Ankle repair - arthroscopic
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 Ankle repair - arthroscopic Standard Service Package (SSP MS009). 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 J2003 | Facility Fee | Injection, lidocaine hydrochloride, 1mg |
| HCPCS J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| HCPCS J0665 | Facility Fee | Injection of numbing medication for pain relief |
| HCPCS J2250 | Facility Fee | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS J0690 | Facility Fee | Intramuscular injection cefazolin sodium, 500mg |
| HCPCS J2405 | Facility Fee | Intramuscular injection of ondansetron hydrochloride, 1mg |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J2704 | Facility Fee | Intramuscular injection of 10mg propofol |
| HCPCS J8501 | Facility Fee | Chemically Mediated Oral Prophylaxis of 5 MG Aprepitant |
| HCPCS 29898 | Facility Fee | Extensive Ankle Arthroscopic Debridement of Tibiotalar and Fibulotalar Joints |
| HCPCS 29898 | Professional Fee | Extensive Ankle Arthroscopic Debridement of Tibiotalar and Fibulotalar Joints |
| Revenue Code 250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |