Hysterectomy - 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 Hysterectomy - laparoscopic Standard Service Package (SSP RE000). 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 J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| HCPCS J1885 | Facility Fee | Intramuscular injection of 15mg ketorolac tromethamine |
| 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 J7120 | Facility Fee | Intravenous infusion of 1000cc of ringer's lactate solution |
| HCPCS 58542 | Facility Fee | Minimally-invasive Laparoscopic Supracervical Hysterectomy for Uterus 250g or Less with Salpingo-oophorectomy |
| HCPCS 58542 | Professional Fee | Minimally-invasive Laparoscopic Supracervical Hysterectomy for Uterus 250g or Less with Salpingo-oophorectomy |
| HCPCS 88307 | Facility Fee | Surgical Pathology Gross/Microscopic Exam, Various Organ/Tissue Resections/Biopsies |
| HCPCS 85027 | Facility Fee | Complete blood count (CBC) – basic blood cell count |