Hysterectomy - laparoscopic
What goes into a price?
Negotiated prices across insurers
Self pay or cash prices vary by facility when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts facilities charge for this service if you were paying without insurance benefits. If you're uninsured or not submitting a claim to insurance, you also have the right to a Good Faith Estimate under federal law. Contact the provider for a copy of your Good Faith Estimate or to better understand payment options available to you.
Procedures included in this package
This list includes the services and fees bundled into the Hysterectomy - laparoscopic Standard Service Package (SSP RE000). The final price for the procedure will depend on which services your provider ultimately performs, your insurance plan and your medical benefits.
| Code | Code Type | Description |
|---|---|---|
| HCPCS J1885 | Facility Fee | Intramuscular injection of 15mg ketorolac tromethamine |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J0690 | Facility Fee | Intramuscular injection cefazolin sodium, 500mg |
| HCPCS 58552 | Facility Fee | Surgical Laparoscopy with Vaginal Hysterectomy and Ovarian/Tubal Removal for Uterus Under 250 G |
| HCPCS J2405 | Facility Fee | Intramuscular injection of ondansetron hydrochloride, 1mg |
| HCPCS J2250 | Facility Fee | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| HCPCS 86900 | Facility Fee | Serologic test to determine abo blood type |
| HCPCS 58552 | Professional Fee | Surgical Laparoscopy with Vaginal Hysterectomy and Ovarian/Tubal Removal for Uterus Under 250 G |
| HCPCS 85027 | Facility Fee | Complete blood count (CBC) – basic blood cell count |
| HCPCS 88307 | Facility Fee | Surgical Pathology Gross/Microscopic Exam, Various Organ/Tissue Resections/Biopsies |
| HCPCS J7120 | Facility Fee | Intravenous infusion of 1000cc of ringer's lactate solution |