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Package

Ovary/fallopian tube surgery – laparoscopic

Package

Ovary/fallopian tube surgery – laparoscopic

Ovary/fallopian tube surgery (laparoscopic) is a minimally invasive procedure that uses small incisions and a camera to treat or remove problems such as cysts, ectopic pregnancy, endometriosis, or infection. The laparoscopic approach causes less pain and scarring than open surgery and typically allows for a shorter recovery time. The procedure is done under general anesthesia and may be performed as an outpatient or short-stay procedure, depending on what is found and repaired. Your doctor will explain the specific findings and provide recovery instructions after the surgery.
You'd pay up to
$5,250 / Case Rate

A single, all-inclusive pricing methodology for a procedure in healthcare contracts, instead of separate charges for each service.

The estimated total cost of care without any insurance coverage or discounts.

$5,250

Without insurance

What goes into a price?

Negotiated prices across insurers

Lowest
$1,204
Highest
$12,073
Cash price
up to $5,250

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 Ovary/fallopian tube surgery – laparoscopic Standard Service Package (SSP RE004). 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 J2405 Facility Fee Intramuscular injection of ondansetron hydrochloride, 1mg
HCPCS J1100 Facility Fee Intramuscular injection of 1mg dexamethasone sodium phosphate
HCPCS 58661 Facility Fee Minimally Invasive Removal of Ovarian and/or Fallopian Tube Structures
HCPCS 86900 Facility Fee Serologic test to determine abo blood type
HCPCS 58661 Professional Fee Minimally Invasive Removal of Ovarian and/or Fallopian Tube Structures
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 88302 Facility Fee Gross/microscopic Pathology Examination for Appendectomy, Traumatic Amputations, Hydrocelectomy, Nerve Incision, Plastic Skin Repair, Castration, and Vasectomy
Revenue Code 250 Facility Fee Pharmacy (Also see 063X, an extension of 250X) - General
HCPCS A9900 Facility Fee Additional Equipment or Service for Medical Supplies Under Specific Code

Disclaimer

Hawaii Health Systems Corporation is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.

In compliance with federal law, we provide a list of standard charges that are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient's unique needs.

You'd pay up to
$5,250 / Case Rate

A single, all-inclusive pricing methodology for a procedure in healthcare contracts, instead of separate charges for each service.

The estimated total cost of care without any insurance coverage or discounts.

Disclaimer

Hawaii Health Systems Corporation is committed to empowering our patients to make informed decisions about their healthcare. This includes helping patients understand the cost of care and the availability of financial assistance.

In compliance with federal law, we provide a list of standard charges that are reviewed on an annual basis. Charges for hospital services are not equivalent to the actual amount paid by insurance companies or patients. The amount paid for services is based on many factors, including health insurance benefit plans, applicable discounts, and services provided based on each patient's unique needs.

What’s the difference between an individual procedure and a Standard Service Package (SSP)?

Individual Procedure

Individual procedures, like blood tests, each have unique prices and billing codes (like a CPT or HCPCS code). While they can be billed alone, they're usually grouped with other procedures on a claim. This grouping is what determines the total cost of your care.

Standard Service Package (SSP)

A SSP combines all medical services, materials, and fees associated with a healthcare visit or procedure into a single bundle to offer a more comprehensive estimate.

Contact us to verify your estimate

Have your service name, codes, and payment preference ready. If you’re using insurance, you may be asked for insurance details like your Member or Group ID.

Service Ovary/fallopian tube surgery – laparoscopic
Service Codes HCPCS 86901, HCPCS J1885, HCPCS J3010, HCPCS J2405, HCPCS J1100
Insurance I'm not using insurance
Location Hilo Benioff Medical Center Main
When you contact us, you can say:
"Hi, I'm calling to verify a price for Ovary/fallopian tube surgery – laparoscopic I found through Hilo Benioff Medical Center Main's price estimate tool. Here are the codes I’m looking at: HCPCS 86901, HCPCS J1885, HCPCS J3010, HCPCS J2405, HCPCS J1100. I'm not using insurance, can you confirm the cash pay estimate and help me schedule if needed?"
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