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, 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: $2293
Nursery: $1032
Maternity: $1092
Private: $1080
Monitored Bed: 1,345
Swing Bed: 1,092
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: $3,106
Cesarean Section Delivery: $4,452
Fetal Non-Stress Test: $433
Labor Room Per Hour: $155
Anesthesia Physician Fee Information may be obtained from:
Pomerene Anesthesia Services
844 Boulevard St.
Dover, Ohio 44622
330-473-661
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: $292
Level 2: $414
Level 3: $584
Level 4: $704
Level 5: $1,063
Critical Care First Hour: $1,516
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: $1,654.00
LEVEL 1 EACH ADDITIONAL 15 MINUTES: $827.00
LEVEL 2 FIRST 30 MINUTES: $1,888.00
LEVEL 2 EACH ADDITIONAL 15 MINUTES: $909.00
LEVEL 3 FIRST 30 MINUTES: $2,153.00
LEVEL 3 EACH ADDITIONAL 15 MINUTES: $992.00
LEVEL 4 FIRST 30 MINUTES: $2,332.00
LEVEL 4 EACH ADDITIONAL 15 MINUTES: $1060.00
ENDOSCOPY ROOM CHARGES
LEVEL 2 ENDOSCOPY FIRST 30 MINUTES: $1,785.00
LEVEL 2 ENDOSCOPY EACH ADDITIONAL 15 MIN: $893.00
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.: $108
Ultrasound per 15 Min.: $71
Aquatic Therapy per 15 Min.: $81
Gait Training per 15 Min.: $76
Orthotics/Prosthetics per 15 Min.: $125
Evaluation - Low: $186
Electrical Stimulation Unattended: $64
Respiratory Therapy Charges
Arterial Blood Gas: $252
Acapella Device: $204
BiPap Per Day: $269
Medication Nebulizer Initial: $273
Oxygen Daily: $60
Oxygen Set Up: $60
Pulmonary Function Test Complete: $1,033
Ventilator Management 1st Day: $730
Pulse Ox: $42
Sleep Lab Charges
Sleep Lab without CPAP: $4,607
Sleep Lab with CPAP: $5,020
Home Sleep Test: $589
Speech Therapy Charges
Evaluation: $262
Treatment: $217
Evaluation Swallowing: $314
Treatment Swallowing: $268
Occupational Therapy Charges
Therapeutic Charges per 15 min.: $108
Fluidotherapy: $59
Functional Capacity Test per 15 min.: $108
Evaluation Low Complexity: $197
Orthotic Training per 15 min: $125
X-Ray & Radiological Charges
Diagnostic
Chest One View: $181
Chest Two View: $258
Screening Mammogram Digital: $335
KUB: $260
Lumbosacral Complete Min 4 Views: $511
Pelvis AP: $238
Bone Density Dexa Axial Skeleton: $315
Cervical Spine Complete: $541
Ankle Complete Unilateral: $347
Foot Complete Unilateral: $354
Hand Complete Unilateral: $346
Knee Complete Unilateral Min 4 Views: $393
Hip Complete Unilateral Min 2 Views: $243
Wrist Unilateral Min 3 Views: $341
Shoulder Complete: $337
Ultrasound
Abdomen Complete: $730
Abdomen Limited: $649
Pelvis: $693
Breast Bilateral: $351
Breast Unilateral: $338
Both Kidneys: $505
Soft Tissue Head and Neck: $686
Thyroid: $686
OB Initial> 14 Weeks: $428
Nuclear Medicine
Gastric Emptying: $1,141
Bone/Whole Body: $1030
Thyroid Uptake and Scan: $1429
Hida Scan: $1780
CT
Brain with/without Contrast: $2,055
Abdomen and Pelvis with Contrast: $2,411
Abdomen without Contrast: $1,244
Chest without Contrast: $1,141
Cervical Spine without Contrast: $1,365
MRI
Lumbar Spine without Contrast: $2,167
Any Joint Lower without Contrast: $2,450
Breast Bilateral with/without Contrast: $2,596
Brain with/without Contrast: $2,947
Cervical without Contrast: $2,109
MRA
Brain or Neck without Contrast: $1,947
Brain or Neck with Contrast: $2,271
Vascular Ultrasound
Vascular Ultrasound: $530
Carotid: $838
Venous Bilateral: $735
Arterial Bilateral Duplex Upper Ext: $562
Cardiology
Echocardiogram Complete: $1,568
Nuclear Stress (Lexiscan): $4,056
Exercise Stress: $708
Transesophageal Echo (TEE): $2,272
EKG: $140
Holter Monitor: $552
Laboratory Charges
Amylase: $54
APTT: $48
Basic Metabolic Panel: $67
Bilirubin Total: $38
Blood Culture: $73
BNP: $139
BUN: $35
C Reactive Protein: $64
CBC No Diff: $46
Complete Blood Count: $57
Comprehensive Metabolic Panel: $136
CPK: $54
Depakene (Valproic Acid): $85
Electrolytes Panel 4: $67
Glucose: $34
Glucose Bedside: $34
Hematocrit: $23
Hemoglobin: $22
Hemoglobin Glycosylated (HGB A1C): $53
Hepatic Panel: $85
Iron: $48
Lipid Panel: $100
Magnesium: $54
Occult Blood Stool: $29
Pathology Level 4: $129
Potassium $37
Protime: $29
PSA Total: $75
PSA Cancer Screen: $62
Renal Function Panel: $77
Sedimentation Rate: $32
Thyroid Stimulating Hormone (TSH): $97
Troponin: $92
Urinalysis: $38
Urine Culture: $50
Vitamin D: $75
Venipuncture: $22
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 2025 Pomerene Hospital Standard Charges
Click here for the 2025 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