Pay Your Bill

Simple. Easy. MyChart.

Through MyChart, you can pay your bill online with or without a MyChart account.

Benefits of creating a MyChart account

  • Go paperless
  • View your balance real-time
  • View your statements online
  • Save your payment methods
  • View payment history

Need help? Download our guide to paying your bill with MyChart.

Did you receive a bill from one of our partnering providers? View more information here.

Patient Payment Options

All Major Payment Methods Accepted

  • Cash
  • Check
  • Debit Card
  • Money Order
  • Visa
  • MasterCard
  • Discover
  • American Express

Payment Plans

Short-term payment plans (up to 3 months) can be set up through Avita. Payments can be automated through your preferred card or bank account.

Long-term payment plans (up to 36 months) can be set up through our partner HELP Financial.

Help Financial

Financial Assistance Program

Paperless Billing

You can opt out of paper statements on MyChart and view your statement electronically instead. If you have an email listed on your account, you will receive a notification that your statement is ready to view.

To sign up for paperless billing, sign into MyChart and go to the Billing Account Summary page.

At the top of the page, click the box with the green leaf and follow the instructions on the next page.

Personalized Estimates

Avita Health System is committed to offering fair and competitive prices to our patients. The amount you will owe depends on many factors, including the services rendered and your insurance plan.

When you have scheduled or outpatient services at Avita, a representative will provide you with an accurate estimate of what you are expected to owe for services based on your plan benefits. We will discuss payment arrangements with you to inform you of Avita’s generous financial options.

Self-Service Patient Estimates

Create a personalized estimate that will accurately quote your estimated costs for services based on your plan benefits.

Contact Us for an Estimate

Avita can generate your estimate prior to services. Contact us today for your free personalized estimate:

  • Contact our Customer Service team:
  • Visit any Avita Hospital: Financial Counselors are available Monday thru Friday 8:00am – 4:30pm

Financial Aid

Avita is committed to providing access to health care for everyone regardless of their ability to pay. We commit to do so in a professional and compassionate manner that respects our patients’ dignity and privacy.

Resources to Help Pay Your Healthcare Costs

Avita Financial Counselors can assist you with applying for:

  • Medicaid
  • The Marketplace
  • 3-36 Month Payment Plans
  • Financial Assistance

Avita’s Financial Assistance Program

The Avita Financial Assistance Program is designed to provide fair and consistent access for all patients and is available for qualified patients. Financial Assistance for qualified patients may be applied to any Avita bill.

Financial Assistance includes:

  • Free care for individuals and families who earn less than 200% of the federal poverty level
  • Sliding scale of discounted care for individuals and families who are between 200% and 400% of the federal poverty level
  • Medical hardship assistance for families who would not otherwise qualify for financial assistance but have unique circumstances

Mail in the application with income verification to the address at the bottom of page 1. You can also bring it in to a Financial Counselor at any Avita Hospital.

Additional Information:

Pricing Information

Avita Health System is committed to offering fair and competitive prices to our patients. The amount you will owe depends on many factors, including the services rendered and your insurance plan.

Below is pricing information for Avita hospital services. Please remember that while hospital charges are the same for all patients, your patient responsibility may vary based on many factors. These lists are not helpful tools for patients to comparison shop between hospitals or to estimate what health care services are going to cost them out of their own pocket.

Standard Charges

Avita provides a list of Standard Charges as they appear in our hospital Chargemaster, as well as average Standard Charges for Diagnosis-Related Groups (DRGs). Download a machine-readable list of Avita’s standard hospital charges.

This list does not reflect the amount you will owe, which depends on many factors including the negotiated rate with your insurance and your plan benefits.

  • To see the negotiated rate for your insurance plan, see the Pricing Lists by Payer below.
  • For an estimate of what you will owe based on your plan benefits, see Personalized Estimates below.

Pricing Lists by Payer

Avita has negotiated in-network discounts with many insurance plans. This discount is often reflected on your explanation of benefits and statement as a contractual allowance. See How Medical Insurance Works for more information.

To help you understand hospital charges and negotiated rates, Avita provides a price list for each hospital in our health system.

These lists do not reflect the amount you will owe, which depends on many factors including your plan benefits.

  • For an estimate of what you will owe based on your plan benefits, see Personalized Estimates below.

Personalized Estimates

You can also create a personalized estimate that will accurately quote what you are expected to owe for services based on your plan benefits.

Common Charges

Below are standard charges for common hospital services as of 07/01/2022. Please remember that this does not reflect payer-negotiated rates, patient benefits or available discounts.

Outpatient Labs

Lab TestCPTCharge Before Insurance or Discount
Venipuncture – This is charged for labs collected
via blood draw
36415$7.00
ALT (SGPT)84460$18.00
Amylase82150$79.00
APTT85730$67.00
AST (SGOT)84450$18.00
Basic Metabolic Panel80048$25.00
Calcium82310$43.00
CBC & Platelet with Differential85025$26.00
Comprehensive Metabolic Panel80053$36.00
COVID-1987635$100.00
COVID-19 Antibody86769$55.00
Creatinine82565$18.00
Glucose82947$14.00
Hemoglobin85018$38.00
Hemoglobin A1C83036$32.00
Hepatic Panel80076$21.00
Lipid Panel80061$41.00
Magnesium83735$70.00
Myoglobin83874$161.00
Phosphorus84100$67.00
Potassium84132$30.00
Prothrombin Time85610$14.00
PSA84153$34.00
Sedimentation Rate85651$53.00
Sensitivity Study87186$28.00
Sodium84295$28.00
Thyroid Stimulating Hormone84443$56.00
Thyroxine, Free T484439$72.00
Troponin84484$145.00
Urinalysis with Microscope81001$12.00
Urine Culture with Colony87086$27.00
Urine Culture with Organism ID87088$40.00

Outpatient Imaging

The following charges reflect the most common outpatient imaging services. Patients may have different or additional charges, depending on the services performed and the contrast administered. Fees for the Radiologist provider will be billed separately.

CT and MRI Charges
Imaging TestCPTCharge Before Insurance or Discount
CT Abdomen with Contrast74160$4,758.50
CT Abdomen with & without Contrast74170$4,834.00
CT Chest with Contrast (Thorax)71260$3,102.00
CT Head with & without Contrast70470$2,785.50
CT Head without Contrast70450$1,709.00
CT Pelvis with Contrast72193$3,760.00
MRI Brain with & without Contrast70553$4,332.50
MRI Lumbar Spine without Contrast72148$4,071.00
X-Ray (XR) Charges
Imaging TestCPTCharge Before Insurance or Discount
XR Abdomen (KUB)74018$410.00
XR Acute Abdominal Series74022$561.00
XR Ankle73610$390.00
XR Chest – Portable71045$280.00
XR Chest 2 views (PA & Lateral)71046$293.00
XR Foot73630$391.00
XR Hand/Fingers73140$296.00
XR Hip and Pelvis73502$313.00
XR Knee73560$351.00
XR Lumbar Spine 2 views (PA & Lateral)72100$512.00
XR Pelvis72170$267.00
XR Shoulder73020$390.00
XR Wrist73100$317.00
Other Imaging Charges
Imaging TestCPTCharge Before Insurance or Discount
Bone Density Scan (Dexa)78306$2,164.00
Mammogram, Diagnostic Unilateral77065$519.00
Mammogram, Screening77067$214.00
Modified Barium SwallowIncludes 2 tests$925.00
Thyroid Uptake and Scan78014$3,491.00
Ultrasound Abdomen Complete76700$1,103.00
Ultrasound Carotid Duplex Bilateral93880$841.00
Ultrasound Extremity Non Vascular76881$489.00
Ultrasound Gallbladder76705$802.00

Outpatient Therapy

The following charges reflect the most common outpatient therapy services offered. Patients may have additional charges, depending on the services performed.

Physical Therapy
TherapyCPTCharge Before Insurance or Discount
Evaluation – Moderate Complexity97162$353.00
Electrical Stimulation97032$156.00
Gait Training – 15 minutes each97116$110.00
Manual Therapy – 15 minutes each97140$202.00
Therapeutic Activity – 15 minutes each97530$118.00
Therapeutic Exercise – 15 minutes each97110$128.00
Ultrasound97035$153.00
Occupational Therapy
TherapyCPTCharge Before Insurance or Discount
Evaluation – Moderate Complexity97166$353.00
Therapeutic Activity – 15 minutes each97530$118.00
Therapeutic Exercise – 15 minutes each97110$128.00

Outpatient Cardiopulmonary and Neurology Services

The following charges reflect the most common outpatient cardiopulmonary and neurology tests. Patients may have different or additional charges, depending on the services performed. Fees for the provider or interpretation are billed separately.

Stress Tests
Cardiopulmonary ServiceCPTCharge Before Insurance or Discount
Echo Complete with Doppler93306$1,663.00
Stress Test – Treadmill with EKG93017$1,285.00
Stress Test – Treadmill with EchoIncludes 2 tests$4,012.00
Stress Test – All CardiolitesIncludes 2 tests$6,704.00
Diagnostic Testing
Cardiopulmonary ServiceCPTCharge Before Insurance or Discount
EKG 12-Lead93005$169.00
Holter Monitor – 24-48 hoursIncludes 2 services$923.00
Holter Monitor – 48 hours to 7 daysIncludes 2 services$1,216.00
Pulmonary Function StudyIncludes 3 tests$1,615.00
EEGs/EMGs
Neurology ServiceCPTCharge Before Insurance or Discount
EMG One ExtremityIncludes 2 tests$782.00
EMG Two ExtremitiesIncludes 3 tests$1,295.00
EEG – Up to 60 minutes95816$970.00

Avita Walk-in Clinics

Avita has two Walk-In Clinics located in Bellville and Ontario to provide convenient, fast treatment for injuries and conditions that are not critical, but need prompt attention. For more information, visit our walk-in clinic page.

Walk-In Clinic charges are based on the level of care needed to treat our patients (with Level 1 representing basic urgent care). The following charges do not include fees for drugs, supplies, or additional services provided during treatment.

Level of CareCPTCharge Before Insurance or Discount
Level 199211$115.00
Level 299212$163.00
Level 399213$221.00
Level 499214$241.00
Level 599215$324.00

Emergency Services

Avita has three Emergency Departments located in Ontario, Galion, and Bucyrus. Visit our locations page for directions.

Emergency Department charges are based on the level of emergency care needed to treat our patients (with Level 1 representing basic emergency care). The following charges do not include fees for drugs, supplies, or additional services provided during treatment. These also only reflect the Hospital level charges and do not include fees for the Emergency Department physicians, which is billed separately.

Level of CareCPTCharge Before Insurance or Discount
Level 199281$224.00
Level 299282$390.00
Level 399283$552.00
Level 499284$884.00
Level 599285$1,319.00

Room Charges

Room and Board charges reflect the type of care needed to provide treatment. Operating Room charges are based on the level of care needed to treat our patients (with Level 1 representing basic care). The following charges do not include fees for drugs, supplies, or additional services provided during treatment. These also only reflect the Hospital level charges and do not include fees for the physicians, which is billed separately.

Room and Board – per day
Room ChargeCharge Before Insurance or Discount
Routine Care$813.00
Intensive Care (ICU)$1,695.00
Labor & Delivery (Obstetrics)$813.00
Nursery$813.00
Inpatient Rehab$1,032.00
Swingbed$609.00
Operating Room – up to 30 minutes
Room ChargeCharge Before Insurance or Discount
Level 1$2,775.00
Level 2$3,151.00
Level 3$3,445.00
Level 4$3,807.00
Level 5$4,154.00

Customer Service

If you have questions about your bill and payment options or would like a free personalized estimate, contact our Customer Service team at:

419-468-0512
Toll free: 1-833-462-8428
Email us at: pfs.customer.service@avitahs.org

Did you receive a bill from one of our partnering providers? View more information here.

Financial Counselors

If you have questions about Avita’s financial assistance program or need help applying for Medicaid, contact our Financial Counselors at any of the following locations:

Bucyrus Hospital 419-563-9810
Galion Hospital 419-468-0513
419-468-0516
Ontario Hospital 419-462-3386
Crestline Business Office*419-468-0852
*By appointment only419-462-3390

Patient Billing Advocates

If you need assistance with your medical bills and insurance letters, or help applying for Medicaid, contact our Patient Billing Advocates at 419-468-0513 or 419-563-9810.

What is a patient billing advocate?

To help with the daunting and confusing task of paying and organizing bills, Avita Health System added Patient Billing Advocates to our line of community services. Our Billing Advocates help patients understand and sort through the paperwork they receive from their healthcare providers and insurance companies.

What connections do you have to help individuals with bills?

We have developed relationships with local, state, and federal organizations to help supply provide information regarding financial assistance and other programs that are offered. A few agency connections we have include: Council On Aging, Health Department, Community Action, Job and Family Services, and Veterans Affairs.

How do I schedule an appointment with a billing advocate?

By calling one of the following numbers, appointments can be made with a Billing Advocate. Appointments typically last for one hour.

Galion 419-468-0513
Bucyrus 419-563-9810

How much does an appointment cost?

Appointments are free of charge! Avita is proud to be able to offer this type of community service.

Do I have to be an Avita patient?

Absolutely not! Advice and assistance from our Billing Advocates is an option to anybody, regardless if you utilize Avita for your healthcare services.

Partnering Providers

Avita partners with other providers to ensure patients receive the highest quality care. While nearly all Avita services will be on a single billing statement, patients may receive more than one bill for some services. One bill will be from the hospital for the facility charge. You may also receive a bill from the independent provider(s) who interprets test(s) results. This is most common for imaging services, preadmission testing, surgery, and emergency services.

For example, when you get an x-ray, there is a claim from the hospital for the facility charge and a claim from the Radiologist for interpreting the test. As another example, if you were transported by ambulance or helicopter, you may receive a separate bill from the medical transport company.

Disclaimer: Please be aware that the providers listed below who perform these additional services are not necessarily in your insurance network. When in doubt, please contact either the provider or your insurance company.

These are some of the providers with whom Avita partners:

Service(s)ProviderBilling Phone
Outside PathologistNeoGenomics949-362-7307
Pain ManagementPain Management Group
(Arjun Sharma, MD)
866-776-8150
RadiologistRiverside Radiology and Interventional Associates866-863-6739
Spine and NeurosurgeryKey Clinics, LLC
(Joel Siegal, MD)
216-916-7771
VascularGalion Vascular Associates
(Barry Zadeh, MD, FACC, FACS)
877-668-1155

If you don’t see the provider listed above, please contact them at the number on your bill. For questions about your Avita bill, please contact our Customer Service team.

How Medical Insurance Works

Avita Health System is committed to offering fair and competitive prices to our patients. How much you will owe depends on many factors, including the services rendered and your insurance plan. This is why we’ve created a personalized estimate tool that will accurately quote what you are expected to owe for services based on your plan benefits.

Avita has negotiated in-network discounts with many insurance plans. This discount is often reflected on your explanation of benefits and statement as a contractual allowance.

  • Example: Avita agrees to a 5% in-network discount. This reduces a $100 charge to $95.

From the negotiated charge amount, the insurance pays according to your benefit plan. You will owe any applicable co-pays, co-insurance or remaining deductible until your out-of-pocket maximum is met.

Definitions

Co-pay – The fixed amount you pay at time of visit.

Co-insurance – The percentage of the covered amount that your insurance requires you to pay. For example, if you have an 80/20 plan, you owe 20% of the negotiated charge amount and insurance pays 80%.

Deductible – The amount you have to pay each year before your plan starts paying benefits. After you meet your deductible, you will continue to owe any co-pays and co-insurance amounts.

Out-of-pocket maximum – The amount your insurance company requires you to satisfy before you are no longer subject to co-insurance.

Examples

What Your Co-pay Might Look Like

In this example, if you visit an in-network doctor and your office visit was $200, you would pay a $25 co-pay and your plan would pay the remaining $175. The amount you pay for your co-pay will vary based on your plan.

What Your Co-insurance Plan (No Deductible) Might Look Like

This example shows what your payments would look like if your plan had a 75/25 co-insurance plan with no deductible. Your plan would pay 75% of your bill until your out-of-pocket maximum was met. Then, your plan would cover 100% of the cost.

What Your Inpatient Costs Might Look Like on a Deductible and Co-insurance Plan

Let’s assume you have a health plan with a $1,000 deductible, 20% coinsurance, and a $6,000 out-of-pocket maximum. If you incur $50,000 in medical charges, you would first need to pay your $1,000 deductible. While 20% coinsurance of the remaining charges is $9,800, you would only owe $5,000 because this would meet your $6,000 out-of-pocket maximum for the year. That means, for the total $50,000 medical charges, you would owe $6,000 and your insurer would pay $44,000.

What Your Year Might Look Like for a $3,000 Deductible and 20% Co-insurance Plan

Your Rights and Protection Against Surprise Medical Bills

When you get emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.

Insured Patients

What is “Balance Billing” (Sometimes Called “Surprise Billing”)?

When you see a doctor or other health care provider, you may owe certain out-of-pocket costs, such as a copayment, coinsurance, and/or a deductible. You may have other costs or have to pay the entire bill if you see a provider or visit a health care facility that isn’t in your health plan’s network.

“Out-of-network” describes providers and facilities that haven’t signed a contract with your health plan. Out-of-network providers may be permitted to bill you for the difference between what your plan agreed to pay and the full amount charged for a service. This is called “balance billing.” This amount is likely more than in-network costs for the same service and might not count toward your annual out-of-pocket limit.

“Surprise billing” is an unexpected balance bill. This can happen when you can’t control who is involved in your care—like when you have an emergency or when you schedule a visit at an in-network facility but are unexpectedly treated by an out-of-network provider.

You are protected from balance billing for:

Emergency services

If you have an emergency medical condition and get emergency services from an out-of-network provider or facility, the most the provider or facility may bill you is your plan’s in-network cost-sharing amount (such as copayments and coinsurance). You can’t be balance billed for these emergency services. This includes services you may get after you’re in stable condition, unless you give written consent and give up your protections not to be balanced billed for these post-stabilization services.

Certain services at an in-network hospital or ambulatory surgical center

When you get services from an in-network hospital or ambulatory surgical center, certain providers there may be out-of-network. In these cases, the most those providers may bill you is your plan’s in-network cost-sharing amount. This applies to emergency medicine, anesthesia, pathology, radiology, laboratory, neonatology, assistant surgeon, hospitalist, or intensivist services. These providers can’t balance bill you and may not ask you to give up your protections not to be balance billed.

If you get other services at these in-network facilities, out-of-network providers can’t balance bill you, unless you give written consent and give up your protections.

You’re never required to give up your protections from balance billing. You also aren’t required to get care out-of-network. You can choose a provider or facility in your plan’s network.

When balance billing isn’t allowed, you also have the following protections:

  • You are only responsible for paying your share of the cost (like the copayments, coinsurance, and deductibles that you would pay if the provider or facility was in-network). Your health plan will pay out-of-network providers and facilities directly.
  • Your health plan generally must:
    • Cover emergency services without requiring you to get approval for services in advance (prior authorization).
    • Cover emergency services by out-of-network providers.
    • Base what you owe the provider or facility (cost-sharing) on what it would pay an in-network provider or facility and show that amount in your explanation of benefits.
    • Count any amount you pay for emergency services or out-of-network services toward your deductible and out-of-pocket limit.

Avita Health System complies with applicable Federal and State of Ohio laws including House Bill 388 Revised Code 3902.50; 3902.52; 3902.52; 3902.53; 3902.54.

If you believe you’ve been wrongly billed, you may contact the Departments of Health and Human Services, Labor, and Treasury at 1-800-985-3059

Visit https://www.cms.gov/nosurprises/consumers for more information about your rights under federal law.

Visit https://insurance.ohio.gov/wps/portal/gov/odi/home for more information about your rights under Ohio laws.

Download a printable version of the insured patient information

Self-Pay Patients

You Have the Right to Receive a “Good Faith Estimate” Explaining How Much Your Medical Care Will Cost

Under the No Surprises Act, health care providers are required to give patients who don’t have insurance or who are not using insurance an estimate of the bill for scheduled medical items and services.

  • You have the right to receive a Good Faith Estimate for the expected cost of any scheduled non-emergency items or services. This includes related costs like medical tests, equipment, and hospital fees.
  • Make sure your health care provider gives you a Good Faith Estimate verbally and/or in writing at least 1 business day before your scheduled medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
  • If you receive a bill that is at least $400 or more than your Good Faith Estimate, you can dispute the bill.
  • Make sure to save a copy or picture of your Good Faith Estimate.

For questions or more information about your right to a Good Faith Estimate, or to dispute your bill, visit www.cms.gov/nosurprises or call 1-800-985-3059

Download a printable version of the self-pay patient information