ADULT & PEDIATRIC UROLOGY | ||
CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
50590 | Kidney stone removal | $3,536.20 |
52204 | Exam of bladder with biopsy | $1,569.14 |
52224 | Exam of bladder and removal of tissue with electrical pulses | $1,569.14 |
52281 | Exam of bladder and urethra | $1,569.14 |
52310 | Exam of bladder and removal of stent in ureter | $1,569.14 |
52332 | Exam of bladder and ureters with placement of stent to maintain patency | $2,427.14 |
52351 | Exam of upper urinary tract | $1,569.14 |
52352 | Cystourethroscopy, with ureteroscopy | $3,536.20 |
52353 | Exam of ureter with possible laser | $3,536.20 |
52356 | Cystourethroscopy, with ureteroscopy | $3,536.20 |
52601 | Vesical neck and prostate | $3,536.20 |
52648 | Partial removal of enlarged prostate | $3,536.20 |
53440 | Repair of dropped bladder for men * | $12,189.33 |
54160 | Circumcision under 28 days | $2,575.00** |
54161 | Circumcision 28 days or more | $2,575.00** |
54163 | Revision of circumcision | $1,569.14 |
54901 | Epididymovasostomy, bilateral | $4,000.00** |
55200 | Vasotomy, unilateral or bilateral | $2,575.00** |
55250 | Male sterilization | $2,575.00** |
55400 | Reversal of male sterilization | $4,000.00** |
55530 | Varicocelectomy, unilateral | $2,150.00** |
55530 | Varicocelectomy, bilateral | $3,225.00** |
55899 | MESA | $2,000.00** |
55899 | TESE | $2,000.00** |
55870 | Electroejaculation | $212.88 |
57288 | Repair of dropped bladder for women * | $3,701.95 |
64561 | Percutaneous implantation of neurostimulator electrode array * | $9,446.53 |
64581 | Incision for implantation of neurostimulator electrode array and placement of partial device to reduce urinary incontinence * | $10,014.47 |
64590 | Neurostimulator procedure on the peripheral nerves and placement of full device to reduce urinary incontinence * | $33,134.16 |
* Implant/device is included ** Discount not available |
ENT | ||
CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
30520 | Repair of deviated septum | $1,209.61 |
42820 | Tonsil & adenoid removal | $4,312.55 |
42826 | Tonsil removal | $1,916.48 |
69436 | Ear tubes* | $1,193.16 |
69501 | Simple mastoidectomy | $4,312.55 |
69502 | Complete mastoidectomy | $4,312.55 |
69505 | Modified radical mastoidectomy | $4,312.55 |
69601 | Revision mastoidectomy | $4,312.55 |
69602 | Revision modified radical mastoidectomy | $4,312.55 |
69604 | Revision mastoidectomy with tymp | $4,312.55 |
69635 | Tympanoplasty without ossicular reconstruction | $4,312.55 |
69637 | Tympanoplasty with ossicular reconstruction | $4,312.55 |
69643 | Tymp with mastoidectomy, without ossicular reconstruction | $4,312.55 |
69644 | Tymp with mastoidectomy, with ossicular reconstruction | $4,312.55 |
69645 | Tymp with modified radical mastoidectomy, without OCR | $4,312.55 |
69646 | Tymp with modified radical mastoidectomy, with OCR | $4,312.55 |
69662 | Revision stapedotomy | $4,312.55 |
69660 | Stapedotomy | $4,312.55 |
69715 | Osteointegrated implant | $23,880.80 |
69910 | Labyrinthectomy, transmastoid | $4,312.55 |
69806 | Endolymphatic sac decompression with shunt | $4,312.55 |
69436 | Tympanostomy tube placement * | $1,193.16 |
69424 | PET removal under general | $190.73 |
69930 | Cochlear implantation * | $61,578.56 |
* Implant/device is included ** Discount not available |
GEN
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CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
10060 | Simple abscess incision and drainage | $156.65 |
10061 | Complex abscess incision and drainage | $436.15 |
11770 | Simple excision pilonidal cyst | $577.85 |
11771 or 11772 | Extensive/complicated excision pilonidal cyst | $2,281.50 |
38510 – 38520 | Excision biopsy lymph node cervical | $2,211.30 |
43246 | Insertion tube gastrostomy (G-tube) | $1,346.80 |
44970 | Laparoscopic appendectomy | $3,477.50 |
46250, 46255, or 46260 | Hemorrhoidectomy | $2,445.30 |
47562, 47563, or 47564 | Laparoscopic cholecystectomy | $4,844.45 |
49501, 49505, or 49520 | Repair of hernia inguinal | $2,861.30 |
49525 | Repair of sliding inguinal hernia | $3,055.00 |
49560 or 49561 | Repair of hernia ventral/incisional | $3,055.00 |
49585 | Repair of hernia umbilical | $3,055.00 |
60240 | Thyroidectomy | $1,925.95 |
GYN
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CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
58661 | Laparoscopic on the oviduct/ovary (tubal ligation) | $4,221.14 |
58670 | Laparoscopic with removal of adnexal structures (tubal ligation) | $4,221.14 |
ENDOSCOPIC CARPAL TUNNEL RELEASE
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CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
64721 | Endoscopic Carpal Tunnel Release | $1,778.40 |
OPHTHALMOLOGY
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CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied |
67036 | Vitrectomy, mechanical, pars plana approach | $3,567.28 |
67039 | Vitrectomy, mechanical, pars plana approach | $3,567.28 |
67041 | Vitrectomy, mechanical, pars plana approach | $3,567.28 |
67042 | Vitrectomy, mechanical, pars plana approach | $3,567.28 |
67108 | Repair of retinal detachment | $3,567.28 |
67113 | Repair Procedures on the Retina or Choroid | $3,567.28 |
67145 | Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage, 1 or more sessions | $511.88 |
OTOLOGY & NEUROTOLOGY | |||
CPT | Procedure/Surgery | Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied | |
69501 | Simple mastoidectomy | $4,312.55 | |
69502 | Complete mastoidectomy | $4,312.55 | |
69505 | Modified radical mastoidectomy | $4,312.55 | |
69601 | Revision mastoidectomy | $4,312.55 | |
69602 | Revision modified radical mastoidectomy | $4,312.55 | |
69604 | Revision mastoidectomy with tymp | $4,312.55 | |
69635 | Tympanoplasty without ossicular reconstruction | $4,312.55 | |
69637 | Tympanoplasty with ossicular reconstruction | $4,312.55 | |
69643 | Tymp with mastoidectomy, without ossicular reconstruction | $4,312.55 | |
69644 | Tymp with mastoidectomy, with ossicular reconstruction | $4,312.55 | |
69645 | Tymp with modified radical mastoidectomy, without OCR | $4,312.55 | |
69646 | Tymp with modified radical mastoidectomy, with OCR | $4,312.55 | |
69662 | Revision stapedotomy | $4,312.55 | |
69660 | Stapedotomy | $4,312.55 | |
69715 | Osteointegrated implant | $23,880.805 | |
69910 | Labyrinthectomy, transmastoid | $4,312.55 | |
69806 | Endolymphatic sac decompression with shunt | $4,312.55 | |
69436 | Tympanostomy tube placement * | $1,193.16 | |
69424 | PET removal under general | $190.73 | |
69930 | Cochlear implantation * | $61,578.56 | |
* Implant/device is included ** Discount not available |
PLASTIC/COSMETIC SURGERY
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CPT | Procedure/Surgery* | Out-of-Pocket/Self-Pay/Cash-Only Facility Costs | |
15001 & 15100 | Prep body wound for graft <100cm2 & split skin graft <100cm2 | Coming Soon | |
15002, 15100, & 15101 | Prep body wound for graft >100cm2, split skin graft >100cm2, & additional 100cm2 | Coming Soon | |
15003 & 15100 | Prep face/hand wound for graft <100cm2 & split skin graft <100cm2 | Coming Soon | |
15003, 15004, 15100, & 15101 | Prep face/hand wound for graft >100cm2, split skin graft >100cm2, & additional 100cm2 | Coming Soon | |
BUNDLED PLASTIC/COSMETIC SURGERY | |||
Surgery for 1 Hour | Bundle (facility fee = $680 plus anesthesia fee = $360) | Total = $1,040 | |
Surgery for 1 1/2 Hours | Bundle (facility fee = $830 plus anesthesia fee = $480) | Total = $1,310 | |
Surgery for 2 Hours | Bundle (facility fee = $980 plus anesthesia fee = $600) | Total = $1,580 | |
Surgery for 2 1/2 Hours | Bundle (facility fee = $1,130 plus anesthesia fee = $720) | Total = $1,850 | |
Surgery for 3 Hours | Bundle (facility fee = $1,280 plus anesthesia fee = $840) | Total = $2,120 | |
Surgery for 3 1/2 Hours | Bundle (facility fee = $1,430 plus anesthesia fee = $960) | Total = $2,390 | |
Surgery for 4 Hours | Bundle (facility fee = $1,580 plus anesthesia fee = $1,080) | Total = $2,660 | |
Surgery for 4 1/2 Hours | Bundle (facility fee = $1,730 plus anesthesia fee = $1,200) | Total = $2,930 | |
Surgery for 5 Hours | Bundle (facility fee = $1,880 plus anesthesia fee = $1,320) | Total = $3,200 | |
Surgery for 5 1/2 Hours | Bundle (facility fee = $2,030 plus anesthesia fee = $1,440) | Total = $3,470 | |
Surgery for 6 Hours | Bundle (facility fee = $2,180 plus anesthesia fee = $1,560) | Total = $3,740 | |
* Discount not available (costs do not include surgeon or, if needed, lab/pathology/imaging fees) | |||
** Procedures under plastic/cosmetic bundles (not all inclusive): Mastopexy (CPT 19316), Placement of acellular dermal matrix for breast reconstruction (CPT 15777+), Reduction mammoplasty (CPT 19318), Augmentation mammoplasty/breast implants (CPT 19325), Removal of intact breast implants (CPT 19328), Removal of ruptured breast implants (CPT 19330), Delayed insertion of implant for breast reconstruction (CPT 19342), Nipple/areola reconstruction (CPT 19350), Tissue expander placement for breast reconstruction (CPT 19357), Revision of reconstruction breast/includes large volume fat grafting (CPT 19380), Autologous fat grafting to breast/small volume (CPT 20926) | |||
NOTE 1: If extraordinary items are added such as long-lasting anesthesia, an additional charge will be applied to the bundled fee NOTE 2: Implants will be provided by the surgeon for self-pay/cash-only/bundled surgeries so please contact surgeon for details |
The examples above are the out-of-pocket/self-pay/cash-only (or if you have a high deductible insurance plan) FACILITY FEE costs for the most common surgeries and procedures performed at the Surgery Center of Idaho (SCI). These costs do not include surgeon or anesthesia fees (you will receive those as separate bill). If the procedure you are having is not listed, please contact us at 208-639-4900 to see if a cash price is offered. Compare our prices and see how we can provide a safe, convenient, and affordable alternative to traditional hospital outpatient or inpatient surgical facilities.
Every health insurance plan is different. The costs on this website are out-of-pocket/self-pay/cash only FACILITY FEES and do not take into account coverage of a health insurance provider. To be sure you are making an educated decision, check with your own insurance company to determine what the cost of your procedure will be.