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Hospital charges

Common procedure pricing list

In compliance with state law, Clinton Memorial 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. These prices are correct as of January 5, 2017.

Room and board – Per day charges

Medical/Surgical 1 Private $578.80
Intensive Care Unit (ICU) $1,324.30
Medical/Surgical 1 Telemetry Private $601.95

Emergency room (ER)

ER Visit Level 1 $144.70
ER Visit Level 2 $195.60
ER Visit Level 3 $382.00
ER Visit Level 4 $926.10
ER Visit Level 5 $1,405.35

Labor and delivery

Outpatient Labor Room First Hour $120.40
Outpatient Labor Room Additional Hour $10.40
Vaginal Delivery $2,698.40
C-Section (Or Level III 1 Hour) $8,336.10
Nursery Level 1 $584.60

Operating room (OR)

OR Level I First 30 Minutes $5,304.25
OR Level I Each Additional 15 Minutes $905.25
OR Level II First 30 Minutes $5,771.90
OR Level II Each Additional 15 Minutes $1,033.75
OR Level III First 30 Minutes $6,060.20
OR Level III Each Additional 15 Minutes $1,137.95
OR Level IV First 30 Minutes $6,263.90
OR Level IV Each Additional 15 Minutes $1,239.80

Physical therapy (PT)

PT Evaluation Limited $323.00
Therapact/15 Minutes $62.50
Manual Therapy/15 Minutes $135.45
Therapeutic Exercise/15 Minutes $163.20
Ultrasound/15 Minutes $106.50
Gait Training/15 Minutes $45.15

Occupational therapy (OT)

OT Evaluation Limited $226.90
Therapact/15 Minutes $62.50
Manual Therapy/15 Minutes $135.45
Therapeutic Exercise/15 Minutes $136.60
Whirlpool/Visit $90.30

Respiratory therapy

Inhalation Treatment, Initial $298.15
Inhalation Treatment, Additional $298.15

Radiology

Chest X-ray 1 View $163.20
Chest X-ray 2 Views $299.80
CT Head/Brain Without Contrast $1,264.15
CT Abdomen/Pelvis Without Contrast $1,855.65
CT Abdomen/Pelvis With Contrast $2,174.00
Kidney, Ureter and Bladder X-ray $231.50
Lumbar Spine X-ray 4 Views $358.85
Foot X-ray 3+ Views $281.30
DEXA Bone Density $195.65
CT C-Spine Without Contrast $1,634.60
CTA Chest With or Without Contrast $2,321.00
Knee X-ray 1 to 2 Views $258.15
CT Chest With Contrast $1,797.80
C-Spine X-ray 4 to 5 Views $369.30
Hand X-ray 3 Views $267.40
Shoulder X-ray $347.30
Ankle X-ray 3+ Views $283.60
Abdominal Series X-ray $287.05
Thoracic Spine 3 Views $394.75
Hip X-ray 2 to 3 Views $125.45
CT Chest Without Contrast $1,482.90
Wrist X-ray 3+ Views $267.40
MRI Brain With or Without Contrast $3,537.70
MRI Brain Without Contrast $2,455.30
CT Maxillofacial Without Contrast $1,279.15
Retrograde $612.35
CT Abdomen/Pelvis With or Without Contrast $2,583.85
Abdomen Flat/Upright X-ray $209.50
Pelvis X-ray $225.75
Elbow X-ray 1 to 2 Views $$254.65

Laboratory

Complete Blood Count With Differential $59.00
Basic Metabolic Panel $92.60
Complete Metabolic Panel $184.05
Complete Blood Count Without Differential $35.85
Urinalysis Automated With Microscopic Examination $31.25
Prothrombin Time/International Normalized Ratio (Protime) $28.90
Lipid Panel $63.70
TSH (Thyroid-Stimulating Hormone) $99.55
Troponin Quantity $79.85
Hemoglobin A1C $70.60
Urine Culture $67.15
Renal Function Panel $149.30
Lipase $55.55
Hepatic Function Panel $119.20
Urine Pregnancy Test $72.90
Urinalysis Without Microscopic Examination $26.60
Partial Thromboplastin Time $48.60
Vitamin D; 25 Hydroxy $140.05
Hemoglobin $25.45
Hematocrit $26.60
Magnesium Serum $42.85
RH Type $70.45
ABO Blood Type $120.40
Uric Acid Blood $37.05
Iron $42.85
Iron Binding Capacity $46.30
T4 Free $54.40
Lactic Acid $40.55
Antibody Screen $67.15
Vitamin B-12 $91.45
Venipuncture $22.00

Hospital billing policies

For additional information about billing policies visit our general billing information page or call 937.382.9593.