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Surgical Procedures

For the time period: 10/01/16 - 9/30/17

Surgical Procedures: CPT Codes 50000-59999

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Note

  1. The pricing on this page is for the surgical procedures listed. It is the average charge for the total procedure including any supplies, testing and other charges associated with the procedure.
  2. Charging is based on the length of stay, amount of supplies used, therapies provided, testing given as well as other care provided.
  3. This pricing is an average charge and not intended to be the exact charge for any particular patient.
  4. The average charge shown is an estimate and actual charges for the service depend on the circumstances at the time the service is provided and the patient.
  5. Any insurance discount is negotiated by the insurance carrier. Most insurance providers should be able to tell their members what financial responsibility they will have.
  6. The charges shown below is only for patients without insurance. 

List of Surgical Procedures: CPT Codes 50000-59999

CPTDESCRIPTIONPLAIN LANGUAGE DESCRIPTIONSelf-Pay Price
50435 EXCHANGE NEPHROSTOMY CATH EXCHANGE NEPHROSTOMY CATHETER, PERCUTANEOUS INCLUDING DAINOSTIC NEPHROSTOGRAM, IMAGING GUIDANCE; SUPRVISION AND INTERPRETATION $3,216.41
50590 FRAGMENTING OF KIDNEY STONE FRAGMENTING OF KIDNEY STONE (LITHOTRISY, EXTRACORPOREAL SHOCK WAVE) $8,511.35
51040 INCISE  DRAIN BLADDER INCISE  DRAIN BLADDER ( CYSTOSTOMY, CISOTOMY, W/DRAINAGE $6,736.53
51102 DRAIN BL W/CATH INSERTION CYSTOTOMY; FOR SIMPLE EXCISION OF VESSEL NECK (SEPARATE PROCEDURE) $5,675.75
51600 INJECTION FOR BLADDER X-RAY INJECTION PROCEDURE FOR CYSTOGRAPHY $3,341.54
51700 IRRIGATION OF BLADDER BLADDER IRRIGATION; SIMPLE LAVAGE &/OR INSTILLATION $5,902.24
51701 INSERT BLADDER CATHETER INSERTION OF NON-INDWELLING CATHETER FOR RESIDUAL URINE $4,606.94
51705 CHANGE OF BLADDER TUBE CHANGE OF CYSTOSTMY TUBE, SIMPLE $3,889.79
51715 ENDOSCOPIC INJECTION/IMPLANT ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO SUBMUCOSAL TISSUE OF THE URETHRA $7,502.12
51720 TREATMENT OF BLADDER LESION BLADDER INSTILLATION OF ANTI CARCINOGENIC AGENT $1,329.52
52000 CYSTOSCOPY CYSTOURETHROSCOPY $7,317.30
52005 CYSTOSCOPY  URETER CATHETER CYSTOURETHROSCOPY, W/URETERAL CATHETERIZATION $8,040.30
52204 CYSTOSCOPY W/BIOPSY(S) CYSTOURETHROSCOPY W/BIOPSY(S) $5,764.13
52234 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) OR TREATMENT .5 CM OR LESS $7,649.06
52235 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) MEDIUM BLADDER SURGERY 2.0 - 5.0 CM  $7,659.96
52240 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) LARGE BLADDER TUMOR(S) $10,462.40
52260 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/DILATION OF BLADDER $9,770.24
52276 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/DIRECT VISION INTERNAL URETHROTOMY $6,413.81
52287 CYSTOSCOPY CHEMODENERVATION CYSTOURETHROSCOPY, W/INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER $6,983.50
52310 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY, W/REMOVAL OF FOREIGN BODY CALCULUS, OR URETERAL STENT $7,762.72
52317 REMOVE BLADDER STONE LITHOLAPAXY (REMOVE OR BREAK UP BLADDER STONE) $8,534.44
52320 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION) W/REMOVAL OF URERTAL CALCULAS (STONE) $9,871.40
52325 CYSTOSCOPY STONE REMOVAL CYSTOURETHROSCOPY W/FRAGMENTATION OF CALCULUS (E.G. ULTRASONIC OR ELECTRO HYDRAULIC TECHNIQUE) $9,268.10
52332 CYSTOSCOPY AND TREATMENT CYSTOURETHROSCOPY W/INSERTION OF INDWELLING URETERAL STENT $8,530.44
52351 CYSTOURETERO  OR PYELOSCOPE CYSTOURETHROSCOPY W/URTEROSCOPY &/OR PYLOSCOPY; DIAGNOSTIC $8,529.87
52352 CYSTOURETERO W/STONE REMOVE CYSTOURETHROSCOPY W/URTEROSCOPY &/OR PYLOSCOPY; W/REMOVAL OR MANIPULATION OF CALCULUS $9,578.81
52354 CYSTOURETERO W/BIOPSY CYSTOURETHROSCOPY W/URTEROSCOPY &/OR PYLOSCOPY; W/BIOPSY OR FULURATION OF URETRERAL OR RENAL PELVIC LESION $10,242.73
52356 CYSTO/URETERO W/LITHOTRIPSY CYSTOURETHROSCOPY W/URTEROSCOPY &/OR PYLOSCOPY; W/LITHOTRIPSY AND INSERTION OF STENT $10,174.63
52601 PROSTATECTOMY (TURP) TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE $10,829.18
54161 CIRCUM 28 DAYS OR OLDER CIRCUMCISION, SURGICAL; AGE 28 DAYS OR MORE $6,700.11
55040 REMOVAL OF HYDROCELE REMOVAL OF HYDROCELE $7,768.16
55250 REMOVAL OF SPERM DUCT(S) VASECTOMY, UNILATERAL OR BILATERAL $7,312.13
55700 BIOPSY OF PROSTATE BIOPSY OF PROSTATE; NEEDLE OR PUNCH; SINGLE OR MULTIPLE $6,632.91
56405 I  D OF VULVA/PERINEUM INCISION AND DRAINAGE OF VULVA OR PERINEAL ABCESS $1,602.62
57240 REPAIR BLADDER  VAGINA REPAIR BLADDER  VAGINA $16,801.19
57250 REPAIR RECTUM  VAGINA REPAIR RECTUM  VAGINA $17,235.34
57260 REPAIR OF VAGINA REPAIR OF VAGINA $17,465.36
57265 EXTENSIVE REPAIR OF VAGINA EXTENSIVE REPAIR OF VAGINA $25,040.56
57267 INSERT MESH/PELVIC FLR ADDON INSERTION OF MESH FOR REPAIR OF PELVIC FLOOR DEFECT $27,595.04
57268 REPAIR OF BOWEL BULGE REPAIR OF BOWEL BULGE; VAGINA APPROACH $11,228.58
57282 COLPOPEXY EXTRAPERITONEAL COLPOPEXY VAGINA OR EXTRAPERITONEAL APPROACH $22,618.83
57283 COLPOPEXY INTRAPERITONEAL COLPOPEXY INTRAPERITONEAL APPROACH $24,166.71
57288 REPAIR BLADDER DEFECT SLING OPERATION FOR STRESS INCONTINENCE $16,686.66
57425 LAPAROSCOPY SURG COLPOPEXY LAPAROSCOPY SURGICAL COLPOPEXY OF THE CERVIX INCLUDING UPPER/ADJACENT VAGINA $23,744.48
57520 CONIZATION OF CERVIX CONIZATION OF CERVIX $9,072.45
58120 DILATION AND CURETTAGE DILATION AND CURETTAGE; DIAGNOSTIC OR THERAPEUTIC $8,716.69
58260 VAGINAL HYSTERECTOMY VAGINAL HYSTERECTOMY $12,662.77
58262 VAG HYST INCLUDING T/O VAGINAL  HYSTERACTOMY INCLUDING TUBES &/OR OVARIES $14,066.47
58301 REMOVE INTRAUTERINE DEVICE REMOVAL OF IUD $8,958.56
58552 LAPARO-VAG HYST INCL T/O LAPAROSCOPY, SURGICAL; VAGINA HYSTERECTOMY W/REMOVAL OF TUBES(S) &/OR OVARY(S) $16,103.53
58558 HYSTEROSCOPY BIOPSY HYSTEROSCOPY, SURGICAL; W/BIOPSY $9,602.87
58561 HYSTEROSCOPY REMOVE MYOMA HYSTEROSCOPY, SURGICAL; W/REMOVAL OF LEIOMYOMATA $12,223.59
58563 HYSTEROSCOPY ABLATION HYSTEROSCOPY, SURGICAL; W/ENODMETRIAL ABLATION $12,471.25
58570 TLH UTERUS 250 G OR LESS LAPRAOSCOPY, SURGICAL; TOTAL HYSTERECTOMY FOR UTERUS 250 GRAMS OR LESS $17,807.06
58571 TLH W/T/O 250 G OR LESS LAPRAOSCOPY, SURGICAL; TOTAL HYSTERECTOMY FOR UTERUS 250 GRAMS OR LESS, W/REMOVAL OF TUBE(S) &/OR OVARY(S) $19,822.94
58600 DIVISION OF FALLOPIAN TUBE LIGATION OR TRANSECTION OF FALLOPIAN TUBE(S) $7,818.82
58661 LAPAROSCOPY REMOVE ADNEXA LAPRAOSCOPY, SURGICAL; W/REMOVAL OF ADNEXAL STRUCTURES $12,125.12
58662 LAPAROSCOPY EXCISE LESIONS LAPRAOSCOPY, SURGICAL; W/FULGURATIOJN OR EXCISION OF THE OVARY, PELVIC VISCERA OR PERTONEAL SURFACE $14,319.96
58670 LAPAROSCOPY TUBAL CAUTERY LAPRAOSCOPY, SURGICAL; W/CAUTERY OF TUBES $10,314.04
58671 LAPAROSCOPY TUBAL BLOCK LAPRAOSCOPY, SURGICAL; W/OCLUSION OF OVIDUCTS BY DEVICE (E.G. BAND, CLIP OR FALOPE RING) $8,826.70
59025 FETAL NON-STRESS TEST FETAL NON-STRESS TEST $320.48
59812 TREATMENT OF MISCARRIAGE TREATMENT OF MISCARRIAGE (ANY TRIMESTER) $9,451.40
59820 CARE OF MISCARRIAGE TREATMENT OF MISCARRIAGE, SURGICAL ; 1ST TRIMESTER $7,093.02

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719.584.4000