Wooster Community Hospital For more information call 1761 Beall Avenue, Wooster, OH 330.263.8158 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 330.264.9699 69421 $1,190 69421 $1,190 Tonsillectomy 42825 $1,865 42826 $1,892 Tonsillectomy & Myringotomy 69421 & 42825 $2,157 69421 & 42826 $2,173 Tonsillectomy & Adenoidectomy (T&A) 42820 $1,892 42821 $1,919 T&A including Myringotomy 69421 & 42820 $2,532 69421 & 42821 $2,532 Adenoidectomy 42830 $1,714 42831 $1,714 Adenoidectomy & Myringotomy 69421 & 42830 $2,077 69421 & 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. OB/GYN Wooster OB/GYN Emily Benekos, MD; John Weeman, MD; Anne Shriner, MD or David Seals, MD 330.345.2229 Revision of cervix/cerclage 59320 $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 58552 58554 58550 58553 58558 58150 58260 $6,999 $7,475 $8,920 $7,222 $3,248 $9,508 $5,348 Total vaginal hysterectomy w/bso 58262 $5,485 D&C (dilation & curettage) 58120 $2,557 Miscarriage, 1st trimester, suction D&E 59820 $2,779 Miscarriage, 2nd trimester, suction D&E 59821 $4,162
OB/GYN Anterior repair, vagina & bladder Wooster OB/GYN Emily Benekos, MD; John Weeman, MD; Anne Shriner, MD or David Seals, MD 57240 330.345.2229 $4,674 Posterior repair, rectum & vagina 57250 $4,689 Anterior & posterior repair, vagina 57260 $4,912 Repair of enterocele (bowel bulge), vagina 57268 $4,347 (1) C-section 59510 $8,986 (2) Vaginal delivery (anesthesia not included) 59400 $6,350 Laparoscopy with tubal block 58671 $5,296 Tubal w/c-section 58611 $6,345 Bladder suspension /TVT/TVTO 57288 $5,683 Hysterosalpingography Salingo-oophorectomy (complete or partial/ unilat or bilat) 58340, 74740 $544 58720 $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: 330.345.2229. WCH Business Office: 330.263.8158 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 330.263.8660
General Surgery **Procedure performed by Dr. Slaby Bloomington Medical Services, LLC Linda Wang, MD and James Slaby, MD 330.287.2595 Inguinal hernia repair, w/o mesh (unilateral) 49505 $4,107 Inguinal hernia repair, w/mesh (unilateral) 49505 & 49568 $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) 49650 $5,298 49650 & 49568 $5,734 49650-50 & 49568-50 $8,408 47562 $4,912 47563 $4,979 47600 $11,643 Open cholecystectomy w/ cholangiography (Inpatient only) 47605 $11,749 **Skin biopsy 11100 $401 Screening colonoscopy 45378 $1,137 Diagnostic colonoscopy 45380 $1,353 **Debridement & possible skin graft 15002 & 15100 $4,501 Open umbilical hernia repair, w/o mesh 49585 $4,017 Open umbilical hernia repair, w/mesh 49585 + 49568 $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, 38792 $9,807 49650, 49568, 49585 $7,871 49650-50, 49568-50, 49585 $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.
Orthopedic **Procedure also performed by Dr. Slaby The OSU Medical Center Sports Medicine Orthopaedics Anne Marie Chicorelli, DO & Michael Todd, DO 330.202.3420 **Carpal tunnel - unilateral (open) 64721 $2,550 **Carpal tunnel - bilateral (open) 64721-50 $3,703 Total knee replacement, unilateral 27447 $17,191 Total knee replacement, bilateral 27447-50 $18,503 Revision of knee joint, unicompartmental 27446 $21,293 Knee revision, with or without allograft, one component 27486 $21,661 Knee revision, femoral & entire tibial component 27487 $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 27134 $22,427 27137 $21,902 27138 $21,971 Total hip, anterior 27130 $17,312 Shoulder rotator cuff arthroscopy 29827 $6,966 Arthroscopic ACL knee with allograft 29888 $9,561 ORIF, ankle 27814 $6,327 ORIF, wrist 25574 $7,717 Shoulder arthroscopy 28924 + 29826 $6,544 Knee arthroplasty 29880, 29881, 29882 or 29883 $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.
Orthopedic Wooster Orthopaedic & Sports Medicine Center Drs. Gesler, Knapic, or R. Miller 330.804.9712 Total knee replacement, unilateral 27447 $17,257 Total knee replacement, bilateral 27447-50 $18,800 Revision of knee joint, unicompartmental Knee revision, with or without allograft, one component Knee revision, femoral & entire tibial component 27446 $21,462 27486 $21,866 27487 $21,992 Total hip replacement 27130 $17,298 Revision of total hip arthroplasty, both components 27134 $22,708 Revision of total hip arthroplasty, acetabular component only 27137 $22,117 Revision of total hip arthroplasty, femoral component only 27138 $22,195 Total hip, anterior Surgical Specialists 27130 of Wayne County Dr. Stern $17,378 330.264.5347 Vascular Studies Carotid complete 93880 $263 Venous complete bilateral 93970 $270 Venous limited (1-Leg) 93971 $188 Arterial complete 93923 $186 Arterial Cardiovascular with Exercise Wooster 93924 Heart Group $159 330-202.5700 Nuclear stress test with exercise 93016, 93018, 78456-26 $1,097 Nuclear stress test without exercise (with Ragadenoson) 93016, 93018, 78456-26 $1,347 Echocardiogram, complete 93306-TC, 93306-26 $521 Stress test 93017 $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.
Elective Plastic Surgery (u=unilateral b=bilateral) Wooster Plastic & Reconstructive Surgery James Slaby, MD 330.202.3350 Dermabrasion 15780 $2,604 Blepharoplasty - lower eyelid (u) 15820 $2,005 Blepharoplasty - lower eyelid (b) 15820-50 $2,988 Blepharoplasty - lower eyelid (u) 15821 $2,005 Blepharoplasty - lower eyelid (b) 15821-50 $2,988 Blepharoplasty - upper eyelid (u) 15822 $2,005 Blepharoplasty - upper eyelid (b) 15822-50 $2,988 Blepharoplasty - upper eyelid (u) 15823 $2,005 Blepharoplasty - upper eyelid (b) 15823-50 $2,988 Plastic surgery, neck 15825 $3,080 Removal of face wrinkles (face lift) 15828 $7,543 Removal excessive skin, thigh (u) 15832 $2,484 Removal excessive skin, thigh (b) 15832-50 $3,766 Removal excessive skin, hip (u) 15834 $2,404 Removal excessive skin, hip (b) 15834-50 $3,606 Removal excessive skin, arm (u) 15836 $1,896 Removal excessive skin, arm (b) 15836-50 $2,983 Removal excessive skin, forearm/hand 15837 $1,736 Abdominoplasty 15830+15847 $9,004 Mini-abdominoplasty 15830+15847 $5,874 Gynecomastia (u) 19300 $2,889 Gyncecomastia (b) 19300-50 $4,394 Breast reduction (u) 19318 $4,824 Breast reduction (b) 19318-50 $7,296 Breast lift (u) 19316 $4,503 Breast lift (b) 19316-50 $6,815 Breast implants-saline (u) 19325 $5,287 Breast implants-silicone (u) 19325 $5,287 Breast implants-saline (b) 19325-50 $7,950 Breast implants-silicone (b) 19325-50 $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.
Elective Plastic Surgery (u=unilateral b=bilateral) Wooster Plastic & Reconstructive Surgery James Slaby, MD 330.202.3350 Breast implant removal (u) 19371 $4,383 Breast implant removal (b) 19371-50 $6,655 Rhinoplasty 30400 $3,071 Rhinoplasty 30410 $5,118 Rhinoplasty 30430 $2,751 Rhinoplasty 30450 $4,598 Brow ptosis repair (brow lift) (u) 67900 $2,704 Brow ptosis repair (brow lift) (b) 67900-50 $4,256 Otoplasty (u) 69300 $2,751 Otoplasty (b) 69300-50 $4,187 Lower body lift (hips & abdominoplasty) (b) 15834-50 + 1587-50 $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 = 99221-99223 Subsequent = 99231-99233 Discharge = 99238 330.263.8265 $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.