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Package

Shoulder repair, simple - arthroscopic

Package

Shoulder repair, simple - arthroscopic

Arthroscopic shoulder repair (simple) addresses minor damage inside the shoulder joint using small incisions and a tiny camera. The surgeon may remove inflamed tissue, smooth rough areas, or clean out debris to reduce pain and restore comfortable movement. The procedure is performed under anesthesia and is typically done as an outpatient. Recovery involves a brief period of restricted activity followed by physical therapy to restore strength and range of motion.
You'd pay up to
$52,778 / 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.

$52,778

Without insurance

What goes into a price?

Negotiated prices across insurers

Lowest
$21,047
Highest
$67,653
Cash price
up to $52,778

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 Shoulder repair, simple - arthroscopic Standard Service Package (SSP MS003). 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 J3490 Facility Fee Pharmaceuticals without Categories
HCPCS J7030 Facility Fee Intravenous infusion of 1000cc of normal saline
HCPCS J2795 Facility Fee Injection, Ropivacaine Hydrochloride, 1 MG Dose
HCPCS J1100 Facility Fee Intramuscular injection of 1mg dexamethasone sodium phosphate
HCPCS 82962 Facility Fee Fda-cleared Home Glucose Monitoring Device-measured Blood Glucose
HCPCS J2250 Facility Fee Intramuscular injection of 1mg midazolam hydrochloride
HCPCS J2405 Facility Fee Intramuscular injection of ondansetron hydrochloride, 1mg
HCPCS J0690 Facility Fee Intramuscular injection cefazolin sodium, 500mg
HCPCS J2704 Facility Fee Intramuscular injection of 10mg propofol
HCPCS J3010 Facility Fee Intramuscular injection of fentanyl citrate, 0.1mg
HCPCS J7120 Facility Fee Intravenous infusion of 1000cc of ringer's lactate solution
HCPCS 29823 Facility Fee Arthroscopic Shoulder Surgery Involving Debridement of 3+ Structures
HCPCS 29826 Facility Fee Arthroscopic Shoulder Decompression with Partial Acromioplasty, Ligament Release
HCPCS 29826 Professional Fee Arthroscopic Shoulder Decompression with Partial Acromioplasty, Ligament Release
HCPCS 29823 Professional Fee Arthroscopic Shoulder Surgery Involving Debridement of 3+ Structures
Revenue Code 250 Facility Fee Pharmacy (Also see 063X, an extension of 250X) - General
HCPCS J0171 Facility Fee Injection of 0.1mg Epinephrine/Adrenaline into Body
HCPCS J2001 Facility Fee Injection of 10mg Lidocaine Hcl via IV Infusion

Disclaimer

Southern Ohio Medical Center 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
$52,778 / 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

Southern Ohio Medical Center 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 Shoulder repair, simple - arthroscopic
Service Codes HCPCS J3490, HCPCS J7030, HCPCS J2795, HCPCS J1100, HCPCS 82962
Insurance I'm not using insurance
Location Southern Ohio Medical Center
When you contact us, you can say:
"Hi, I'm calling to verify a price for Shoulder repair, simple - arthroscopic I found through Southern Ohio Medical Center's price estimate tool. Here are the codes I’m looking at: HCPCS J3490, HCPCS J7030, HCPCS J2795, HCPCS J1100, HCPCS 82962. I'm not using insurance, can you confirm the cash pay estimate and help me schedule if needed?"
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