Pricing

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Dayton Children's is providing this price list containing our charges for room and board, emergency department, operating room, medical imaging, 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 July 1, 2012.

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Room and Board -- Per Day Charges

Room Charge - Per Day
General pediatrics $2,677.00  
Chronic care $2,464.00  
Regional Level III B Newborn Intensive Care Unit (NICU) $3,988.00  
Hematology/oncolog $2,895.00  
     
     
Observation Charges
OBS 1-day only low severity $675.00  
OBS 1-day only moderate severity $1,291.00  
OBS 1-day only high severity $1,817.00  
OBS first day stay low severity $695.00  
OBS first day stay moderate severity $1,291.00  
OBS first day stay high severity $1,817.00  
OBS second day stay low severity $459.00  
OBS second day stay moderate severity $699.00  
OBS second day stay high severity $1,262.00  
     
Other Inpatient Services
CVVH- Hemofiltration $1,265.00  
Therapeutic apheresis $2,000.00  
Acute Hemodialysis $1,087.90  
     
     
     
 
 

Emergency Department Charges

These are hospital charges only and do not include any physicians' fees.

Emergency department
ED room level  I $101.00  
ED room level  II $196.00  
ED room level III $333.00  
ED room level  IV $499.00  
ED room level V $755.00  
ED critical care 30 - 74 minutes $972.00  
ED critical care each additional 30 minutes $841.00  
These are hospital charges only and do not include any physicians' fees.
 

Operating Room Charges

Prices do not include physicians' fees and supplies. Both the surgeon and anesthesiologist will bill for services. Please check with your health insurance company to make sure these charges are covered.

Surgery
Surgery room charge $521.00  
1-30 minutes surgery $898.00  
31-45 minutes surgery $1,166.00  
46-60 minutes surgery $1,535.00  
61-75 minutes surgery $1,905.00  
76-90 minutes surgery $2,280.00  
91-105 minutes surgery $2,658.00  
106-120 minutes surgery $3,041.00  
121-135 minutes surgery $3,427.00  
136-150 minutes surgery $3,817.00  
151-165 minutes surgery $4,212.00  
166-180 minutes surgery $4,607.00  
181-195 minutes surgery $5,010.00  
196-210 minutes surgery $5,416.00  
These charges are hospital charges only and do not include any physicians' fees. For a listing of doctors' chargesm you need to talk to your surgeon.
 
 

Physical/Occupational Therapy Charges

These charges are complete for therapy visits. If you see a physician, there may be other charges.

PT and OT  
PT EVALUATION $285.00    
PT THER EXERCISE 15 MIN $57.00    
OT EVAL $285.00    
OT ORTHOTIC FAB 15 MIN $57.00    
OT TREATMENT 15 MIN $57.00    
BURN GARMENT MEAS 15 MIN $57.00    
BURN GARMENT ISSUE 15 MIN $57.00    
These charges are complete for therapy visits.
If you see a physician there may be other charges.
 

Pulmonary Therapy Charges

       
Pulmonary Therapy Hospital      Physician    
Oxygen per day $101.00      
Tent, per day $152.00      
Nebulizer, per day $285.00      
Vent, initial day $849.00      
Vent, subsequent day $741.00      
CPAP per day $695.00      
TCPO2/TCPCO2 per day $300.00      
Exhaled Carbon Dioxide $449.00      
Aerosol initial RX $75.00      
Aerosol subsequent RX $64.00      
Airway Clearance Init $82.00      
Airway Clearance Subq $77.00      
Intubation $412.00      
Oximetry $68.00      
Complete blood gases $105.00      
Multichannel somnogram $697.00 $73.00    
Polysomnography $2,398.00 $421.00    
Inhalation challenge $373.00 $82.50    
Breath H2 $145.00 $59.00    
PF spirometry $165.00 $81.00    
PF FRC $116.00 $27.00    
         
PF DLCO $116.00 $110.00    
Pulmonary stress $292.00 $91.00    
Pulmonary stress complex $334.00 $91.00    
 

X-Ray and Radiological (Medical Imaging) Charges

The following charges reflect the hospital's 40 most common x-ray and radiological procedures. These are hospital charges only and do not include any physicians' fees.

Radiology  
Elbow L, 2V $140.00      
Forearm L $131.00      
Wrist  L, 3+V $157.00      
Hand R $157.00      
Fingers R, 2+V $118.00      
Femur L, 2V $148.00      
Knee R 1 OR 2 views $150.00      
TIB/FIB R $138.00      
Ankle R,3+V $157.00      
Foot R, 3V $157.00      
C-spine AP LAT 2 OR 3 VW $215.00      
Pelvis AP 1 VIEW ONLY $133.00      
SCOLI-AP & LAT erect $202.00      
Hips AP & FROGLEG LAT $174.00      
Sinuses complete $228.00      
Skull <4 VIEWS x-ray $170.00      
Neck soft tissue (airway) $169.00      
Chest port AP $153.00      
Chest with lateral view $180.00      
Abdomen 1 VIEW (KUB) $147.00      
Abdomen 2 VIEW $167.00      
Upper GI W/O KUB $354.00      
UGI/SBFT (small bowel) $529.00      
Barium enema $399.00      
VCUG $396.00      
Bone age, 5 years and over $150.00      
Head W/O,CT $1,117.00      
Head W,CT $1,412.00      
Head W/O&W,CT $1,908.00      
ABD W,CT $1,512.00      
ABD W/O&W,CT $1,908.00      
Sinus W/O CT $1,117.00      
Sinus W,CT $1,512.00      
Nuclear cystogram, NM $789.00      
Cerebral, US $508.00      
Renal echography, US $510.00      
Pelvic echography, US $429.00      
Brain, brainstem W/O, MRI $2,000.00      
Brain W,MRI $2,675.00      
Brain W/O&W, MRI $3,179.00      
These are hospital charges only and do not      
include any physicians' fees.        
 

Laboratory Charges

The following charges reflect the hospital's 50 most common laboratory procedures. These lab charges are complete. There are no pathologists' fees.

Lab  
Manual differential $34.00    
Blood count W/O diff W/PLT $58.00    
Basic metabolic $63.00    
CBC, AUTO DIFF W/ PLT $38.00    
Urinalysis dip only $28.00    
Comprehensive metabolic $85.00    
Urine culture, clean catch $69.00    
THRT CULT B STREP, GRP A $44.00    
Rapid B-strep, GRP A $43.00    
Bilirubin direct $29.00    
TSH, highly sensitive $104.00    
Blood culture routine $80.00    
Urinalysis and microscopic $34.00    
MIC-SUSCEPT, EACH ORG $73.00    
Magnesium $36.00    
Phosphorous $31.00    
Urine drug of abuse, EA $34.00    
Gram stain smear $32.00    
FREE T4 $74.00    
RSV EIA $63.00    
Sedimentation rate $41.00    
Bilirubin total $29.00    
UCG urine pregnancy test $63.00    
Rapid flu $69.00    
Insulin $47.00    
Hemoglobin A1C $69.00    
Lipid profile $62.00    
Reticulocyte count, auto $22.00    
Lead, blood $53.00    
BID1, AEROBIC, DEFIN ID1 $87.00    
Renal profile $63.00    
PT (PROTIME) $45.00    
AMYLASE $40.00    
LIPASE $55.00    
Hepatic function $70.00    
Ionized calcium $85.00    
PTT $55.00    
H&H, HEMOGLOBIN & HCT $31.00    
T4 $48.00    
Glucose random $32.00    
Pertussis, PCR $209.00    
CSF CELL CNT & DIFF $41.00    
CSF glucose $76.00    
CSF protein $40.00    
SGPT $31.00    
Creatinine urine $36.00    
Stool cult ROUT SAL/SHIG $80.00    
Stool cult E-coli $76.00    
SGOT $31.00    
Human growth hormone $97.00    
These lab charges are complete. There are no pathologists fees.  
 

Hospital Billing Policies

 
 

For specific billing questions and information on billing policies, please call patient accounts at 937-641-3555.

 

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