Hysteroscopy with surgical procedure, complex
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 Hysteroscopy with surgical procedure, complex Standard Service Package (SSP RE003). 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 58561 | Facility Fee | Hysteroscopy with Endoscopic Resection of Uterine Leiomyomata |
| HCPCS J1885 | Facility Fee | Intramuscular injection of 15mg ketorolac tromethamine |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| 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 58561 | Professional Fee | Hysteroscopy with Endoscopic Resection of Uterine Leiomyomata |
| HCPCS 88305 | Facility Fee | Microscopic/gross-exam of surgical pathology biopsies/exam/resections |