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Out-of-Pocket Costs

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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
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
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
CPT Procedure/Surgery Out-of-Pocket/Self-Pay Facility Costs with 35% Discount Applied
64721 Endoscopic Carpal Tunnel Release $1,778.40
OPHTHALMOLOGY
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 SURGERY
CPT Procedure/Surgery* Out-of-Pocket/Self-Pay/Cash-Only Facility Costs
14020 Adjacent tissue transfer scalp/arms/legs $680 for 1st hour and $300 for each additional hour
14040 Adjacent tissue transfer forehead/cheek/neck $680 for 1st hour and $300 for each additional hour
14060 Adjacent tissue transfer eyelids/nose/ears/lips $680 for 1st hour and $300 for each additional hour
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
15777 Placement of acellular dermal matrix for breast reconstruction $680 for 1st hour and $300 for each additional hour
19316 Mastopexy $680 for 1st hour and $300 for each additional hour
19318 Reduction mammoplasty $680 for 1st hour and $300 for each additional hour
19325 Augmentation mammoplasty (breast implants) $680 for 1st hour and $300 for each additional hour
19328 Removal of intact breast implant $680 for 1st hour and $300 for each additional hour
19330 Removal of ruptured breast implant $680 for 1st hour and $300 for each additional hour
19342 Delayed insertion of implant for breast reconstruction $680 for 1st hour and $300 for each additional hour
19350 Nipple/areola reconstruction $680 for 1st hour and $300 for each additional hour
19357 Tissue expander placement for breast reconstruction $680 for 1st hour and $300 for each additional hour
19380 Revision of reconstruction breast (includes large volume fat grafting) $680 for 1st hour and $300 for each additional hour
20926 Autologous fat grafting to breast (small volume) $680 for 1st hour and $300 for each additional hour
* Discount not available (costs do not include surgeon or anesthesia fees or, if needed, lab/pathology/imaging fees)
NOTE 1: If extraordinary items are added such as long-lasting anesthesia, an additional charge will be applied to the total facility fee
NOTE 2: Implants will be provided by the surgeon for self-pay/cash-only 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.

INSURANCE NOTE

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.



PRICING DISCLAIMER:

IF YOU ARE SCHEDULED FOR SURGERY AT THE SURGERY CENTER OF IDAHO (SCI) AND WE ARE FILING INSURANCE CLAIMS FOR YOU, THE PRICES LISTED ON THIS WEBSITE MAY NOT APPLY.  Each insurance company and governmental payor (e.g., Medicare or Medicaid) has different negotiated fee schedules. Therefore, depending upon your insurance carrier, the costs to you may vary. The pricing made available is intended to provide you with an estimate of your expected out-of-pocket SCI facility fee costs:  A) if you have a High Deductible Health Care Plan (where you are responsible for paying for the procedure up front), B) if you have co-insurance that is a percent of the allowable charges, or C) if you are paying cash for the procedure.

It is our goal for you to be able to estimate your out-of-pocket SCI facility fee costs in the event you have a procedure performed at SCI. Each procedure performed at SCI may include multiple fees, including the SCI facility fee, the surgeon's professional fee, anesthesia and pathology fees, hardware, implants and devices. The pricing provided by this website is for the FACILITY FEE at SCI alone and assumes that it is an uncomplicated procedure (some of the listed procedures DO include the cost of the implant or device). The following are NOT INCLUDED IN THE FACILITY FEE: anesthesia, pathology, and surgical professional fees, implants (unless annotated on the following lists), hardware or devices. Anesthesia, pathology (if needed), and surgical professional fees will be billed separately.

Any hardware or implants necessary for the completion of the procedure (for example: cochlear implants, implantable penile prosthesis, neurostimulator, etc.) will be billed in addition to the Facility Fee (unless included). We will do our best to provide you with an estimate of these costs based upon your surgeon's plan for you. Implants will be provided to you at cost, with no mark-up.

Because the human body is different for everyone, additional procedures may be performed in the same case in order to meet your specific care needs. This pricing does not include any complications that may be common with the procedure(s). In addition, expenses or fees resulting from complications subsequent to the completion of the surgery and discharge from the facility are not included. In the event that this occurs, your total costs may increase.

The costs provided are only an estimate. Your actual costs will depend upon the surgical procedure(s) performed by your physician. Please contact us for more detailed pricing and explanations.

This website is a partial list of procedures (many other procedures are performed so please ask your surgeon or call us at 208-639-4900 if you don’t see your procedure). The out-of-pocket (cash) costs listed are not negotiable and reflect a 35% discount based on being paid in full, in advance (some procedures are not eligible for a discount).

 

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