Coming Soon

Our patient price estimator tool will be activated by January 1, 2021 or sooner.

Patient Price Information List

Disclaimer: Wagoner Community Hospital determines its standard charges for patient items and services through the use of a chargemaster system, which is a list of charges for the components of patient care that go into every patient’s bill. These are the baseline rates for items and services provided at the Hospital. The chargemaster is similar in concept to the manufacturer’s suggested retail price (“MSRP”) on a particular product or good. The charges listed provide only a general starting point in determining the potential costs of an individual patient’s care at the Hospital. This list does not reflect the actual out-of-pocket costs that may be paid by a patient for any particular service, it is not binding, and the actual charges for items and services may vary.

Many factors may influence the actual cost of an item or service, including insurance coverage, rates negotiated with payors, and so on. Government payors, such as Medicare and Medicaid for example, do not pay the chargemaster rates, but rather have their own set rates that hospitals are obligated to accept. Commercial insurance payments are based on contract negotiations with payors and may or may not reflect the standard charges. The cost of treatment also may be impacted by variables involved in a patient’s actual care, such as specific equipment or supplies required, the length of time spent in surgery or recovery, additional tests, or any changes in care or unexpected conditions or complications that arise. Moreover, the foregoing list of charges for services only includes charges from the Hospital. It does not reflect the charges for physicians, such as the surgeon, anesthesiologist, radiologist, pathologist, or other physician specialists or providers who may be involved in providing particular services to a patient. These charges are billed separately.

Individuals with questions about their out-of-pocket costs of service and other financial information should contact the hospital or consider contacting their insurers for further information.

LOCAL MARKET HOSPITALS

In order to present a meaningful comparison, Wagoner Community Hospital has partnered with Hospital Pricing Specialists LLC to analyze current charges, based off CMS adjudicated claims through 3/31/2020. Wagoner Community Hospital's charges are displayed and compared with the local market charge, consisting of the following hospitals:

Hospital Name
Location

Hillcrest Hospital Pryor

Pryor

OK

Hillcrest Hospital South

Tulsa

OK

Northeastern Health System

Tahlequah

OK

Saint Francis Hospital

Tulsa

OK

Saint Francis Hospital Muskogee

Muskogee

OK

Saint John Broken Arrow

Broken Arrow

OK

INPATIENT ROOM AND BOARD DAILY CHARGES

Description

Our Charge
Market Charge

Variance

Private Room

$1,150
$1,105

4% higher than market

Semi-Private Room

$1,150
$1,240

7% lower than market

Intensive Care Unit

$1,700
$1,811

6% lower than market

OUTPATIENT EMERGENCY DEPARTMENT CHARGES

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, who will bill separately for their services.

Description

Our Charge
Market Charge

Variance

Emergency department visit, self limited or minor problem [CPT 99281]

$172
$370

54% lower than market

Emergency department visit, low to moderately severe problem [CPT 99282]

$280
$607

54% lower than market

Emergency department visit, moderately severe problem [CPT 99283]

$493
$985

50% lower than market

Emergency department visit, problem of high severity [CPT 99284]

$800
$1,523

47% lower than market

Emergency department visit, problem with significant threat to life or function [CPT 99285]

$1,172
$2,213

47% lower than market

Critical care delivery critically ill or injured patient [CPT 99292]

$242
$753

68% lower than market

Critical care delivery critically ill or injured patient, first 30-74 minutes [CPT 99291]

$1,905
$3,416

44% lower than market

OUTPATIENT PHYSICAL THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Application of electrical stimulation to 1 or more areas, each 15 minutes [CPT 97032]

$105
$101

4% higher than market

Therapeutic exercise to develop strength, endurance, range of motion, and flexibility, each 15 minutes [CPT 97110]

$134
$123

9% higher than market

Evaluation of physical therapy, typically 45 minutes [CPT 97163]

$274
$255

7% higher than market

Re-evaluation of physical therapy, typically 20 minutes [CPT 97164]

$114
$126

9% lower than market

OUTPATIENT CLINIC CHARGES

Description

Our Charge
Market Charge

Variance

Hospital outpt clinic visit [HCPCS G0463]

$255
$296

14% lower than market

OUTPATIENT OCCUPATIONAL THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Application of hot wax bath to 1 or more areas [CPT 97018]

$51
$76

33% lower than market

OUTPATIENT PULMONARY THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Initiation and management of continued pressured respiratory assistance by mask or breathing tube [CPT 94660]

$420
$524

20% lower than market

Pulmonary rehab w exer [HCPCS G0424]

$140
$291

52% lower than market

Routine electrocardiogram (EKG) with tracing using at least 12 leads [CPT 93005]

$197
$292

32% lower than market

Measurement and graphic recording of the amount and speed of breathed air, before and following medication administration [CPT 94060]

$560
$519

8% higher than market

Exercise or drug-induced heart and blood vessel stress test with EKG tracing and monitoring [CPT 93017]

$568
$981

42% lower than market

OUTPATIENT LABORATORY AND PATHOLOGY CHARGES

The following charges reflect our most common laboratory procedures. For all lab specimens collected via blood draw, the venipuncture will be charged separately.

Description

Our Charge
Market Charge

Variance

Albumin (protein) level [CPT 82040]

$34
$106

68% lower than market

Bacterial blood culture [CPT 87040]

$119
$193

38% lower than market

Bacterial urine culture [CPT 87088]

$64
$124

48% lower than market

Bacterial colony count, urine [CPT 87086]

$78
$158

51% lower than market

Blood group typing (ABO) [CPT 86900]

$64
$167

62% lower than market

Blood typing for Rh (D) antigen [CPT 86901]

$32
$132

76% lower than market

Blood creatinine level [CPT 82565]

$35
$95

63% lower than market

Blood test, basic group of blood chemicals (Calcium, total) [CPT 80048]

$58
$196

71% lower than market

Blood test, clotting time [CPT 85610]

$71
$127

44% lower than market

Blood test, comprehensive group of blood chemicals [CPT 80053]

$72
$205

65% lower than market

Blood test, lipids (cholesterol and triglycerides) [CPT 80061]

$256
$218

18% higher than market

Blood test, thyroid stimulating hormone (TSH) [CPT 84443]

$114
$279

59% lower than market

Complete blood cell count (red cells, white blood cell, platelets), automated test and automated differential white blood cell count [CPT 85025]

$53
$173

69% lower than market

Complete blood cell count (red cells, white blood cell, platelets), automated test [CPT 85027]

$96
$123

22% lower than market

Amplifed DNA or RNA probe detection of severe acute respiratory syndrome coronavirus 2 (Covid-19) antigen [CPT 87635]

$180
$109

65% higher than market

Creatine kinase (cardiac enzyme) level, total [CPT 82550]

$59
$137

57% lower than market

Creatine kinase (cardiac enzyme) level, MB fraction only [CPT 82553]

$105
$178

41% lower than market

Creatinine level to test for kidney function or muscle injury [CPT 82570]

$78
$107

27% lower than market

Cyanocobalamin (vitamin B-12) level [CPT 82607]

$103
$162

37% lower than market

Detection test by nucleic acid for multiple types influenza virus [CPT 87502]

$525
$721

27% lower than market

Evaluation of fine needle aspirate with interpretation and report [CPT 88173]

$188
$236

20% lower than market

Ferritin (blood protein) level [CPT 82728]

$93
$161

43% lower than market

Folic acid level, serum [CPT 82746]

$100
$170

41% lower than market

Hemoglobin A1C level [CPT 83036]

$66
$118

44% lower than market

Irradiation of blood product, each unit [CPT 86945]

$75
$101

26% lower than market

Iron binding capacity [CPT 83550]

$60
$90

34% lower than market

Iron level [CPT 83540]

$44
$118

63% lower than market

Kidney function blood test panel [CPT 80069]

$119
$229

48% lower than market

Lactic acid level [CPT 83605]

$136
$187

27% lower than market

Lipase (fat enzyme) level [CPT 83690]

$47
$146

68% lower than market

Liver function blood test panel [CPT 80076]

$100
$162

38% lower than market

Magnesium level [CPT 83735]

$94
$146

36% lower than market

Measurement C-reactive protein for detection of infection or inflammation [CPT 86140]

$38
$108

65% lower than market

Measurement of complement (immune system proteins), antigen, [CPT 86160]

$127
$133

5% lower than market

Measurement of antibody for assessment of autoimmune disorder, titer [CPT 86039]

$132
$153

14% lower than market

PSA (prostate specific antigen) measurement, total [CPT 84153]

$125
$180

30% lower than market

PSA (prostate specific antigen) measurement, free [CPT 84154]

$102
$125

18% lower than market

Parathormone (parathyroid hormone) level [CPT 83970]

$282
$336

16% lower than market

Coagulation assessment blood test, plasma or whole blood [CPT 85730]

$65
$148

56% lower than market

Pathology examination of tissue using a microscope, intermediate complexity [CPT 88305]

$235
$493

52% lower than market

Pathology examination of tissue using a microscope, moderately low complexity [CPT 88304]

$135
$357

62% lower than market

Phosphate level [CPT 84100]

$32
$111

71% lower than market

Psa screening [HCPCS G0103]

$125
$142

12% lower than market

Screening test for autoimmune disorder [CPT 86038]

$189
$199

5% lower than market

Screening test for pathogenic organisms [CPT 87081]

$113
$151

25% lower than market

Special Gram or Giemsa stain for microorganism [CPT 87205]

$89
$109

18% lower than market

Special stained specimen slides to identify organisms including interpretation and report [CPT 88312]

$152
$249

39% lower than market

Stool analysis for blood, by peroxidase activity [CPT 82272]

$17
$52

67% lower than market

Evaluation of antimicrobial drug (antibiotic, antifungal, antiviral), microdilution or agar dilution [CPT 87186]

$51
$156

67% lower than market

Testosterone (hormone) level, total [CPT 84403]

$176
$332

47% lower than market

Thyroxine (thyroid chemical), free [CPT 84439]

$61
$185

67% lower than market

Total protein level, urine [CPT 84156]

$55
$124

56% lower than market

Troponin (protein) analysis, quantitative [CPT 84484]

$105
$193

46% lower than market

Urea nitrogen level to assess kidney function, quantitative [CPT 84520]

$27
$65

59% lower than market

Uric acid level, blood [CPT 84550]

$31
$98

68% lower than market

Manual urinalysis test with examination using microscope, automated [CPT 81001]

$22
$90

76% lower than market

Automated urinalysis test [CPT 81003]

$15
$67

77% lower than market

Urine microalbumin (protein) level [CPT 82043]

$38
$152

75% lower than market

Vitamin D-3 level [CPT 82306]

$202
$373

46% lower than market

OUTPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Administration of vaccine [CPT 90472]

$22
$75

71% lower than market

Application of blood vessel compression or decompression device to 1 or more areas [CPT 97016]

$66
$89

26% lower than market

Application of mechanical traction to 1 or more areas [CPT 97012]

$107
$117

9% lower than market

Application of medication through skin using electrical current, each 15 minutes [CPT 97033]

$83
$195

57% lower than market

Application of whirlpool therapy to 1 or more areas [CPT 97022]

$114
$114

Approximately equal to market

Attempt to restart heart and lungs [CPT 92950]

$560
$1,115

50% lower than market

Removal of tissue from wounds per session, first 20 sq cms or less [CPT 97597]

$380
$654

42% lower than market

Removal of tissue from wounds per session, each additional 20 sq cm [CPT 97598]

$195
$475

59% lower than market

Diagnostic test for sleep disorder [CPT 95805]

$2,500
$3,396

26% lower than market

Dialysis procedure including one evaluation [CPT 90945]

$900
$1,403

36% lower than market

Examination of the nose and throat using an endoscope [CPT 92511]

$300
$280

7% higher than market

Vaccine for Haemophilus influenzae B (4 dose schedule) injection into muscle [CPT 90648]

$69
$174

61% lower than market

Hemodialysis procedure with one physician evaluation [CPT 90935]

$1,200
$2,563

53% lower than market

Hydration infusion into a vein [CPT 96361]

$93
$187

50% lower than market

Hydration infusion into a vein 31 minutes to 1 hour [CPT 96360]

$430
$443

3% lower than market

Infusion into a vein for therapy prevention or diagnosis additional sequential infusion up to 1 hour [CPT 96367]

$145
$189

23% lower than market

Infusion into a vein for therapy, prevention, or diagnosis [CPT 96366]

$104
$211

51% lower than market

Infusion into a vein for therapy, prevention, or diagnosis up to 1 hour [CPT 96365]

$430
$555

23% lower than market

Injection beneath the skin or into muscle for therapy, diagnosis, or prevention [CPT 96372]

$145
$142

2% higher than market

Injection of drug or substance into a vein for therapy, diagnosis, or prevention, in a facility [CPT 96376]

$73
$191

62% lower than market

Irrigation of implanted venous access drug delivery device [CPT 96523]

$197
$197

Approximately equal to market

Moderate sedation services by physician also performing a procedure, additional 15 minutes [CPT 99153]

$80
$255

69% lower than market

Moderate sedation services by physician also performing a procedure, patient 5 years of age or older, first 15 minutes [CPT 99152]

$182
$392

54% lower than market

Multiple measurements of oxygen saturation in blood using ear or finger device [CPT 94761]

$84
$136

38% lower than market

Negative pressure wound therapy, surface area greater than 50 square centimeters, per session [CPT 97606]

$329
$1,020

68% lower than market

Peripheral arterial disease (PAD) rehabilitation per session [CPT 93668]

$140
$178

21% lower than market

Physical performance test or measurement with report, each 15 minutes [CPT 97750]

$84
$125

33% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab with continued pressured respiratory assistance by mask or breathing tube [CPT 95811]

$2,500
$6,173

59% lower than market

Sleep monitoring of patient (6 years or older) in sleep lab [CPT 95810]

$2,500
$5,745

56% lower than market

Therapeutic massage to 1 or more areas, each 15 minutes [CPT 97124]

$102
$94

8% higher than market

Therapeutic procedures in a group setting [CPT 97150]

$79
$112

29% lower than market

Therapeutic removal of whole blood to correct blood level imbalance [CPT 99195]

$150
$174

14% lower than market

Vaccine for pneumococcal polysaccharide for injection beneath the skin or into muscle, patient 2 years or older [CPT 90732]

$131
$433

70% lower than market

Vaccine for influenza for injection into muscle, split virus, preservation free [CPT 90662]

$138
$293

53% lower than market

Vaccine for tetanus and diphtheria toxoids injection into muscle, patient 7 years or older [CPT 90714]

$57
$143

60% lower than market

Infusion into a vein for therapy, prevention, or diagnosis, concurrent with another infusion [CPT 96368]

$57
$161

65% lower than market

Ventilation assistance and management, hospital inpatient or observation, each subsequent day [CPT 94003]

$1,036
$1,046

1% lower than market

Ventilation assistance and management, hospital inpatient or observation, initial day [CPT 94002]

$1,036
$2,239

54% lower than market

OUTPATIENT OBSERVATION CHARGES

Description

Our Charge
Market Charge

Variance

Hospital observation per hr [HCPCS G0378]

$28
$76

63% lower than market

OUTPATIENT OTHER CHARGES

Description

Our Charge
Market Charge

Variance

Locm 200-299mg/ml iodine,1ml [HCPCS Q9966]

$21
$23

8% lower than market

OUTPATIENT PHARMACY AND DRUG ADMINISTRATION CHARGES

Description

Our Charge
Market Charge

Variance

Drugs unclassified injection [HCPCS J3490]

$13
$26

50% lower than market

Injection of different drug or substance into a vein for therapy, diagnosis, or prevention [CPT 96375]

$93
$218

57% lower than market

Fentanyl citrate injection [HCPCS J3010]

$17
$36

52% lower than market

Furosemide injection [HCPCS J1940]

$17
$30

43% lower than market

Ketorolac tromethamine inj [HCPCS J1885]

$31
$31

Approximately equal to market

Inj magnesium sulfate [HCPCS J3475]

$17
$22

25% lower than market

Inj midazolam hydrochloride [HCPCS J2250]

$17
$16

5% higher than market

Morphine sulfate injection [HCPCS J2270]

$31
$35

12% lower than market

Promethazine hcl injection [HCPCS J2550]

$31
$28

9% higher than market

Aminophyllin 250 mg inj [HCPCS J0280]

$49
$58

16% lower than market

Butorphanol tartrate 1 mg [HCPCS J0595]

$31
$37

16% lower than market

Denosumab injection [HCPCS J0897]

$51
$69

26% lower than market

Glucagon hydrochloride/1 mg [HCPCS J1610]

$329
$667

51% lower than market

Insulin injection [HCPCS J1815]

$3
$16

81% lower than market

Mannitol injection [HCPCS J2150]

$31
$52

41% lower than market

Meperidine hydrochl /100 mg [HCPCS J2175]

$17
$48

64% lower than market

Methylprednisolone injection [HCPCS J2920]

$31
$54

44% lower than market

Injection, pegfilgrastim 6mg [HCPCS J2505]

$6,733
$15,388

56% lower than market

Na ferric gluconate complex [HCPCS J2916]

$25
$25

3% lower than market

Vaccine for tetanus, diphtheria toxoids and acellular pertussis (whooping cough) for injection into muscle, patient 7 years or older [CPT 90715]

$159
$230

31% lower than market

OUTPATIENT PROSTHETIC PROCEDURES CHARGES

Description

Our Charge
Market Charge

Variance

Prosthetic implant nos [HCPCS L8699]

$4,000
$11,888

66% lower than market

OUTPATIENT RESPIRATORY THERAPY CHARGES

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

Description

Our Charge
Market Charge

Variance

Measurement of oxygen saturation in blood using ear or finger device [CPT 94760]

$42
$63

34% lower than market

OUTPATIENT SUPPLIES CHARGES

Description

Our Charge
Market Charge

Variance

Tc99m tetrofosmin [HCPCS A9502]

$396
$939

58% lower than market

OUTPATIENT SURGICAL SERVICES CHARGES

Description

Our Charge
Market Charge

Variance

Application of skin substitute (wound surface up to 100 sq cm) to trunk, arms, or legs (first 25 sq cm or less) [CPT 15271]

$2,814
$4,211

33% lower than market

Application of vein wound compression system lower leg below knee including ankle and foot [CPT 29581]

$288
$515

44% lower than market

Aspiration of abscess, blood accumulation, blister, or cyst [CPT 10160]

$700
$730

4% lower than market

Biopsy of the large bowel using an endoscope (colonoscopy) [CPT 45380]

$750
$3,242

77% lower than market

Biopsy of the esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43239]

$612
$2,538

76% lower than market

Closed treatment of broken nasal bone, without stabilization [CPT 21315]

$2,533
$2,509

1% higher than market

Closed treatment of shoulder dislocation with manipulation [CPT 23650]

$593
$683

13% lower than market

Closed treatment of shoulder dislocation with manipulation under anesthesia [CPT 23655]

$2,700
$2,456

10% higher than market

Diagnostic examination of the colon (large bowel) using an endoscope(colonoscopy); high risk [CPT 45378]

$750
$2,974

75% lower than market

Control of nose bleed and insertion of packing [CPT 30905]

$295
$426

31% lower than market

Declotting infusion of implanted central venous access device or catheter [CPT 36593]

$697
$739

6% lower than market

Destruction of skin growth [CPT 17000]

$123
$139

12% lower than market

Diagnostic examination of esophagus, stomach, and/or upper small bowel using an endoscope [CPT 43235]

$600
$2,720

78% lower than market

Drainage of abscess, cyst, or blood accumulation of dental bone [CPT 41800]

$365
$415

12% lower than market

Drainage of finger abscess, uncomplicated [CPT 26010]

$380
$414

8% lower than market

Drainage of fluid from abdominal cavity using imaging guidance [CPT 49083]

$1,101
$1,476

25% lower than market

Dressing change and/or removal of burn tissue (less than 5% total body surface) [CPT 16020]

$380
$464

18% lower than market

Fluid collection drainage of the abdominal region by catheter using imaging guidance, accessed through the skin [CPT 49406]

$2,105
$2,713

22% lower than market

Fusion of sacroiliac joint obtaining bone graft open procedure [CPT 27280]

$2,698
$3,789

29% lower than market

Removal of gallbladder using an endoscope [CPT 47562]

$1,365
$11,974

89% lower than market

Hbot, full body chamber, 30m [HCPCS G0277]

$246
$933

74% lower than market

Injection of drug into erectile tissue at sides and back of penis [CPT 54220]

$516
$575

10% lower than market

Injections of anesthetic and/or steroid drug into lower or sacral spine nerve root using imaging guidance, single level [CPT 64483]

$335
$2,205

85% lower than market

Injection of substance into spinal canal of lower back or sacrum [CPT 62322]

$600
$1,091

45% lower than market

Injections of trigger points in 1 or 2 muscles [CPT 20552]

$550
$775

29% lower than market

Insertion of peripherally inserted central venous catheter for infusion (PICC), patient 5 years or older [CPT 36569]

$2,212
$2,890

23% lower than market

Insertion of indwelling bladder catheter, simple [CPT 51702]

$297
$427

30% lower than market

Insertion of needle into vein for collection of blood sample [CPT 36415]

$14
$38

63% lower than market

Insertion of indwelling bladder catheter, complicated [CPT 51703]

$305
$398

23% lower than market

Insertion of central venous catheter for infusion, patient 5 years or older, not tunneled [CPT 36556]

$2,212
$2,579

14% lower than market

Removal of one knee cartilage using an endoscope [CPT 29881]

$1,115
$8,429

87% lower than market

Injections of lower or sacral spine facet joint using imaging guidance, single level [CPT 64493]

$1,512
$1,770

15% lower than market

Needle biopsy of kidney, accessed through the skin [CPT 50200]

$2,105
$2,484

15% lower than market

Needle biopsy of liver, accessed through the skin [CPT 47000]

$2,105
$1,977

6% higher than market

Needle biopsy of lung or chest tissue, accessed through the skin

$2,105
$2,587

19% lower than market

Removal of 1 or more breast growth, open procedure [CPT 19120]

$892
$9,737

91% lower than market

Removal of polyps or growths in large bowel using an endoscope (colonoscopy) using a mechanical snare [CPT 45385]

$520
$3,512

85% lower than market

Removal of fluid from chest cavity [CPT 32554]

$1,378
$1,483

7% lower than market

Removal of fluid from chest cavity with imaging guidance [CPT 32555]

$1,378
$1,765

22% lower than market

Removal of foreign body of foot tissue, accessed beneath the skin [CPT 28190]

$1,860
$1,984

6% lower than market

Repair of groin hernia patient age 5 years or older [CPT 49505]

$1,075
$10,210

89% lower than market

Repair of wound (7.6 to 12.5 centimeters) of the face, ears, eyelids, nose, lips, and/or mucous membranes [CPT 12015]

$380
$549

31% lower than market

Shaving of shoulder bone using an endoscope [CPT 29826]

$372
$4,825

92% lower than market

Repair of wound (2.5 centimeters or less) of the scalp, neck, underarms, trunk, arms and/or legs [CPT 12001]

$380
$557

32% lower than market

Incision of nasal (sphenoid) sinus [CPT 31050]

$1,492
$1,901

22% lower than market

Spinal tap for diagnosis [CPT 62270]

$1,222
$1,101

11% higher than market

Infusion of drug into a vein to dissolve blood clot obstructing blood flow to brain [CPT 37195]

$650
$623

4% higher than market

Transfusion of blood or blood products [CPT 36430]

$844
$1,355

38% lower than market

Treatment of hip dislocation [CPT 27250]

$484
$469

3% higher than market

Widening of nasal passage [CPT 30465]

$1,868
$2,279

18% lower than market

OUTPATIENT VISION CHARGES

Description

Our Charge
Market Charge

Variance

Amniotic membrane [HCPCS V2790]

$5,100
$8,195

38% lower than market

OUTPATIENT X-RAY AND RADIOLOGICAL CHARGES

The following charges reflect our most common x-ray and radiological procedures. For all exams requiring contrast, the contrast will be charged separately.

Description

Our Charge
Market Charge

Variance

Bone density measurement of the core or central skeleton (e.g., hips, pelvis, spine) [CPT 77080]

$180
$322

44% lower than market

Ultrasound of one breast, limited [CPT 76642]

$321
$658

51% lower than market

CT scan of abdomen and pelvis with contrast [CPT 74177]

$2,440
$4,334

44% lower than market

CT scan of abdomen and pelvis before and after contrast [CPT 74178]

$2,440
$4,914

50% lower than market

CT scan of abdomen and pelvis [CPT 74176]

$1,540
$3,771

59% lower than market

Diagnostic CT scan of chest with contrast [CPT 71260]

$1,565
$2,548

39% lower than market

Diagnostic CT scan of chest [CPT 71250]

$780
$2,176

64% lower than market

CT scan of face [CPT 70486]

$780
$1,937

60% lower than market

CT scan head or brain before and after contrast [CPT 70470]

$1,752
$2,939

40% lower than market

CT scan head or brain [CPT 70450]

$780
$2,351

67% lower than market

CT scan pelvis with contrast [CPT 72193]

$1,565
$2,197

29% lower than market

CT scan of abdominal aorta and both leg arteries with contrast [CPT 75635]

$1,832
$3,118

41% lower than market

CT scan of upper spine [CPT 72125]

$780
$2,332

67% lower than market

CT scan of lower spine [CPT 72131]

$780
$2,369

67% lower than market

X-ray of chest, 2 views [CPT 71046]

$178
$385

54% lower than market

X-ray of chest, 1 view [CPT 71045]

$178
$312

43% lower than market

Ultrasound study of arteries of both arms and legs, complete [CPT 93923]

$394
$943

58% lower than market

Diagnostic mammography of both breasts [CPT 77066]

$270
$447

40% lower than market

Diagnostic mammography of one breast [CPT 77065]

$245
$367

33% lower than market

Imaging guidance for procedure, up to 1 hour [CPT 76000]

$236
$489

52% lower than market

Complete X-ray study of abdomen with single X-ray of chest [CPT 74022]

$285
$671

58% lower than market

X-ray of abdomen, 2 views [CPT 74019]

$178
$443

60% lower than market

X-ray of abdomen, 1 view [CPT 74018]

$178
$320

44% lower than market

MRI scan of arm joint [CPT 73221]

$1,861
$3,206

42% lower than market

MRI scan of brain before and after contrast [CPT 70553]

$3,139
$3,653

14% lower than market

MRI scan of leg joint [CPT 73721]

$1,861
$2,744

32% lower than market

MRI scan of upper spinal canal [CPT 72141]

$1,861
$2,929

36% lower than market

MRI scan of lower spinal canal [CPT 72148]

$1,861
$2,822

34% lower than market

Nuclear medicine study of vessels of heart using drugs or exercise multiple studies [CPT 78452]

$3,420
$5,277

35% lower than market

Screening mammography of both breasts [CPT 77067]

$584
$430

36% higher than market

Screening digital tomography of both breasts [CPT 77063]

$65
$97

33% lower than market

Ultrasound of abdomen, complete [CPT 76700]

$472
$1,022

54% lower than market

Ultrasound of abdomen, limited [CPT 76705]

$472
$779

39% lower than market

Ultrasound behind abdominal cavity [CPT 76770]

$472
$863

45% lower than market

Ultrasound behind abdominal cavity, limited [CPT 76775]

$472
$617

23% lower than market

Ultrasound scanning of blood flow (outside the brain) on both sides of head and neck [CPT 93880]

$663
$1,093

39% lower than market

Ultrasound of head and neck [CPT 76536]

$472
$755

37% lower than market

Ultrasound examination of heart including color-depicted blood flow rate, direction, and valve function [CPT 93306]

$1,479
$2,270

35% lower than market

Ultrasound pelvis through vagina [CPT 76830]

$472
$616

23% lower than market

Abdominal ultrasound of pregnant uterus (greater or equal to 14 weeks 0 days) single or first fetus [CPT 76805]

$472
$652

28% lower than market

Ultrasound scan of veins of one arm or leg or limited including assessment of compression and functional maneuvers [CPT 93971]

$472
$1,125

58% lower than market

Ultrasound study of arteries and arterial grafts of both legs [CPT 93925]

$663
$1,319

50% lower than market

Ultrasound scan of abdominal, pelvic, and/or scrotal arterial inflow and venous outflow [CPT 93975]

$663
$875

24% lower than market

X-ray of ankle, minimum of 3 views [CPT 73610]

$285
$469

39% lower than market

X-ray of foot, 2 views [CPT 73620]

$178
$416

57% lower than market

X-ray of foot, minimum of 3 views [CPT 73630]

$178
$461

61% lower than market

X-ray of hand, minimum of 3 views [CPT 73130]

$178
$463

62% lower than market

X-ray of hip with pelvis, 2-3 views [CPT 73502]

$178
$365

51% lower than market

X-ray of knee, 1 or 2 views [CPT 73560]

$178
$382

53% lower than market

X-ray of knee, 3 views [CPT 73562]

$285
$448

36% lower than market

X-ray of lower leg, 2 views [CPT 73590]

$178
$386

54% lower than market

X-ray of lower and sacral spine, 2 or 3 views [CPT 72100]

$285
$444

36% lower than market

X-ray of lower and sacral spine, minimum of 4 views [CPT 72110]

$285
$671

58% lower than market

X-ray of spine of neck, 2 or 3 views [CPT 72040]

$285
$475

40% lower than market

X-ray of shoulder, minimum of 2 views [CPT 73030]

$285
$401

29% lower than market

X-ray of upper arm, minimum of 2 views [CPT 73060]

$178
$416

57% lower than market

X-ray of wrist, minimum of 3 views [CPT 73110]

$178
$431

59% lower than market

X-ray of middle spine, 3 views [CPT 72072]

$285
$518

45% lower than market

X-ray of ribs on one side of body including the chest, minimum of 3 views [CPT 71101]

$285
$621

54% lower than market

INPATIENT CARDIOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Abnormal or Irregular Heartbeat with complications

$11,396
$18,584

39% lower than market

Abnormal or Irregular Heartbeat without complications

$11,303
$13,541

17% lower than market

Acute myocardial infarction, discharged alive with major complications

$19,720
$38,064

48% lower than market

Acute myocardial infarction, discharged alive without complications

$4,480
$18,659

76% lower than market

Angina pectoris

$10,836
$22,754

52% lower than market

Atherosclerosis with major complications

$11,215
$25,479

56% lower than market

Atherosclerosis without major complications

$8,271
$19,554

58% lower than market

Cardiac arrhythmia & conduction disorders with major complications

$10,450
$30,412

66% lower than market

Heart Failure with complications

$12,770
$21,646

41% lower than market

Heart Failure with major complications

$14,900
$27,337

45% lower than market

Heart failure & shock without complications

$9,678
$15,715

38% lower than market

Hypertension with major complications

$13,008
$31,932

59% lower than market

Hypertension without major complications

$8,813
$17,088

48% lower than market

Other circulatory system diagnoses with complications

$14,435
$25,557

44% lower than market

Other circulatory system diagnoses with major complications

$28,626
$42,484

33% lower than market

Peripheral vascular disorders with complications

$9,003
$23,243

61% lower than market

Peripheral vascular disorders without complications

$9,696
$19,719

51% lower than market

Syncope & collapse

$5,103
$18,747

73% lower than market

INPATIENT GENERAL SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Anal & stomal procedures with complications

$18,028
$21,637

17% lower than market

Appendectomy with complicated diagnosis without complications

$17,801
$32,309

45% lower than market

Extensive O.R. procedure unrelated to principal diagnosis with complications

$12,329
$56,042

78% lower than market

Non-extensive O.R. procedure unrelated to principal diagnosis with complications

$9,008
$44,398

80% lower than market

Other skin, subcutaneous tissue & breast procedure with major complications

$25,429
$43,524

42% lower than market

Peritoneal adhesiolysis with complications

$32,065
$75,768

58% lower than market

INPATIENT GYNECOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Female reproductive system reconstructive procedures

$11,284
$45,331

75% lower than market

INPATIENT MEDICINE CHARGES

Description

Our Charge
Market Charge

Variance

Allergic reactions without major complications

$10,612
$20,722

49% lower than market

Anemia or other red blood cell disorders without complications

$8,535
$18,277

53% lower than market

Blood Infection with major complications

$16,397
$39,185

58% lower than market

Blood infection without major complications

$11,097
$21,984

50% lower than market

Cellulitis with major complications

$13,563
$33,432

59% lower than market

Cirrhosis & alcoholic hepatitis with complications

$12,339
$24,677

50% lower than market

Complications of treatment without complications

$2,665
$13,245

80% lower than market

Diabetes with complications

$5,321
$21,258

75% lower than market

Diabetes with major complications

$9,364
$27,748

66% lower than market

Diabetes without complications

$8,132
$16,273

50% lower than market

Digestive System Bleeding with complications

$6,217
$22,961

73% lower than market

Disorders of liver except malig,cirr,alc hepa without complications

$13,325
$17,914

26% lower than market

Disorders of liver except malignancy with complications

$7,782
$19,549

60% lower than market

Disorders of liver except malignancy with major complications

$7,011
$31,623

78% lower than market

Disorders of pancreas except malignancy with complications

$10,697
$20,492

48% lower than market

Disorders of pancreas except malignancy without complications

$7,273
$17,967

60% lower than market

Disorders of the biliary tract with complications

$14,808
$23,520

37% lower than market

Disorders of the biliary tract with major complications

$10,811
$35,077

69% lower than market

Disorders of the biliary tract without complications

$5,282
$22,772

77% lower than market

Drug poisoning without complications

$4,400
$18,708

76% lower than market

Esophagitis, gastroent & misc digest disorders with major complications

$19,474
$24,708

21% lower than market

G.I. obstruction with complications

$7,008
$18,834

63% lower than market

G.I. obstruction with major complications

$13,770
$37,858

64% lower than market

G.I. obstruction without complications

$3,186
$15,211

79% lower than market

General symptoms of illness such as fever, pain, shortness of breath

$7,384
$19,004

61% lower than market

Infection of the skin

$6,774
$19,517

65% lower than market

Inflammatory bowel disease without complications

$6,162
$17,480

65% lower than market

Minor skin disorders without major complications

$9,555
$14,841

36% lower than market

Nutritional or Metabolic Disorders without major complications

$6,845
$17,769

61% lower than market

Other injury, poisoning & toxic effect diag without major complications

$10,492
$39,167

73% lower than market

Postoperative & post-traumatic infections without major complications

$7,174
$24,629

71% lower than market

Red blood cell disorders with major complications

$8,204
$28,180

71% lower than market

Skin ulcers with complications

$12,452
$23,976

48% lower than market

Stomach Disorder without complications

$8,919
$19,400

54% lower than market

Trauma to the skin, subcut tiss & breast without major complications

$28,288
$26,240

8% higher than market

INPATIENT NEUROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Cranial & peripheral nerve disorders with major complications

$21,776
$37,960

43% lower than market

Cranial & peripheral nerve disorders without major complications

$7,703
$25,875

70% lower than market

Degenerative nervous system disorders without complications

$5,929
$25,645

77% lower than market

Nonspecific CVA & precerebral occlusion without infarct without major complications

$7,585
$22,115

66% lower than market

Seizures without major complications

$10,331
$21,517

52% lower than market

Stroke with complications

$11,890
$23,205

49% lower than market

Transient ischemia

$5,192
$21,332

76% lower than market

INPATIENT ONCOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Malignancy of hepatobiliary system or pancreas with complications

$14,583
$25,519

43% lower than market

Malignancy of hepatobiliary system or pancreas with major complications

$11,375
$28,602

60% lower than market

Malignancy, female reproductive system with complications

$16,787
$19,052

12% lower than market

INPATIENT ORTHOPEDIC SURGERY CHARGES

Description

Our Charge
Market Charge

Variance

Hip & femur procedures except major joint with complications

$22,383
$50,196

55% lower than market

Other musculoskelet system & connective tissue O.R. procedure with complications

$33,816
$49,475

32% lower than market

Revision of hip or knee replacement with complications

$30,323
$77,475

61% lower than market

Spinal fusion other than the neck without major complications

$79,056
$74,080

7% higher than market

Total Ankle Replacement

$31,093
$79,521

61% lower than market

Total Knee or Hip Replacement

$34,332
$49,275

30% lower than market

Total Knee or Hip Revision

$15,632
$66,173

76% lower than market

Total Shoulder Replacement

$27,198
$66,893

59% lower than market

INPATIENT ORTHOPEDICS CHARGES

Description

Our Charge
Market Charge

Variance

Bone diseases & arthropathies without major complications

$6,457
$16,432

61% lower than market

Fractures of hip & pelvis without major complications

$7,410
$20,160

63% lower than market

Fractures of hip, pelvis & thigh without major complications

$10,445
$15,346

32% lower than market

Medical back problems with major complications

$11,025
$37,436

71% lower than market

Medical back problems without major complications

$7,108
$23,707

70% lower than market

Osteomyelitis with complications

$14,656
$28,585

49% lower than market

INPATIENT PSYCHIATRY CHARGES

Description

Our Charge
Market Charge

Variance

Alcohol or Drug Abuse without rehab or major complications

$6,718
$16,073

58% lower than market

Depression

$6,649
$11,330

41% lower than market

Mental Illness

$11,444
$18,711

39% lower than market

Mental disturbances and retardation

$6,537
$24,833

74% lower than market

INPATIENT PULMONOLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Bronchitis & asthma with major complications

$18,059
$20,906

14% lower than market

Chronic Lung Disease with complications

$12,944
$19,856

35% lower than market

Chronic Lung Disease with major complications

$15,696
$24,114

35% lower than market

Chronic Lung Disease without complications

$12,933
$16,095

20% lower than market

Major chest trauma with complications

$10,857
$20,783

48% lower than market

Other respiratory system diagnoses without major complications

$7,700
$21,153

64% lower than market

Pleural effusion with complications

$9,274
$29,066

68% lower than market

Pneumonia with complications

$14,434
$21,754

34% lower than market

Pneumonia with major complications

$17,685
$29,735

41% lower than market

Pneumonia without complications

$14,097
$16,722

16% lower than market

Pneumothorax with complications

$19,348
$23,566

18% lower than market

Pulmonary embolism without major complications

$16,101
$23,073

30% lower than market

Respiratory Failure

$15,864
$30,229

48% lower than market

Respiratory infections and inflammations with major complications

$28,257
$35,920

21% lower than market

Respiratory signs & symptoms

$12,543
$24,865

50% lower than market

INPATIENT UROLOGY CHARGES

Description

Our Charge
Market Charge

Variance

Kidney & urinary Infection with major complications

$16,436
$25,428

35% lower than market

Kidney & urinary Infection without complications

$8,905
$17,864

50% lower than market

Kidney failure with complications

$7,756
$18,166

57% lower than market

Kidney failure with major complications

$9,535
$29,398

68% lower than market

Minor bladder procedures with complications

$7,503
$34,498

78% lower than market

Minor bladder procedures without complications

$8,659
$23,081

62% lower than market

Other kidney & urinary tract diagnoses with complications

$8,466
$20,715

59% lower than market

Other kidney & urinary tract diagnoses without complications

$6,557
$17,802

63% lower than market

Renal failure without complications

$5,608
$15,484

64% lower than market

Transurethral prostatectomy with major complications

$12,090
$44,586

73% lower than market

Transurethral prostatectomy without complications

$9,065
$30,094

70% lower than market

BILLING PROCESS AND INFORMATION

How You Can Help

Thank you for choosing Wagoner Community Hospital for your healthcare needs. We want to make understanding and paying your bill as easy as possible. Here are some ways you can help us as we work to make the billing process go smoothly.

• Please give us complete health insurance information.

In addition to your health insurance card, we may ask for a photo ID. If you have been seen at Wagoner Community Hospital, let us know if your personal information or insurance information has changed since your last visit.

• Please understand and follow the requirements of your health plan.

Be sure to know your benefits, obtain proper authorization for services and submit referral claim forms if necessary. Many insurance plans require patients to pay a co-payment or deductible amount. You are responsible for paying co-payments required by your insurance provider and Wagoner Community Hospital is responsible for collecting co-payments. Please come to your appointment prepared to make your co-payment.

• Please respond promptly to any requests from your insurance provider.

You may receive multiple bills from your hospital visit, including your family doctor, specialists, physicians that read x-rays, providers that give anesthesia, or physicians that interpret blood work. Insurance benefits are the result of your contract with your insurance company. We are a third-party to those benefits and may need your help with your insurance. If your insurance plan does not pay the bill within 90 days after billing, or your claim is denied, you will receive a statement from Wagoner Community Hospital indicating the bill is now your responsibility. All bills sent to you are due upon receipt.

Questions about Price and Billing Information

Our goal is for each of our patients and their families to have the best healthcare experience possible. Part of our commitment is to provide you with information that helps you make well informed decisions about your own care.

To ask questions or get more information about a bill for services you've received, please contact our Billing Department at 918-485-5514.

If you need more information about the price of a future service, please contact our Customer Service at 918-485-5514. A physician’s order or CPT code is strongly encouraged when you call to assist us in providing you with the most accurate estimate. You can obtain the CPT code from the ordering physician.