Today, you have more choices than ever for your healthcare. Pomerene Hospital recognizes the significant decision families make when they select their healthcare insurance during their open enrollment time. The decision on which insurance company or plan is often difficult or confusing, therefore we want to share a few helpful tips to consider when choosing your healthcare plan:

If you are in need of financial assistance, please complete our Financial Assistance Application
form. You may also view our Financial Aid Policy
and our Plain Language Summary of Financial Assistance.
Family size includes the patient, patient's spouse whether they reside in the home or not, and ALL of the patient's children, natural or adopted under the age of 18. Grandparents, step-parents, and legal guardians are not considered part of a minor patient's "family". They must be related by birth or formal adoption in order to be considered. Both parents should be counted if the child is the patient, even if only one of them has been granted responsibility. Siblings who reside in the home can only be counted in the family size.
Income would be considered as anything made from:
Residents of Holmes County Who:
Only medically necessary and emergency health care services are covered.
Once your application has been processed, you must immediately set up payments for the balance, no longer than 10 days after notification. You can do so by contacting the Financial Counselor at (330) 674-1574, extension 1163 or the Billing Office at (330) 674-1584, extension 1744.
You may qualify for Medicare if:

The following links provide information about available healthcare coverage for those who are eligible:
The following links provide information about available healthcare coverage for those who are eligible.
Per Day Charges
ICU: $2205
Nursery: $992
Maternity: $1050
Private: $1029
Monitored Bed: 1,281
Swing Bed: 1,050
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.
Normal Delivery: $2,900
Cesarean Section Delivery: $3,690
Fetal Non-Stress Test: $400
Labor Room Per Hour: $110
Anesthesia Physician Fee Information may be obtained from:
Anesthesia Management Partners
921 Sherwood Drive
Lake Bluff, IL 60044
1-800-444-6110
Emergency Department charges are based on the level of emergency care provided to our patients. The levels, with level 1 representing basic emergency care, reflect the type of accommodations needed, the personnel resources, the intensity of care, and the amount of time needed to provide treatment. The following charges do not include fees for drugs, supplies, or additional ancillary procedures that may be required for a particular emergency treatment. They also do not include fees or Emergency Department physicians who will bill separately for their services.
Level 1: $278
Level 2: $394
Level 3: $541
Level 4: $646
Level 5: $966
Critical Care First Hour: $1,391
Operating Room charges are based on the complexity level, with Level 1 being the most basic, for a particular operation.
LEVEL 1 FIRST 30 MINUTES: $1,560.00
LEVEL 1 EACH ADDITIONAL 15 MINUTES: $780.00
LEVEL 2 FIRST 30 MINUTES: $1,716.00
LEVEL 2 EACH ADDITIONAL 15 MINUTES: $858.00
LEVEL 3 FIRST 30 MINUTES: $1,872.00
LEVEL 3 EACH ADDITIONAL 15 MINUTES: $936.00
LEVEL 4 FIRST 30 MINUTES: $2,028.00
LEVEL 4 EACH ADDITIONAL 15 MINUTES: $1014.00
ENDOSCOPY ROOM CHARGES
LEVEL 2 ENDOSCOPY FIRST 30 MINUTES: $1,716.00
LEVEL 2 ENDOSCOPY EACH ADDITIONAL 15 MIN: $858.00
The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges depending on the services performed.
Therapeutic Exercise per 15 Min.: $104
Ultrasound per 15 Min.: $68
Aquatic Therapy per 15 Min.: $78
Gait Training per 15 Min.: $73
Orthotics/Prosthetics per 15 Min.: $120
Evaluation- Low: $189
Electrical Stimulation Unattended: $62
Respiratory Therapy Charges
Arterial Blood Gas: $120
Acapella Device: $188
BiPap Per Day: $259
Medication Nebulizer Initial: $229
Oxygen Daily: $65
Oxygen Set Up: $65
Pulmonary Function Test Complete: $961
Ventilator Management 1st Day: $702
Pulse Ox: $41
Sleep Lab Charges
Sleep Lab without CPAP: $4,266
Sleep Lab with CPAP: $4,482
Home Sleep Test: $540
Speech Therapy Charges
Evaluation: $25
Treatment: $203
Evaluation Swallowing: $29
Treatment Swallowing: $250
Occupational Therapy Charges
Therapeutic Charges per 15 min.: $104
Fluidotherapy: $55
Functional Capacity Test per 15 min.: $104
Evaluation Low Complexity: $189
Orthotic Training per 15 min: $120
X-Ray & Radiological Charges
Diagnostic
Chest One View: $174
Chest Two View: $239
Screening Mammogram Digital: $263
KUB: $250
Lumbosacral Complete Min 4 Views: $473
Pelvis AP: $229
Bone Density Dexa Axial Skeleton: $286
Cervical Spine Complete: $520
Ankle Complete Unilateral: $321
Foot Complete Unilateral: $328
Hand Complete Unilateral: $3233
Knee Complete Unilateral Min 4 Views: $364
Hip Complete Unilateral Min 2 Views: $234
Wrist Unilateral Min 3 Views: $328
Shoulder Complete: $312
Ultrasound
Abdomen Complete: $702
Abdomen Limited: $541
Pelvis: $666
Breast Bilateral: $333
Breast Unilateral: $270
Both Kidneys: $468
Soft Tissue Head and Neck: $572
Thyroid: $572
OB Initial> 14 Weeks: $416
Nuclear Medicine
Gastric Emptying: $1,097
Bone/Whole Body: $1024
Thyroid Uptake and Scan: $1404
Hida Scan: $1510
CT
Brain with/without Contrast: $1,976
Abdomen and Pelvis with Contrast: $2,387
Abdomen without Contrast: $1,196
Chest without Contrast: $1,097
Cervical Spine without Contrast: $1,300
MRI
Lumbar Spine without Contrast: $2.064
Any Joint Lower without Contrast: $2,356
Breast Bilateral with/without Contrast: $2,496
Brain with/without Contrast: $2,834
Cervical without Contrast: $2028
MRA
Brain or Neck without Contrast: $1,872
Brain or Neck with Contrast: $2,184
Vascular Ultrasound
Vascular Ultrasound: $510
Carotid: $806
Venous Bilateral: $707
Arterial Bilateral Duplex Upper Ext: $468
Cardiology
Echocardiogram Complete: $1,508
Nuclear Stress (adenosine or Lexiscan): $3,838
Exercise Stress: $681
Transesophageal Echo (TEE): $2,184
EKG: $135
Holter Monitor: $518
Laboratory Charges
Amylase: $52
APTT: $46
Basic Metabolic Panel: $64
Bilirubin Total: $37
Blood Culture: $69
BNP: $134
BUN: $34
C Reactive Protein: $62
CBC No Diff: $44
Complete Blood Count: $55
Comprehensive Metabolic Panel: $131
CPK: $52
Depakene (Valproic Acid): $82
Electrolytes Panel 4: $64
Glucose: $32
Glucose Bedside: $33
Hematocrit: $22
Hemoglobin: $21
Hemoglobin Glycosylated (HGB A1C): $52
Hepatic Panel: $82
Iron: $46
Lipid Panel: $96
Magnesium: $52
Occult Blood Stool: $28
Pathology Level 4: $124
Potassium $36
Protime: $28
PSA Total: $72
PSA Cancer Screen: $60
Renal Function Panel: $74
Sedimentation Rate: $31
Thyroid Stimulating Hormone (TSH): $93
Troponin: $88
Urinalysis: $37
Urine Culture: $47
Vitamin D: $77
Venipuncture: $21
For general billing questions or to arrange a payment plan, please call 330-674-1584, ext. 1744
Chargemaster is a comprehensive list of charges for each inpatient and outpatient service item provided by a hospital. It includes every test, exams, surgical procedure, room charge, supply, etc. Given the many services provided by hospitals 24 hours a day, seven days a week, a chargemaster contains thousands of services and related charges.
Disclaimer: The information provided in the file below, is a comprehensive list of charges for each inpatient and outpatient service or item provided by a hospital, also known as a chargemaster. It is not a helpful tool for patients to comparison shop between hospitals or to estimate what total health care services are going to cost them out of their own pocket. For more information about the total cost of your care, please contact our Patient Financial Services at (330) 674-1584 ext. 1163.
Click here for the
2024 Pomerene Hospital Standard Charges
Click here for the 2024 Shoppable Services list
Click here to view the Right to Good Faith Estimate
Click here to view the Rights and Protections Against Surprise Medical Billing
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