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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
$19,311 / 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.

$19,311

Without insurance

What goes into a price?

Negotiated prices across insurers

Lowest
$8,792
Highest
$27,471
Cash price
up to $19,311

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 J3490 Facility Fee Pharmaceuticals without Categories
HCPCS J7030 Facility Fee Intravenous infusion of 1000cc of normal saline
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 A4217 Facility Fee Injectable Sterile Water/Saline, 500 ml. Volume
HCPCS J2405 Facility Fee Intramuscular injection of ondansetron hydrochloride, 1mg
HCPCS J2704 Facility Fee Intramuscular injection of 10mg propofol
HCPCS J3010 Facility Fee Intramuscular injection of fentanyl citrate, 0.1mg
HCPCS 58662 Facility Fee Minimally Invasive Laparoscopic Surgery to Remove Tissue From Ovaries, Pelvic Organs or Abdominal Wall
HCPCS 58662 Professional Fee Minimally Invasive Laparoscopic Surgery to Remove Tissue From Ovaries, Pelvic Organs or Abdominal Wall
Revenue Code 250 Facility Fee Pharmacy (Also see 063X, an extension of 250X) - General
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
$19,311 / 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 Ovary/fallopian tube surgery – laparoscopic
Service Codes HCPCS J3490, HCPCS J7030, HCPCS J1100, HCPCS J1885, HCPCS J2250
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 Ovary/fallopian tube surgery – laparoscopic I found through Southern Ohio Medical Center's price estimate tool. Here are the codes I’m looking at: HCPCS J3490, HCPCS J7030, HCPCS J1100, HCPCS J1885, HCPCS J2250. I'm not using insurance, can you confirm the cash pay estimate and help me schedule if needed?"
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