Wooster. Community. Hospital. Far Ahead...Close to Home AWARD WINNING

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Linette Baker
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1 Wooster Community Hospital S E L F - PA Y PAC K AG E P R I C I N G Far Ahead...Close to Home AWARD WINNING H O S P I T A L

2 Wooster Community Hospital 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 AWARD WINNING H O S P I T A L Self Pay Packages 2017 Wooster ENT Drs. Hessler, A. Mathur, K. Mathur, & Wartmann ENT Procedures CPT Code(s) Price Bilateral ear tubes (myringotomy) $1,190 Tonsillectomy - <12 yrs old $1,865 Tonsillectomy - >12 yrs old $1,892 Tonsillectomy & myringotomy - <12 yrs old & $2,157 Tonsillectomy & myringotomy - >12 yrs old & $2,173 Tonsillectomy & adenoidectomy (T&A) - <12 yrs old $1,892 Tonsillectomy & adenoidectomy (T&A) - >12 yrs old $1,919 T&A including myringotomy - <12 yrs old & $2,532 T&A including myringotomy - >12 yrs old & $2,532 Adenoidectomy - <12 yrs old $1,714 Adenoidectomy - >12 yrs old $1,714 Adenoidectomy & myringotomy - <12 yrs old & $2,077 Adenoidectomy & myringotomy - >12 yrs old & $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 BEALL AVENUE WOOSTER, OH

3 Wooster OB/GYN Drs. Benekos, Weeman, Shriner, Seals, & Holmes Mason OB/GYN Procedures CPT Code(s) Price Cerclage of cervix/revision of cervix $3,023 Vaginal/laparoscopic hysterectomy, <250Gm LAVH/BSO $10,878 Vaginal/laparoscopic hysterectomy, >250Gm LAVH/BSO $11,319 Vaginal/laparoscopic hysterectomy, <250Gm LAVH Only $7,414 Vaginal/laparoscopic hysterectomy, >250Gm LAVH Only $11,071 Hysteroscopy biopsy, with or without D&C $3,477 D&C (dilation & curettage) $3,414 Miscarriage, 1st trimester, suction D&E $3,635 Miscarriage, 2nd trimester, suction D&E $3,637 Laparoscopy with tubal block $6,084 Anterior repair, vagina & bladder $6,179 Posterior repair, rectum & vagina $6,183 Anterior & posterior repair, vagina $6,387 Repair of enterocele (bowel bulge), vaginal $4,364 (1) C-section DRG $8,658 (2) Vaginal delivery DRG $6,776 Total abdominal hysterectomy (inpatient) DRG $13,981 Total vaginal hysterectomy $6,796 Total vaginal hysterectomy w/bso $6,921 Tubal w/c-section DRG & $9,934 Bladder suspension/tvt/tvto $5,898 Hysterosalpingography & $365 Salingo-oophorectomy (complete or partial/unilat or bilat) DRG $9,424 Total vaginal hysterectomy with AP repair & $8,013 Vaginal birth after cesearean (VBAC) $7,534 Tubal ligation w/epidural $2,833 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: BEALL AVENUE WOOSTER, OH

4 WCH Health System Drs. Calabretta, Robotham, Slaby, Cebul, Peabody, and more General Surgery Procedures CPT Code(s) Price Inguinal hernia repair, w/o mesh (unilateral) $4,383 Inguinal hernia repair, w/mesh (unilateral) $4,383 Inguinal hernia repair, w/mesh (unilateral) $328 Inguinal hernia repair, laparoscopic, w/o mesh (unilateral) $5,954 Laparoscopic inguinal hernia repair w/mesh (unilateral) $6,034 Laparoscopic inguinal hernia repair w/mesh (unilateral) $328 Laparoscopic inguinal hernia repair w/mesh (bilateral) $8,632 Laparoscopic inguinal hernia repair w/mesh (bilateral) $328 Laparoscopic cholecystectomy w/o cholangiography $6,465 Laparoscopic cholecystectomy w/cholangiography $6,534 Laparo cholecystectomy/explr $6,539 Open cholecystectomy w/o cholangiography* DRG $11,462 Open cholecystectomy w/cholangiography* DRG $14,727 **Skin biopsy $695 Screening colonoscopy $1,029 Diagnostic colonoscopy $1,650 **Debridement & possible skin graft $2,267 Debridement $1,987 Skin graft $2,568 Open umbilical hernia repair, w/o mesh $4,291 Open umbilical hernia repair, w/mesh $4, $328 Modified radical mastectomy $8,730 Lymph node biopsy $527 Sentinel lymphy node tracer $48 Laparoscopic unilateral inguinal hernia w/mesh + umbilical hernia repairs $6, $ $537 Laparoscopic bilateral inguinal hernia w/mesh + umbilical hernia repairs $8, $ $537 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 BEALL AVENUE WOOSTER, OH

5 Drs. Calabretta, Robotham, Slaby, Cebul, Peabody, and more General Surgery Procedures CPT Code(s) Price **Procedure performed by Dr. Slaby * = Inpatient only Laparoscopic bilateral inguinal hernia w/mesh + umbilical hernia repairs $6, $ $537 EGD (upper endoscopy) $991 EGD (upper endoscopy) $1,010 Litholaplaxy $4,957 Removal of hydrocele $3,961 Endovenous laser 1st vein $3,294 Endovenous laser vein add on $169 Probe nasolacrimal duct $2,401 Cystoscopy & ureter catheter $2,375 Cysto/uretero w/lithotripsy $4,886 Fragmenting of kidney stone $5,305 Cystoscopy and treatment $3,359 Exc neck tum deep < 5 cm $3,411 Debride skin musc at fx site $1,010 Deb skin bone at fx site $3,093 Laparoscopy appendectomy $6,125 Repair vagina/perineum $3,057 Removal of nose polyp(s) $3,687 Laparoscopy pyeloplasty $10,636 Excision, malignant lesion, face $2,026 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 BEALL AVENUE WOOSTER, OH

6 Ohio State Medical Center Sports Medicine Orthopaedics Drs. Chicorelli & Todd Orthopedic Procedures CPT Code(s) Price **Procedure also performed by Dr. Slaby **Carpal tunnel - unilateral (open) $2,945 **Carpal tunnel - bilateral (open) - bilateral $3,277 Total hip replacement $16,706 Shoulder rotator cuff arthroscopy $8,600 Shoulder arthroscopy & $4,436 Total shoulder replacement DRG $20,150 Total knee replacement, unilateral DRG $16,165 Total knee replacement, bilateral DRG $17,630 Arthroscopic ACL knee with allograft $8,802 Knee arthroscopy $4,455 Knee arthroscopy $4,417 Knee arthroscopy $4,708 Knee arthroscopy $4,967 Knee arthroscopy $4,562 Knee arthroscopy $2,949 Below knee amputation DRG $34,958 Repair of kneecap tendon $7,319 Treatment of ankle fracture $7,430 ORIF, Ankle $7,645 ORIF, Wrist $7,466 Wrist fracture $4,104 Labral tear - shoulder $8,125 Treat heel fracture $8,839 N block other peripheral $386 Pin finger fracture each $3,659 Treat fx rad intra-articul $7,736 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 BEALL AVENUE WOOSTER, OH

7 Wooster Orthopaedic & Sports Medicine Center Drs. Gesler, Knapic, Miller & Widmer Orthopedic Procedures CPT Code(s) Price Total knee replacement, unilateral $17,752 Total knee replacement, bilateral $20,328 Revision of knee joint, unicompartmental $22,314 Knee revision, with or without allograft, one component $22,729 Knee revision, femoral & entire tibial component $23,204 Total hip replacement $17,792 Revision of total hip arthroplasty, both components $23,582 Revision of total hip arthroplasty, acetabular component only $22,980 Revision of total hip arthroplasty, femoral component only $23,059 Total hip, anterior $15,536 Shoulder Replacement $20,150 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 BEALL AVENUE WOOSTER, OH

8 Wooster Heart Group Drs. Ofori, Moodispaw, & Newton Nuclear stress test with exercise Cardiovascular Procedures CPT Code(s) Price Nuclear stress test without exercise (with Regadenoson) Add drug charge & & & & $1,492 $1,426 Cardioversion $709 Echocardiogram, complete $617 Stress test $326 Stress TTE only $625 Surgical Specialists of Wayne County Dr. Stern Vascular Studies Procedures CPT code(s) Price Carotid Complete $330 Venous Complete - Bilateral $322 Venous Limited (1-leg) $168 Arterial Complete $186 Arterial with Exercise $190 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 BEALL AVENUE WOOSTER, OH

9 Wooster Community Hospital Imaging Services MRI Test CPT code Pricing MRI w/o contrast, per exam $406 MRI w/contrast, per exam $695 MRI w/o & w/contrast, per exam $584 MRI, breast $395 WCH Business Office: To schedule a MRI please call Physicians order required Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure. Test CPT code Pricing PET scan $1,735 Chest x-ray & all plain films $144 Low-dose lung screening $180 Mammogram $216 Ultrasound (basic) $219 To schedule an imaging test please call Physicians order required Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure. Computerized Topography Scan Test CPT code Pricing CT with contrast $505 CT without contrast $339 CT with and without contrast $505 CTA $565 To schedule an a CT scan please call Physicians order required Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure BEALL AVENUE WOOSTER, OH

10 Drs. Friedman, & Novak WCH Inpatient Rehabilitation CPT Code(s) Price Day Inpatient Rehab Stay $1,535 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. Drs. Friedman, & Novak Sleep Studies CPT Code(s) Price Sleep study first night $1,187 Sleep study second night $1, BEALL AVENUE WOOSTER, OH

11 HealthPoint Rehab Outpatient Services Occupational Therapy, Physical Therapy and Speech Therapy HealthPoint Outpatient Rehabilitation CPT Code(s) Price Physical Therapy Evaluation $125 Physical Therapy Treatment $95 Occupational Therapy Evaluation $125 Occupational Therapy Treatment $95 Speech Therapy Evaluation $125 Speech Therapy Treatment $ BEALL AVENUE WOOSTER, OH

12 Wooster Community Hospital Far Ahead...Close to Home 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 Facilitate 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 Wooster Community Hospital B E A L L AV E N U E WOOSTER, OH WCH

Wooster. Community. Hospital AWARD WINNING

Wooster. Community. Hospital AWARD WINNING Wooster Community Hospital 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 1 pre (1 (2 (1 Wooster Community Hospital Discounts Do Not Apply to Packaged Prices Below 25% discount if