In compliance with state law, Brown County General 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. 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 January, 2010.

Patient Price Information List 2009

Room and Board – Per day
Charges
Intensive care $2,221.00
Nursery $725.00
Semi-Private Room $905.00

Labor and Delivery
Charges
Normal Delivery (includes mother and baby) $8,350.00
Cesarean Section Delivery (includes mother and baby) $14,500.00
Amniocentesis $194.00
Fetal Monitoring $194.00 + $58.00 per hour
Maternity Semi-Private Room $905.00

Emergency Department
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 for Emergency Department physicians, which are billed separately by the hospital.

Charges 
Level 1 $158.00
Level 2 $253.00
Level 3 $458.00
Level 4 $526.00
Level 5 $754.00
Critical care $763.00

Operating Room
Operating Room charges are based on each 10 minutes while the operation is being performed.

Charge
Operating Room per 10 minutes $574.00

Physical Therapy
The following charges reflect the most common services offered by our Physical Therapy department. Patients may have additional charges, depending on the services performed.

Charge
Physical Therapy Evaluation $ 244.00
Therapeutic Exercise per 15 minutes $80.00
Electrical Muscle Stimulation $85.00

Occupational Therapy
The following charges reflect the most common services offered by our Occupational Therapy department. Patients may have additional charges, depending on the services performed.

Charge
Occupational Therapy Evaluation $209.00
Therapeutic Activity per 15 minutes $118.00
Therapeutic Exercise per 15 minutes $107.00

Pulmonary Therapy
The following charges reflect the most common services offered by our Pulmonary Therapy department. Patients may have additional charges, depending on the services performed.

Charge
Hand Held Nebulizer Initial Breathing Treatment $53.00
Hand Held Nebulizer Subsequent Breathing Treatment $ 32.00
EKG (Electrocardiogram) $131.00
Basic GXT Stress Test $726.00

X-Ray and Radiological
The following charges reflect the hospital's 30 most common x-ray and radiological procedures.

Charge
Chest X-ray 2 views $ 224.00
Lumbar Spine $288.00
KUB $175.00
Dexa Bone Scan $435.00
Cervical Spine with Obliques $359.00
Abdomen Flan and Upright $214.00
Hip $71.00
IVP (Intravenous Pyelogram) $630.00
Thoracic Spine with Swim View $300.00
Upper GI with KUB $447.00
Barium Enema with KUB $395.00
3 Views One foot or Ankle or Hand or Wrist $215.00
Screening Mammogram with CAD $229.00
Knee 3 Views $245.00
CT Scan of the Abdomen with Contrast $1,426.00
CT Scan of the Abdomen without Contrast $1,198.00
CT Scan of the Chest with Contrast $1,426.00
CT Scan of Chest without Contrast $961.00
CT Scan of the Head with Contrast $1,426.00
CT Scan of the Head without Contrast $961.00
CT Scan of the Lumbar Spine without Contrast $961.00
CT Scan of the Thoracic Spine without Contrast $961.00
CT Scan of the Pelvis with Contrast $1,426.00
CT Scan of the Pelvis without Contrast $1,155.00
MRI Head with Contrast $1,626.00
MRI Cervical Spine with Contrast $2,171.00
MRI Lumbar Spine with Contrast $2,295.00
MRI Knee $1,834.00
Nuclear Medicine Cardiolyte Stress Test - Non Drug Induced $5,293.00

Laboratory Charges
The following charges reflect the hospital's 30 most common laboratory procedures:

Charge
Amylase – Serum $ 65.00
Arterial Blood Gas $47.00
Basic Metabolic Profile $102.00
Comprehensive Metabolic Profile $135.00
CBC w/Diff $71.00
CPK $60.00
CK-MB $96.00
MIC $22.00
Culture, Blood $63.00
Culture, Routine $68.00
Strep A Direct $113.00
Culture, Urine $21.00
Hemoglobin, A1C $26.00
Urine HCG $66.00
Hemoglobin $29.00
Hematocrit $29.00
Lipase – Serum $77.00
Lipid Profile $68.00
Liver Profile $110.00
Magnesium – Serum $62.00
APTT $55.00
Phosphorous – Serum $15.00
Prothrombin Time $13.00
Sedimentation Rate $37.00
Transaminase-SGPT $48.00
Thyroid Stimulating Hormone $129.00
Troponin I $106.00
Urinalysis-Complete $57.00
Pathology Level III $65.00
Pathology Level IV $73.00

Hospital Billing Policies
Recognizing its charitable mission, it is the policy of the Brown County General Hospital to provide a reasonable amount of its services without charge to eligible patients who cannot afford to pay for care. Discounted care will be provided to uninsured or underinsured patients who meet the established eligibility criteria and complete the required application and review process. All medically necessary services of this facility will be available as uncompensated services.