational Therapy and Physical Therapy
departments. Patients may have additional charges, depending on the services performed.
Apply Finger Splint – Static
Apply Short Arm Splint
OT Evaluation and Report
OT Re-Eval
OT Tx Man Ther per 15 Min
OT Tx Proc per Min
OT Whirlpool Therapy
PT E Stim Unat
307.25
707.75
524.50
436.00
241.25
251.25
342.25
146.50
PT Evaluation and Report
PT Re-Eval
PT Tx Active Funct per 15 Min
PT Tx Man Ther Tech per 15 Min
PT Tx Proc Neuro per 15 Min
PT Tx Proc per 15 Min
PT Tract Mech
PT US per 15 Min
Page 4 of 5
499.75
499.75
289.75
241.25
227.75
251.25
228.75
241.25
Summa Akron City, St. Thomas and Barberton Hospitals
Usual and Customary Charges for Selected Procedures
Patient Price List
Pulmonary Therapy
The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have
additional charges, depending on the services performed.
Arterial Puncture Blood for DX
Behav Chng Smoking 3-10 min
Behavior Chng Smoking > 10 min
Blood Gas Mixed WO O2 Sat
Bronchoprovocation
Bronchospasm-Pre & Post BD
Chest Pt; Subsequent
CO Diffuse Capacity
CO Expired Gas by IR
Evaluate Pt Use of Inhaler
Flow Volume Loop
921.75
77.75
104.00
370.25
3,268.25
1,042.00
210.00
791.75
676.25
313.25
1,065.75
Hast w/ Report
Intubation Emerg Proc
Pos Airway Pressure CPAP
Potassium
Pulm Funct Tst by Gas FRC/RV
Pulm Funct Tst Pleth/FRC/RV
Pulse OX Multi Det with Exercise
Pulse OX Sgl w/Procedure Only
Spirometry
Vent Mgmt Inpt Init or Obs 1st Day
Vent Mgmt Inpat Subq Day
226.50
2,013.75
1,259.50
79.50
1,065.75
816.25
192.25
315.25
664.25
3,263.00
1,949.25
Hospital Billing Policies
Your insurance providers, including Medicare, Medicaid, other primary insurance providers and secondary insurance providers
are billed by Summa hospitals before a bill is sent to you. Interest will not be charged on any balance due after insurance
payments are received. If you are not able to pay the amount you owe in full, please contact Patient Financial Services at the
phone number noted on your bill to apply for financial assistance or arrange for a payment plan.
Emergency services are neither delayed nor withheld on the basis of a patient’s ability to pay.
You may also find helpful consumer information at http://www.ohiohealthcareguide.org/.
Page 5 of 5