Package Pricing 2015 - Wooster Community Hospital Pricing...Package Pricing 2015. OB/GYN ... Tonsillectomy & Myringotomy 69436 & 42825 $2,157 69436 & 42826 $2,173 ... Lapraroscopy

Package Pricing 2015

OB/GYN Procedures

Wooster OB/GYN Drs. Benekos, Weeman,

Shriner, Seals, & Holmes Mason

CPT Code(s)

330.345.2229

Price

Revision of cervix/cerclage 59320 $2,757

O/P vaginal/laparoscopic hysterectomy, <250GM LAVH/BSO

58552 $7,464

O/P vaginal/laparoscopic hysterectomy, >250GM LAVH/BSO

58554 $7,952

O/P Vaginal/laparoscopic hysterectomy, <250GM LAVH Only

58550 $9,360

O/P Vaginal/laparoscopic hysterectomy, >250GM LAVH Only

58553 $7,691

Discounts 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

Wooster Community Hospital For more information call 1761 Beall Avenue, Wooster, OH 330.263.8158

Wooster ENT Drs. Hessler,

A. Mathur, K. Mathur,

& Wartmann

3330.264.9699

ENT Procedures

CPT Code(s) <12 years old

Price

CPT Code(s) >12 years old

Price

Bilateral Ear Tubes (Myringotomy)

69436 $1,190 69436 $1,190

Tonsillectomy 42825 $1,865 42826 $1,892

Tonsillectomy & Myringotomy 69436 & 42825 $2,157 69436 & 42826 $2,173

Tonsillectomy & Adenoidectomy (T&A)

42820 $1,892 42821 $1,919

T&A including bilateral myrin-gotomy

69436 & 42820 $2,532 69436 & 42821 $2,532

Adenoidectomy 42830 $1,714 42831 $1,714

Adenoidectomy & Myringotomy 69436 & 42830 $2,077 69436 & 42831 $2,077

Fee includes: hospital, surgeon, anesthesiologist and pathologist, 1 pre-operative and 1 post-operative office visit with the surgeon. Services must be performed by Wooster ENT 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.

OB/GYN Procedures

Wooster OB/GYN Drs. Benekos, Weeman,

Shriner, Seals, & Holmes Mason

330.345.2229

Price

Anterior repair, vagina & bladder 57240 $6,473

Posterior repair, rectum & vagina 57250 $6,491

Anterior & posterior repair, vagina 57260 $6,718

Repair of enterocele (bowel bulge), vagina

57268 $3,540

Hysterectomy biopsy, with or without D&C

58558 $3,429

IP total abdominal hysterectomy 58150 $9,219

Total vaginal hysterectomy 58260 $6,520

Total vaginal hysterectomy w/BSO 58262 $6,659

D&C (dilation & curettage) 58120 $3,203

Miscarriage, 1st trimester, suction D & E 59820 $3,419

Miscarriage, 2nd trimester, suction D & E 59821 $3,527

(1) C-section 59510 $9,252

(2) Vaginal delivery (anesthesia not included)

59400 $6,820

Vaginal birth after C-section (VBAC) 59610 $7,370

Total vaginal hysterectomy with AP repair 58260, 57260 $7,759

Lapraroscopy with tubal block 58671 $5,456

Tubal w/C-section 58611 $6,562

Bladder suspension/TVT/TVTO 57288 $6,180

Hysterosalpingography 58340, 74740 $404

Salingo-oophorectomy (complete or partial/unilat or bilat)

58720 $8,740

Fee includes: hospital, surgeon, anesthesiologist and pathology (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) Includes: 1st ultrasound, prenatal care, six-week postpartum/post-op follow up, and 72 hours length of stay for mom and infant.

(2) 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 call: 330.345.2229.

Self Pay Packages 2015


General Surgery Procedures

WCH Health System Drs. Wang & Slaby

CPT Code(s)

330.287.2595

Price

**Procedure performed by Dr. Slaby

Inguinal hernia repair, w/o mesh (unilateral) 49505 $4,152

Inguinal hernia repair, w/mesh (unilateral) 49505 & 49568 $4,477

Inguinal hernia repair, laparoscopic, w/o mesh

(unilateral)

49650 $5,404

Inguinal hernia repair, laparoscopic, w/o mesh

(bilateral)

49560 $1,167

Laparoscopic inguinal hernia repair w/mesh

(unilateral)

49650 & 49568 $5,849

Laparoscopic inguinal hernia repair w/mesh

(bilateral)

49650 & 49568 $10,124

Laparoscopic cholecystectomy w/o

cholangiography

47562 $5,723

Laparoscopic cholecystectomy w/

cholangiography

47563 $5,792

Open cholecystectomy w/o cholangiography

(Inpatient only)

47600 $11,516

Open cholecystectomy w/ cholangiography

(Inpatient only)

47605 $14,458

**Skin biopsy 11100 $518

Screening colonoscopy 45378 $1,206

Diagnostic colonoscopy 45380 $1,255

**Debridement & possible skin graft– Total 15002, 15100 $7,953

Debridement 15002 $0

Skin Graft 15100 $0

Open umbilical hernia repair, w/o mesh 49585 $4,060

Open umbilical hernia repair, w/mesh 49585 + 49568 $4,384

Modified radical mastectomy w/lymph node bx

& sentinel node tracer

19307, 38525, 38792 $9,868

Laparoscopic unilateral inguinal hernia w/mesh

+ umbilical hernia repairs

49650, 49568, 49585 $6,380

Laparoscopic bilateral inguinal hernia w/mesh

+ umbilical hernia repairs

49650, 49568, 49585 $10,352

Esophagogastroduodenoscopy 43235 $1,051

Esophagogastroduodenoscopy 43239 $1,072

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.


2015 Self Pay Packages

Orthopedic Procedures

The OSU Medical Center Sports Medicine

Orthopaedics Drs. Chicorelli

& Todd

CPT Code(s)

Price

**Procedure also performed by Dr. Slaby

**Carpal tunnel - unilateral (open) 64721 $2,599

**Carpal tunnel - bilateral (open) 64721-50 $3,086

Total knee replacement, unilateral 27447 $16,867

Total knee replacement, bilateral 27447-50 $27,489

Revision of knee joint, unicompartmental 27446 $20,833

Knee revision, with or without allograft, one

component 27486 $21,208

Knee revision, femoral & entire tibial component 27487 $21,451

Revision of total hip arthroplasty, both compo-

nents 27134 $17,634

Revision of total hip arthroplasty, acetabular

component only 27137 $17,098

Revision of total hip arthroplasty, femoral


Total hip replacement 27130 $16,985

Total Hip, anterior 27130 $17,065

Shoulder rotator cuff arthroscopy 29827 $6,908

Arthroscopic ACL knee with allograft 29888 $9,444

ORIF, ankle 27814 $6,351

ORIF, wrist 25574 $7,838

Shoulder arthroscopy 29824 + 29826 $6,742

Knee arthroplasty 29880 $3,693

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 as no arrangement has been made with Cleveland Clinic to date. Cash payment must be made the day of the procedure.


330.202.3420

Orthopedic Procedures

Wooster Orthopaedic & Sports Medicine Center

Drs. Gesler, Knapic, Miller, & Highlander

CPT Code(s)

Price

Total knee replacement, unilateral 27447 $16,935

Total knee replacement, bilateral 27447 $27,726

Revision of knee joint, unicompartmental 27446 $20,969

Knee revision, with or without allograft, one

component 27486 $21,373

Knee revision, femoral & entire tibial component 27487 $21,498

Total hip replacement 27130 $17,029

Revision of total hip arthroplasty, both compo-

nents 27134 $17,861

Revision of total hip arthroplasty, acetabular com-

ponent only 27137 $17,270

Revision of total hip arthroplasty, femoral


Total hip, anterior 27130 $17,109

Knee Arthroscopy 29882 $3,026


Total shoulder replacement 23472 $19,721


Orthopedic

Procedures

The OSU Medical Center Sports Medicine

Orthopaedics Drs. Chicorelli

& Todd

CPT Code(s) Price




Total shoulder replacement 23472 $19,294

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.


330.202.3420

330.804.9712

Vascular Studies Procedures

Surgical Specialists of Wayne County

Dr. Stern CPT Code(s)

330.264.5347

Price

Carotid complete 93880 $268

Venous complete—bilateral 93970 $264

Venous limited (1-Leg) 93971 $184

Arterial complete 93923 $179

Arterial with Exercise 93924 $182

Cardiovascular Procedures

Wooster Heart Group Drs. Ofori, Moodispaw, &

Newton

CPT Code(s)

330.202.5700

Nuclear stress test with exercise 93016, 93018, 78456-26 $1,078

Nuclear stress test without exercise

(with Ragadenoson)

93016, 93018, 78456-26 $1,365

Echocardiogram, complete 93306-TC, 93306-26 $583

Stress test-screening ONLY; no doctor order 93017 $329

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.




Elective Plastic Surgery Procedures (u=unilateral b=bilateral)

Wooster Plastic & Reconstructive Surgery

Dr. Slaby

CPT Code(s)

330.202.3350

Price

Blepharoplasty - lower eyelid (u) 15820 $2,644

Blepharoplasty - lower eyelid (b) 15820 $3,945

Blepharoplasty - lower eyelid (u) 15821 $2,681

Blepharoplasty - lower eyelid (b) 15821 $4,001

Blepharoplasty - upper eyelid (u) 15822 $2,503

Blepharoplasty - upper eyelid (b) 15822 $2,891

Blepharoplasty - upper eyelid (u) 15823 $2,681

Blepharoplasty - upper eyelid (b) 15823 $4,002

Plastic surgery, neck 15825 $3,148

Removal of face wrinkles (face lift) 15828 $7,521

Removal excessive skin, thigh (u) 15832 $3,669

Removal excessive skin, thigh (b) 15832 $4,450

Removal excessive skin, hip (u) 15834 $3,556

Removal excessive skin, hip (b)

15834 $5,334

Removal excessive skin, arm (u) 15836 $3,060

Removal excessive skin, arm (b) 15836 $4,570

Removal excessive skin, forearm/hand 15837 $2,846

Abdominoplasty 15830+15847 $7,170

Mini-abdominoplasty 15830+15847 $6,299

Gynecomastia (u) 19300 $3,607

Gyncecomastia (b) 19300 $5,471

Breast reduction (u) 19318 $6,806

Breast reduction (b) 19318 $10,270

Breast lift (u) 19316 $5,046

Breast lift (b) 19316 $7,629

Breast implants-saline (u) 19325 $10,151

Breast implants-silicone (u) 19325 $10,151

Breast implants-saline (b) 19325 $15,246

Breast implants-silicone (b) 19325 $15,246

Fee includes: hospital, surgeon, and anesthesiologist, 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.



Elective Plastic Surgery Procedures (u=unilateral b=bilateral)

Wooster Plastic & Reconstructive Surgery

Dr. Slaby CPT Code(s)

330.202.3350

Price

Breast implant removal (u) 19371 $4,940

Breast implant removal (b) 19371 $7,491

Rhinoplasty 30400 $4,347




Brow ptosis repair (brow lift) (u) 67900 $2,754

Brow ptosis repair (brow lift) (b) 67900 $4,331

Otoplasty (u) 69300 $3,420

Otoplasty (b) 69300 $5,190

Fee includes: hospital, surgeon, and anesthesiologist , 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.


WCH Inpatient Rehabilitation Procedures

Drs. Friedman, & Novak

330.263.8265

Price

Routine stay (7 - 35 days)

Initial = 99221 - 99223 Subsequent = 99231 - 99233

Discharge = 99238

$1,535 All inclusive

per day

Moderate stay (10 - 21 days)

Average = 14

Initial = 99221– 99223 Subsequent = 99231 - 99233 Discharge = 99238 - 99239


per day

Complex stay (21 - 35 days)

Average = 15

Initial = 99221 - 99223 Subsequent = 99231 - 99233 Discharge = 99238 - 99239


per day

Fee includes: All services provided at Wooster Community Hospital. Payment for the anticipated number of days is expected at the

time of admission.

CPT Code(s)


Wound Care Center Procedures

Hyperbaric Medicine & Wound Healing Center

Drs. Wang, Signs, & Slaby CPT Code(s)

330.263.8750 Price

New patient E&M 99201 $31





Established patient E&M 99211 $11





SQ debridement, 1st 20 sq cm 11042 $413

SQ debridement, addt’l 20 sq cm 11045 $32

SQ & muscle, 1st 20 sq cm 11043 $525

SQ & muscle, addt’l 20 sq cm 11046 $68

SQ/muscle/bone, 1st 20 sq cm 11044 $1,269

SQ/muscle/bone, addt’l 20 sq cm 11047 $119

Selective debridement, 1st 20 sq cm 97597 $204

Selective debridement, addt’l 20 sq cm 97598 $189

Debridement, burn, small 16020 $64

HBO treatment x 30 min, quantity=____ C1300 $0

HBO treatment supervision 99183 $132

I&D abscess, simple 10060 $307

I&D abscess, complex 10061 $405

Cauterization 17250 $219

Biopsy, skin 11100 $233

Biopsy, skin, each addt’l 11101 $30

Biopsy, bone 20240 $2,446

Trimming of nondystrophic nail 11719 $72

Debride nail, 1-5 11720 $81

Debride nail, 6+ 11721 $93

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.



Wound Care Center Procedures

Hyperbaric Medicine & Wound Healing Center

Drs. Wang, Signs, & Slaby CPT Code(s)

330.263.8750 Price

Avulsion of nail plate 11730 $236

Paring of corn/callus 11055 $138

Paring of corn/callus, 2 - 4 11056 $203

Appl skin sub up to 100 1st 25 sq cm, leg/ 15271 $1,790

Appl skin sub ea addt’l 25 sq cm, leg/ankle 15272 $21

Appl skin sub up to 100 1st 25 sq cm, feet/ 15275 $1,804

Appl skin sub ea addt’l 25 sq cm, feet/toes 15276 $30

Appl skin sub 1st 100 sq cm leg/ankle 15273 $3,003

Appl skin sub ea addt’l 100 sq cm, leg/ankle 15274 $55

Appl skin sub 1st 100 sq cm feet/toes 15277 $1,959

Appl skin sub ea addt’l 100 sq cm feet/toes 15278 $70

Application of multilayer compression 29581 $169

Unna boot/Profore/multilayer compression 29580 $196

Negative pressure wound therapy<50 cm 97605 $151

Negative pressure wound therapy >50 cm 97606 $211

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.


Other Imaging Tests Test

Price

WCH Business Office: 330.263.8158

PET scans $1,693

To schedule an MRI please call 330.263.8660

Plain Film x-ray $144

Low-dose lung screening $180

Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure.


Computerized Topography Scan Test

Wooster Community Hospital Imaging Services

Price


CT without contrast $339

CT with contrast $505

CT with and without contrast $505

CTA $565

Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure

MRI Test

Price


MRI without contrast per exam $655

To schedule an MRI please call

330.263.8660

MRI with contrast per exam $805

MRI without and with contrast per exam $805

Breast MRI $395

Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure.

To schedule an MRI please call 330.263.8660

Documents

Package Pricing 2015 - Wooster Community Hospital Pricing...Package Pricing 2015. OB/GYN ... Tonsillectomy & Myringotomy 69436 & 42825 $2,157 69436 & 42826 $2,173 ... Lapraroscopy