Hysteroscopy with Surgical Procedure
NYC Health and Hospitals - Metropolitan
What goes into a price?
Prices across providers
Self pay or cash prices vary by provider when paying out of pocket without insurance benefits. The chart shows you how the lowest and highest amounts providers 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 Hysteroscopy with Surgical Procedure Standard Service Package (SSP RE003). 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 58563 | Base Code | Hysteroscopy with Surgical Procedure |
| HCPCS 58563 | Professional Fee | Hysteroscopy with Surgical Procedure |
| RC 0710 | Facility Fee | Recovery Room - General |
| RC 0370 | Facility Fee | Anesthesia - General |
| HCPCS J3010 | Facility Fee | Intramuscular injection of fentanyl citrate, 0.1mg |
| HCPCS J2405 | Facility Fee | Intramuscular injection of ondansetron hydrochloride, 1mg |
| RC 0250 | Facility Fee | Pharmacy (Also see 063X, an extension of 250X) - General |
| RC 0360 | Facility Fee | Operating Room Services - General |
| HCPCS J2704 | Facility Fee | Intramuscular injection of 10mg propofol |
| RC 0636 | Facility Fee | Pharmacy - Extension of 025X - Drugs requiring detailed coding |
| HCPCS 88305 | Facility Fee | Microscopic/gross-exam of surgical pathology biopsies/exam/resections |
| HCPCS J2250 | Facility Fee | Intramuscular injection of 1mg midazolam hydrochloride |
| HCPCS J1100 | Facility Fee | Intramuscular injection of 1mg dexamethasone sodium phosphate |
| RC 0272 | Facility Fee | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - Sterile |
| HCPCS J1885 | Facility Fee | Intramuscular injection of 15mg ketorolac tromethamine |
| HCPCS J7120 | Facility Fee | Intravenous infusion of 1000cc of ringer's lactate solution |
| RC 0270 | Optional Fee | Medical/Surgical Supplies and Devices (Also see 062X, an extension of 027X) - General |