Myomectomy - 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 Myomectomy - laparoscopic Standard Service Package (SSP RE001). 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 86901 | Facility Fee | Serologic testing to determine RhD antigen blood type |
| HCPCS J1885 | Facility Fee | Intramuscular injection of 15mg ketorolac tromethamine |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J2598 | Facility Fee | Filler - Change Overwrite This |
| HCPCS J0690 | Facility Fee | Intramuscular injection cefazolin sodium, 500mg |
| HCPCS J2405 | Facility Fee | Intramuscular injection of ondansetron hydrochloride, 1mg |
| HCPCS J2250 | Facility Fee | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS 58546 | Professional Fee | Laparoscopic Surgical Myomectomy of >5 Intramural Myomas >250g |
| HCPCS J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| HCPCS 86900 | Facility Fee | Serologic test to determine abo blood type |
| HCPCS 58546 | Facility Fee | Laparoscopic Surgical Myomectomy of >5 Intramural Myomas >250g |
| HCPCS 88305 | Facility Fee | Microscopic/gross-exam of surgical pathology biopsies/exam/resections |
| HCPCS 85027 | Facility Fee | Complete blood count (CBC) – basic blood cell count |
| HCPCS 86850 | Facility Fee | Antibody screening of red blood cells in serum sample |
| HCPCS J7120 | Facility Fee | Intravenous infusion of 1000cc of ringer's lactate solution |