Wooster
Community Hospital
2016 S E L F - PA Y
PAC K AG E P R I C I N G
AWARD WINNING H O S P I T A L
Hospital Review
Discounts
Wooster
Do Not Apply to Packaged Prices Below 25% discount if paid on the date of the hospital statement (approximately 7-10 days after the date of service). 20% discount if paid in 30 days
Community Hospital
AWARD WINNING H O S P I T A L
Hospital Review
Self Pay Packages 2016 Wooster ENT
330.264.9699
Drs. Hessler, A. Mathur, K. Mathur, & Wartmann ENT Procedures Bilateral ear tubes (myringotomy) Tonsillectomy - 12 yrs old Tonsillectomy & myringotomy - 12 yrs old Tonsillectomy & adenoidectomy (T&A) - 12 yrs old T&A including myringotomy - 12 yrs old Adenoidectomy - 12 yrs old Adenoidectomy & myringotomy - 12 yrs old
CPT Code(s)
Price
69436 42825 42826 69436 & 42825 69436 & 42826 42820 42821 69436 & 42820 69436 & 42821 42830 42831 69436 & 42830 69436 & 42831
$1,190 $1,865 $1,892 $2,157 $2,173 $1,892 $1,919 $2,532 $2,532 $1,714 $1,714 $2,077 $2,077
Fee includes: hospital, surgeon, anesthesiologist and pathologist (fee may increase if cancer is suspected), 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by Wooster ENT. Cash payment must be made the day of the procedure. Fee assumes procedure is performed without complications.
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1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
Self Pay Packages 2016 Wooster OB/GYN
330.345.2229
Drs. Benekos, Weeman, Shriner, Seals, & Holmes Mason OB/GYN Procedures
CPT Code(s)
Price
Cerclage of cervix/revision of cervix Vaginal/laparoscopic hysterectomy, 250Gm LAVH/BSO Vaginal/laparoscopic hysterectomy, 250Gm LAVH Only Hysteroscopy biopsy, with or without D&C D&C (dilation & curettage) Miscarriage, 1st trimester, suction D&E Miscarriage, 2nd trimester, suction D&E Laparoscopy with tubal block Anterior repair, vagina & bladder Posterior repair, rectum & vagina Anterior & posterior repair, vagina Repair of enterocele (bowel bulge), vaginal (1) C-section (2) Vaginal delivery Total abdominal hysterectomy (inpatient) Total vaginal hysterectomy Total vaginal hysterectomy w/BSO Tubal w/C-section Bladder suspension/TVT/TVTO Hysterosalpingography Salingo-oophorectomy (complete or partial/unilat or bilat) Total vaginal hysterectomy with AP repair Vaginal birth after cesearean (VBAC)
59320 58552 58554 58550 58553 58558 58120 59820 59821 58671 57240 57250 57260 57268 59510 59400 58150 58260 58262 58611 & 59510 57288 58340 & 74740 58720 58260 & 57260 59610
$2,403 $9,511 $9,999 $6,509 $9,738 $3,080 $2,854 $3,070 $3,078 $5,103 $5,351 $5,369 $5,596 $3,186 $9,621 $7,404 $13,711 $6,007 $6,146 $9,913 $5,067 $352 $9,433 $7,662 $7,867
Fee includes: hospital, surgeon, anesthesiologist and pathologist (fee may increase if cancer is suspected), 1 pre-operative and 1 post-operative office visit with the surgeon. Procedures must be done by the listed physicians. (1) C-section Includes: 1st ultrasound, prenatal care, six-week postpartum/post-op follow up, and 72 hours length of stay for mom and infant. (2) Vaginal delivery Includes: 1st ultrasound, prenatal care, six-week postpartum follow up, and 48 hours length of stay for mom and infant. (1&2) Requires monthly payment. Payment is required in full by week 32. For questions please call: 330.345.2229.
1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
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Self Pay Packages 2016 WCH Health System
330.287.2595
Drs. Wang, Slaby, Proano, other General Surgery Procedures Inguinal hernia repair, w/o mesh (unilateral) Inguinal hernia repair, w/mesh (unilateral) Inguinal hernia repair, laparoscopic, w/o mesh (unilateral) Laparoscopic inguinal hernia repair w/mesh (unilateral) Laparoscopic inguinal hernia repair w/mesh (bilateral) Laparoscopic cholecystectomy w/o cholangiography Laparoscopic cholecystectomy w/cholangiography Laparo cholecystectomy/explr Open cholecystectomy w/o cholangiography* Open cholecystectomy w/cholangiography* **Skin biopsy Screening colonoscopy Diagnostic colonoscopy **Debridement & possible skin graft Open umbilical hernia repair, w/o mesh Open umbilical hernia repair, w/mesh Modified radical mastectomy with Lymph node biopsy and Sentinel node tracer Laparoscopic unilateral inguinal hernia w/mesh + umbilical hernia repairs Laparoscopic bilateral inguinal hernia w/mesh + umbilical hernia repairs
CPT Code(s) 49505 49505 & 49568 49650 49650 & 49568 49650 & 49568 47562 47563 47564 47600 47605 11100 45378 45380 15100 & 15002 49585 49585 & 49568 19307 & 38525 & 38792 49650 & 49568 & 49585 49650 & 49568 & 49585
Price $4,084 $4,411 $5,717 $6,124 $6,626 $6,229 $6,298 $6,304 $11,481 $14,739 $590 $1,137 $1,507 $6,519 $3,992 $4,319 $10,092 $8,228 $10,566
Fee includes: hospital, surgeon, anesthesiologist and pathologist (fee may increase if cancer is suspected), 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by the above listed physicians. Cash payment must be made the day of the procedure. Fee assumes procedure is performed without complications.
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1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
Self Pay Packages 2016 WCH Health System
330.287.2595
Drs. Wang, Slaby, Proano, other General Surgery Procedures **Procedure performed by Dr. Slaby * = Inpatient only EGD (upper endoscopy) EGD (upper endoscopy) Radical nephrectomy (Dr. Proano) Litholaplaxy Repair bladder defect Removal of hydrocele Endovenous laser 1st vein Endovenous laser vein addon Dilate urethra stricture Probe nasolacrimal duct Cystoscopy & ureter catheter Cysto/uretero w/lithotripsy Fragmenting of kidney stone Cystoscopy and treatment Exc neck tum deep < 5 cm Debride skin musc at fx site Deb skin bone at fx site Laparoscopy appendectomy Cystoscopy Repair vagina/perineum Removal of nose polyp(s) TUR/bladder tumors Laparoscopy pyeloplasty Lithotripsy/stent Excision, malignant lesion, face
CPT Code(s)
Price
43235 43239 50545 52318 57288 55040 36478 36479 53620 68811 52005 52356 50590 52332 21556 11011 11012 44970 52000 57210 30115 52240 50544 52356 & 52353 11644
$1,052 $1,071 $11,143 $4,272 $4,632 $3,255 $3,162 $168 $749 $2,074 $2,048 $4,272 $4,512 $1,466 $2,534 $499 $2,214 $5,890 $435 $2,788 $3,025 $3,052 $2,591 $4,432 $1,673
Fee includes: hospital, surgeon, anesthesiologist and pathologist (fee may increase if cancer is suspected), 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by the above listed physicians. Cash payment must be made the day of the procedure. Fee assumes procedure is performed without complications.
1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
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Self Pay Packages 2016 The OSU Medical Center Sports Medicine Orthopaedics Drs. Chicorelli & Todd
Orthopedic Procedures **Procedure also performed by Dr. Slaby **Carpal tunnel - unilateral (open) **Carpal tunnel - bilateral (open) - bilateral Total knee replacement, unilateral Total knee replacement, bilateral Revision of knee joint, unicompartmental Shoulder rotator cuff arthroscopy Arthroscopic ACL knee with allograft ORIF, ankle ORIF, wrist Shoulder arthroscopy Knee arthroscopy Knee arthroscopy Knee arthroscopy Knee arthroscopy Total shoulder replacement Wrist fracture Labral tear - shoulder Below knee amputation Treat heel fracture N block other peripheral Pin finger fracture each Repair of kneecap tendon Treatment of ankle fracture Treat fx rad intra-articul
330.202.3420
CPT Code(s)
Price
64721 64721 27447 27447 27446 29827 29888 27814 25574 29824 & 29826 29880 29881 29882 29883 23472 25606 29807 27880 28415 64450 26756 27380 27792 25608
$2,745 $3,079 $17,072 $18,128 $21,243 $7,673 $10,424 $7,248 $7,125 $4,204 $4,072 $4,048 $4,241 $4,411 $19,201 $3,785 $7,409 $34,503 $9,924 $309 $2,361 $3,700 $6,863 $7,068
Fee includes: hospital, surgeon, anesthesiologist and pathologist, 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by the above listed physicians as no arrangement has been made with Cleveland Clinic to date. Cash payment must be made the day of the procedure. Fee assumes procedure is performed without complications.
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1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
Self Pay Packages 2016 Wooster Orthopaedic & Sports Medicine Center
Drs. Gesler, Knapic, Miller, Highlander & Widmer Total knee replacement, unilateral Total knee replacement, bilateral Revision of knee joint, unicompartmental Knee revision, with or without allograft, one component Knee revision, femoral & entire tibial component Total hip replacement Revision of total hip arthroplasty, both components Revision of total hip arthroplasty, acetabular component only Revision of total hip arthroplasty, femoral component only Total shoulder replacement
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WOOSTER, OH 44691
330.263.8158
330.804.9712 27447 27447 27446 27486 27487 27130 27134 27137 27138 23472
$17,776 $20,352 $21,917 $22,332 $22,808 $17,816 $23,186 $22,583 $22,662 $19,919
WWW.WOOSTERHOSPITAL.ORG
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Self Pay Packages 2016 Wooster Heart Group
330.202.5700
Drs. Ofori, Moodispaw, & Newton Cardiovascular Procedures
CPT Code(s)
Nuclear stress test with exercise Nuclear stress test without exercise (with Regadenoson) Add drug charge Cardioversion Echocardiogram, complete Stress test Stress TTE only
93016 & 93018 & 78456 93016 & 93018 & 78456 92960 93306 93017 93350
Surgical Specialists of Wayne County
$1,432 $1,432 $706 $576 $308 $585
330.264.5347
Dr. Stern
Vascular Studies Procedures
Price
CPT code(s)
Price
93880 93970 93971 93923 93924
$232 $226 $211 $183 $186
Carotid Complete Venous Complete - Bilateral Venous Limited (1-leg) Arterial Complete Arterial with Exercise
Fee includes: hospital, and interpreting physician fee. Cash payment must be made the day of the procedure. There have been no arrangement made with Cleveland Clinic to date. Fee assumes procedure is performed without complications.
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1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
Self Pay Packages 2016 Hyperbaric Medicine & Wound Healing Center
330.263.8750
Drs. Wang, Signs, Slaby, & Malys
Wound Care Center Procedures
CPT Code(s)
Price
99201 99202 99203 99204 99205 99211 99212 99213 99214 99215 11042 11043 11044 97597 16020 10060 10061 17250 20240 11719 11720 11721 11730 11055 11056 29581 29580 97605 97606
$32 $60 $91 $154 $200 $11 $30 $60 $93 $131 $344 $702 $1,411 $299 $205 $255 $486 $185 $1,884 $76 $127 $97 $203 $161 $169 $158 $186 $171 $174
New patient E&M New patient E&M New patient E&M New patient E&M New patient E&M Established patient E&M Established patient E&M Established patient E&M Established patient E&M Established patient E&M SQ debridement, 1st 20 sq cm SQ & muscle, 1st 20 sq cm SQ/muscle/bone, 1st 20 sq cm Selective debridement, 1st 20 sq cm Debridement, burn, small I&D abscess, simple I&D abscess, complex Cauterization Biopsy, bone Trimming of nondystrophic nail Debride nail, 1 - 5 Debride nail, 6+ Avulsion of nail plate Paring of corn/callus Paring of corn/callus, 2 - 4 Application of multilayer compression Unna boot/Profore/multilayer compression Negative pressure wound therapy 50 cm
Fee includes: hospital, surgeon, anesthesiologist and pathologist, 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by the above listed physicians. Cash payment must be made the day of the procedure. Fee assumes procedure is performed without complications.
1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
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Self Pay Packages 2016 WCH Business Office: 330.263.8158
Wooster Community Hospital Imaging Services MRI Test MRI w/o contrast, per exam MRI w/contrast, per exam MRI w/o & w/contrast, per exam MRI, breast
CPT code
Pricing $655 $805 $805 $395
To schedule a MRI please call 330.263.8660
Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure.
Test
CPT code 78815
PET scan Chest x-ray & all plain films
Pricing $1,693
To schedule an imaging test please call 330.263.8660
$144
Low-dose lung screening Mammogram Ultrasound (basic)
$180 $216 $219
Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure.
Computerized Topography Scan Test CPT code CT with contrast 74177 CT without contrast 74176 CT with and without contrast 74178 CTA
Pricing $505 $339 $505 $565
To schedule an a CT scan please call 330.263.8660
Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure.
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1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
Self Pay Packages 2016 330.263.8416
Drs. Friedman, & Novak WCH Inpatient Rehabilitation Routine stay (7 - 10 days)
Moderate stay (10 - 21 days) Average =14
Complex stay (21 - 35 days) Average = 15
CPT Code(s)
Price
Initial = 99221 - 99223 Subsequent = 99231 - 99233 Discharge = 99238 - 99239 Initial = 99221 - 99223 Subsequent = 99231 - 99233 Discharge = 99238 - 99239 Initial = 99221 - 99223 Subsequent = 99231 - 99233 Discharge = 99238 - 99239
$1535 (all inclusive)
$1535 (all inclusive)
$1535 (all inclusive)
Fee includes: All services provided at Wooster Community Hospital. Payment for the anticipated number of days is expected at the time of admission.
1 7 6 1 B E A L L AV E N U E
WOOSTER, OH 44691
330.263.8158
WWW.WOOSTERHOSPITAL.ORG
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Hospital Call Center Providing Assistance to You
Monday - Friday 8:00am – 5:30pm We can help you with the following: Assistance finding a new physician Checking physician appointment availability Create package pricing for self-pay patients Schedule FREE transportation to appointments Provide details about WCH services Assist customers with our website And more...
Call Today 330.263.8144 1761 BEALL AVENUE
WOOSTER, OH 44691
330.263.8144
WWW.WOOSTERHOSPITAL.ORG
1 7 6 1 B E A L L AV E N U E
Wooster
Community Hospital
WOOSTER, OH 44691
330.263.8143 www.woosterhospital.org
WCH 00898 011816
