Belmont Community Hospital

In compliance with state law, Belmont Community Hospital is providing this price list containing charges for room and board 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 the admitting and billing staff to determine whether they qualify for discounts. These prices are correct as of Oct. 31, 2006.

Room and Board -- Per Day Charges
Intensive care		$850
Psychiatric care		$633
Routine care		$447
Rehabilitation		$709

X-Ray and Radiological Charges The following charges reflect the hospital's 30 most common X-ray and radiological procedures.
X-RAY Chest 2 Views		$132
X-RAY Mammogram		$110
X-RAY Abdomen		$165
X-RAY Chest 1 View		$63
X-RAY Foot 3 Views		$113
X-RAY Knee 2 Views		$124
X-RAY Shoulder		$127
X-RAY Lumbar		$151
X-RAY Ankle 3 Views		$113
X-RAY Hand 3 Views		$127
X-RAY Hip 2 Views		$160
X-RAY Cervical + Obl		$226
X-RAY Thoracic AP/LAT/SWIM		$254
X-RAY Wrist 3 views		$113
X-RAY Esophagus		$216
X-RAY Upper GI		$284
X-RAY Elbow 3 Views		$113
X-RAY Body Orbit		$104
X-RAY Femur		$98
Ultrasound Abdomen Limited		$358
Ultrasound Pelvis Complete		$454
Ultrasound Thyroid		$320
CAT Scan Abdomen + contrast		$1,012
CAT Scan Thorax + contrast		$1,010
CAT Scan Brain + contrast		$793
CAT Scan Pelvis + contrast		$1,010
MRI Lumbar + contrast		$2,734
MRI Head + contrast		$2,734
MRI Knee no contrast		$1,481
MRI Shoulder no contrast		$1,481

Laboratory Charges The following charges reflect the hospital's 30 most common laboratory procedures.
TSH		$73
Free Thyroxine		$45
PSA screen		$84
Lipid Panel I		$87
Basic Metabolic Panel		$79
Troponin I Level		$87
Folate		$70
Vitamin B-12 Level		$70
Hepatic Function Panel		$55
SGPT		$40
SGOT		$26
CPK		$37
Comprehensive Metabolic		$86
Magnesium		$35
Lithium		$37
Triglycerides		$26
Glucose		$24
Glycosylated Hemiglo		$42
CPK-MB		$82
Carbamazepine		$71
Valproic Acid		$61
Marijuana (Urine)		$33
Bilirubin, Direct		$28
B Natriuretic Peptide		$129
CBC Complete		$61
Protime		$23
Urinalysis W Reflex Culture		$18
Occult Blood (diagnostic)		$244
Occult Blood (screen)		$15
Beta Strep Screen (Group A)		$31

Emergency Department Charges ER charges are based on the level of emergency care given to patients The following charges do not include fees for drugs, supplies or other ancillary procedures or for ER physicians who bill separately for their services.
Level 1		$80
Level 2		$108
Level 3		$163
Level 4		$235
Level 5		$291

Operating Room Charges OR charges are based on the time needed to complete the procedure. The following charges do not include fees for drugs, supplies or other ancillary procedures or for the surgeon or anesthesiologist, who bill separately for their services.
OR Time, First 30 Minutes		$1,080

Physical Therapy Charges The following reflect the most common services offered by this department. Patients may have additional charges, depending on the services performed.
Therapeutic Exercise per 15 minutes		$46
Ultrasound per 15 minutes		$41
Evaluation		$80

Occupational Therapy Charges The following reflect the most common services offered by this department. Patients may have additional charges, depending on the services performed.
Therapeutic Exercise per 15 minutes		$43
Home Management Training per 15 minutes		$45
Evaluation		$108
Lymph Drainage Massage per 15 minutes		$52

Pulmonary Therapy Charges The following reflect the most common services offered by this department. Patients may have additional charges, depending on the services performed.
Aerosol Treatment		$21
Pulse Oximetry		$19
Arterial Blood Gas		$172

Hospital Billing Policies
Belmont Community Hospital offers discount and charity programs. For information, call the Credit Manager at 740-671-1276. For questions about a bill, call the Business Office at 740-671-1269 or 740-671-1418.