Recent regulations require hospitals and health plans to publish prices of a subset of services. The hospital rule requires publication of “shoppable services,” those that can be scheduled in advance by a consumer. The Transparency in Coverage rule requires a list of 500 items and services to be published. Prostate biopsy, with our without guidance appears on both lists, and there is a standard service package available for it. The services that make up this package are fairly standard across all prostate biopsy procedures
A prostate biopsy is a procedure to remove samples of suspicious tissue from the prostate. The prostate is a small, walnut-shaped gland in males that produces fluid that nourishes and transports sperm. During a prostate biopsy a needle is used to collect a number of tissue samples from your prostate gland. Your doctor may recommend a prostate biopsy if results from initial tests, such as a prostate-specific antigen (PSA) blood test or digital rectal exam, suggest that you may have prostate cancer. This procedure may be performed with or without imaging guidance; with guidance is presented in this service package as an optional fee
This service package does not include any of the procedures or tests used to determine whether a prostate biopsy is needed, nor does it include any post-procedure follow-up services. Your service utilization may vary from this service package for a number of reasons, including your unique clinical profile and where you receive your services.
This Service Package was generated using outpatient care setting claims. However, this service package may also be performed in the below care settings. Please confirm with your provider in which care setting you will receive services, as this may affect your cost.
- Inpatient: Discuss with your provider
- Outpatient facility: 60%
- Free standing ASC: 40%
- Office: Discuss with your provider