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Package

Cystourethroscopy, biopsy, and/or ablation

Package

Cystourethroscopy, biopsy, and/or ablation

Cystourethroscopy, biopsy, and/or ablation uses a thin camera inserted through the urethra to examine the bladder and urethra for signs of bleeding, inflammation, or suspicious growths, with the option to collect tissue samples or treat abnormal areas using targeted energy during the same visit. It helps diagnose and address conditions such as bladder tumors, recurrent infections, or unexplained urinary symptoms. Most patients recover quickly with minimal downtime. Your doctor will provide instructions for care and any follow-up needed after the procedure.
You'd pay up to
$15,604 / 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.

$15,604

Without insurance

What goes into a price?

Negotiated prices across insurers

Lowest
$6,600
Highest
$20,554
Cash price
up to $15,604

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 Cystourethroscopy, biopsy, and/or ablation Standard Service Package (SSP UR001). 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 C1769 Facility Fee Controlled Insertion of Thin Wire for Diagnostic Mapping
HCPCS 86900 Facility Fee Serologic test to determine abo blood type
HCPCS C2617 Facility Fee Temporary Non-coronary Stent without Delivery System
HCPCS 52354 Facility Fee Exploratory Endoscopic Procedures with Biopsy and/or Destruction of Ureter/Renal Tissue
HCPCS J7030 Facility Fee Intravenous infusion of 1000cc of normal saline
HCPCS J1100 Facility Fee Intramuscular injection of 1mg dexamethasone sodium phosphate
HCPCS J2250 Facility Fee Intramuscular injection of 1mg midazolam hydrochloride
HCPCS J2405 Facility Fee Intramuscular injection of ondansetron hydrochloride, 1mg
HCPCS 84132 Facility Fee Clinical measurement of potassium in blood
HCPCS J0690 Facility Fee Intramuscular injection cefazolin sodium, 500mg
HCPCS J2372 Facility Fee INJECTION, PHENYLEPHRINE HYDROCHLORIDE (BIORPHEN), 20 MICROGRAMS
HCPCS Q9967 Facility Fee Non-ionic low osmolar contrast, 300-399mg/ml iodine concentration per ml
HCPCS J2704 Facility Fee Intramuscular injection of 10mg propofol
HCPCS J3010 Facility Fee Intramuscular injection of fentanyl citrate, 0.1mg
HCPCS J2598 Facility Fee Filler - Change Overwrite This
HCPCS 86901 Facility Fee Serologic testing to determine RhD antigen blood type
HCPCS 74018 Facility Fee X-ray of abdomen, 1 view
HCPCS 36415 Facility Fee Collection of blood from a vein via puncture
HCPCS 86850 Facility Fee Antibody screening of red blood cells in serum sample
HCPCS 52332 Facility Fee Cystourethroscopy with Ureteral Stent Insertion
HCPCS 51600 Facility Fee Injection of Contrast Medium for Bladder Imaging
HCPCS 52332 Professional Fee Cystourethroscopy with Ureteral Stent Insertion
HCPCS 52354 Professional Fee Exploratory Endoscopic Procedures with Biopsy and/or Destruction of Ureter/Renal Tissue
HCPCS 51610 Professional Fee Injection of Contrast Medium for Retrograde Urethrography
HCPCS 74420 Professional Fee X-ray Imaging of Urinary Tract Using Both Antegrade and Retrograde Techniques
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
$15,604 / 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 Cystourethroscopy, biopsy, and/or ablation
Service Codes HCPCS C1769, HCPCS 86900, HCPCS C2617, HCPCS 52354, HCPCS J7030
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 Cystourethroscopy, biopsy, and/or ablation I found through Southern Ohio Medical Center's price estimate tool. Here are the codes I’m looking at: HCPCS C1769, HCPCS 86900, HCPCS C2617, HCPCS 52354, HCPCS J7030. I'm not using insurance, can you confirm the cash pay estimate and help me schedule if needed?"
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