Wooster Community Hospital

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1 Wooster Community Hospital For more information call 1761 Beall Avenue, Wooster, OH Discounts Do Not Apply to Packaged s 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 ENT Bilateral Ear Tubes (Myringotomy) Wooster ENT James Hessler, MD PHd; Arun Mathur, MD or Kevin Mathur, MD <12 years old >12 years old $1, $1,190 Tonsillectomy $1, $1,892 Tonsillectomy & Myringotomy & $2, & $2,173 Tonsillectomy & Adenoidectomy (T&A) $1, $1,919 T&A including Myringotomy & $2, & $2,532 Adenoidectomy $1, $1,714 Adenoidectomy & Myringotomy & $2, & $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. OB/GYN Wooster OB/GYN Emily Benekos, MD; John Weeman, MD; Anne Shriner, MD or David Seals, MD Revision of cervix/cerclage $2,192 O/P vaginal/laparoscopic hysterectomy, <250GM LAVH/BSO O/P vaginal/laparoscopic hysterectomy, >250GM LAVH/BSO O/P Vaginal/laparoscopic hysterectomy, <250GM LAVH Only O/P Vaginal/laparoscopic hysterectomy, >250GM LAVH Only Hysteroscopy biopsy, with or without D&C IP total abdominal hysterectomy Total vaginal hysterectomy $6,999 $7,475 $8,920 $7,222 $3,248 $9,508 $5,348 Total vaginal hysterectomy w/bso $5,485 D&C (dilation & curettage) $2,557 Miscarriage, 1st trimester, suction D&E $2,779 Miscarriage, 2nd trimester, suction D&E $4,162

2 OB/GYN Anterior repair, vagina & bladder Wooster OB/GYN Emily Benekos, MD; John Weeman, MD; Anne Shriner, MD or David Seals, MD $4,674 Posterior repair, rectum & vagina $4,689 Anterior & posterior repair, vagina $4,912 Repair of enterocele (bowel bulge), vagina $4,347 (1) C-section $8,986 (2) Vaginal delivery (anesthesia not included) $6,350 Laparoscopy with tubal block $5,296 Tubal w/c-section $6,345 Bladder suspension /TVT/TVTO $5,683 Hysterosalpingography Salingo-oophorectomy (complete or partial/ unilat or bilat) 58340, $ $8,695 Fee includes: hospital, surgeon, anesthesiologist and pathology, 1 pre-operative and 1 post-operative office visit with the surgeon. must be done by the listed physicians. (1) Includes: 1 st ultrasound, prenatal care, six-week postpartum/post op follow up, and 72 hours length of stay for mom and infant. (2) Includes: 1 st ultrasound, prenatal care, six-week postpartum follow up, and 48 hours length of stay for mom and infant. (1&2) MRI Requires monthly payment. Payment is required in full by week 32. For questions call: WCH Business Office: Test MRI without contrast per exam $575 MRI with contrast per exam $725 MRI without and with contrast per exam $725 Fee includes: hospital and radiologist interpretation. Cash payment must be made the day of the procedure. To schedule an MRI please call

3 General Surgery **Procedure performed by Dr. Slaby Bloomington Medical Services, LLC Linda Wang, MD and James Slaby, MD Inguinal hernia repair, w/o mesh (unilateral) $4,107 Inguinal hernia repair, w/mesh (unilateral) & $4,423 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 Open cholecystectomy w/o cholangiography (Inpatient only) $5, & $5, & $8, $4, $4, $11,643 Open cholecystectomy w/ cholangiography (Inpatient only) $11,749 **Skin biopsy $401 Screening colonoscopy $1,137 Diagnostic colonoscopy $1,353 **Debridement & possible skin graft & $4,501 Open umbilical hernia repair, w/o mesh $4,017 Open umbilical hernia repair, w/mesh $4,333 Modified radical mastectomy w/lymph node bx & sentinel node tracer Laparoscopic unilateral inguinal hernia w/mesh + umbilical hernia repairs Laparoscopic bilateral inguinal hernia w/mesh + umbilical hernia repairs 19307, 38525, $9, , 49568, $7, , , $10,546 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.

4 Orthopedic **Procedure also performed by Dr. Slaby The OSU Medical Center Sports Medicine Orthopaedics Anne Marie Chicorelli, DO & Michael Todd, DO **Carpal tunnel - unilateral (open) $2,550 **Carpal tunnel - bilateral (open) $3,703 Total knee replacement, unilateral $17,191 Total knee replacement, bilateral $18,503 Revision of knee joint, unicompartmental $21,293 Knee revision, with or without allograft, one component $21,661 Knee revision, femoral & entire tibial component $21,906 Revision of total hip arthroplasty, both components Revision of total hip arthroplasty, acetabular component only Revision of total hip arthroplasty, femoral component only $22, $21, $21,971 Total hip, anterior $17,312 Shoulder rotator cuff arthroscopy $6,966 Arthroscopic ACL knee with allograft $9,561 ORIF, ankle $6,327 ORIF, wrist $7,717 Shoulder arthroscopy $6,544 Knee arthroplasty 29880, 29881, or $3,716 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.

5 Orthopedic Wooster Orthopaedic & Sports Medicine Center Drs. Gesler, Knapic, or R. Miller Total knee replacement, unilateral $17,257 Total knee replacement, bilateral $18,800 Revision of knee joint, unicompartmental Knee revision, with or without allograft, one component Knee revision, femoral & entire tibial component $21, $21, $21,992 Total hip replacement $17,298 Revision of total hip arthroplasty, both components $22,708 Revision of total hip arthroplasty, acetabular component only $22,117 Revision of total hip arthroplasty, femoral component only $22,195 Total hip, anterior Surgical Specialists of Wayne County Dr. Stern $17, Vascular Studies Carotid complete $263 Venous complete bilateral $270 Venous limited (1-Leg) $188 Arterial complete $186 Arterial Cardiovascular with Exercise Wooster Heart Group $ Nuclear stress test with exercise 93016, 93018, $1,097 Nuclear stress test without exercise (with Ragadenoson) 93016, 93018, $1,347 Echocardiogram, complete TC, $521 Stress test $265 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.

6 Elective Plastic Surgery (u=unilateral b=bilateral) Wooster Plastic & Reconstructive Surgery James Slaby, MD Dermabrasion $2,604 Blepharoplasty - lower eyelid (u) $2,005 Blepharoplasty - lower eyelid (b) $2,988 Blepharoplasty - lower eyelid (u) $2,005 Blepharoplasty - lower eyelid (b) $2,988 Blepharoplasty - upper eyelid (u) $2,005 Blepharoplasty - upper eyelid (b) $2,988 Blepharoplasty - upper eyelid (u) $2,005 Blepharoplasty - upper eyelid (b) $2,988 Plastic surgery, neck $3,080 Removal of face wrinkles (face lift) $7,543 Removal excessive skin, thigh (u) $2,484 Removal excessive skin, thigh (b) $3,766 Removal excessive skin, hip (u) $2,404 Removal excessive skin, hip (b) $3,606 Removal excessive skin, arm (u) $1,896 Removal excessive skin, arm (b) $2,983 Removal excessive skin, forearm/hand $1,736 Abdominoplasty $9,004 Mini-abdominoplasty $5,874 Gynecomastia (u) $2,889 Gyncecomastia (b) $4,394 Breast reduction (u) $4,824 Breast reduction (b) $7,296 Breast lift (u) $4,503 Breast lift (b) $6,815 Breast implants-saline (u) $5,287 Breast implants-silicone (u) $5,287 Breast implants-saline (b) $7,950 Breast implants-silicone (b) $7,950 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.

7 Elective Plastic Surgery (u=unilateral b=bilateral) Wooster Plastic & Reconstructive Surgery James Slaby, MD Breast implant removal (u) $4,383 Breast implant removal (b) $6,655 Rhinoplasty $3,071 Rhinoplasty $5,118 Rhinoplasty $2,751 Rhinoplasty $4,598 Brow ptosis repair (brow lift) (u) $2,704 Brow ptosis repair (brow lift) (b) $4,256 Otoplasty (u) $2,751 Otoplasty (b) $4,187 Lower body lift (hips & abdominoplasty) (b) $9,746 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 Norm Friedman, MD & William Novak, MD Routine stay (7-35 days) Initial = Subsequent = Discharge = $1,535 All inclusive 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.

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