Top 25 most expensive ASC procedures by average charge

Ambulatory surgery centers (ASCs) represent one of the fastest-growing areas of the outpatient care market. Below we’ve compiled a list of the top 25 most expensive ambulatory surgery center procedures by the average charge per procedure. 

What is an ambulatory surgery center (ASC)?

Created in 1970, ASCs are modern healthcare facilities that provide outpatient surgical care for procedures that do not require hospital admission. ASCs are highly regulated by states and by CMS to ensure high-quality care. The combination of high-quality care and lower costs makes them an attractive alternative for both patients and hospital systems. 

What is the most expensive ambulatory surgery center procedure?

Three types of procedures dominate the top five most expensive surgical center procedures: breast reconstruction, implantable therapies and injectable treatments.   

In 2021, breast reconstruction appeared twice in the top five most expensive procedures. Breast reconstruction of a single breast with “stacked” deep inferior epigastric perforator flap(s) and/or gluteal artery perforator flap(s)—HCPCS code S2067 —took the top spot with a reported average charge of $120,262 per procedure. Meanwhile, breast reconstruction with deep inferior epigastric perforator (DIEP) flap or superficial inferior epigastric artery (SIEA) flap (HCPCS code S2068) was the fifth most expensive procedure. Breast reconstruction surgeries with flap repairs of this kind are among the most complex breast procedures, explaining the high average cost. 

The second most expensive surgery center procedure is autologous chondrocyte implantation (HCPCS code J7330), used to treat cartilage defects of the knee. Chondrocytes, the cartilage-producing cells of the body, are taken from the patient, multiplied in number over a few weeks and implanted back in the joint to replace the damaged cartilage with living, healthy cartilage. Multiple implantable treatments, from cardiac contractility modulation devices to defibrillator pulse generators to cochlear implants, appear on the list.   

Injections of specific treatments also appear multiple times on the list and in the top five most expensive procedures. Injections of eculizumab (HCPCS code J1300), a monoclonal antibody treatment used most frequently in the treatment of blood disorders, came in as the third most expensive procedure, and injections of ocrelizumab (HCPCS code J2350), a monoclonal antibody treatment used for multiple sclerosis, took the fourth spot.

Most expensive ambulatory surgery center procedures 

Rank HCPCS/CPT Code Description Total # of Procedures Total Charges Average Charge Per Procedure
1. S2067  Breast reconstruction of a single breast with "stacked" deep inferior epigastric perforator (diep) flap(s) and/or gluteal artery perforator (gap) flap(s), including harvesting of the flap(s), microvascular transfer, closure of donor site(s) and shaping the flap into a breast, unilateral  134  $16,115,051 $120,262  
2.  J7330  Autologous cultured chondrocytes, implant  699  $65,744,708  $94,055  
3.  J1300  Injection, eculizumab, 10 mg  249  $22,213,830  $89,212  
4. J2350  Injection, ocrelizumab, 1 mg  615  $52,840,922   $85,920  
5. S2068  Breast reconstruction with deep inferior epigastric perforator (diep) flap or superficial inferior epigastric artery (siea) flap, including harvesting of the flap, microvascular transfer, closure of donor site and shaping the flap into a breast, unilateral  749  $57,504,604   $76,775  
6. C1824  Generator, cardiac contractility modulation (implantable)  29  $2,213,402   $76,324  
7. 55970  Intersex surgery; male to female  39  $2,963,500   $75,987  
8. C9733  Non-ophthalmic fluorescent vascular angiography  97  $7,057,951   $72,762  
9. 64893  Nerve graft (includes obtaining graft), single strand, arm or leg; more than 4 cm  25  $1,635,780   $65,431  
10. 33264  Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; multiple lead system  1,106  $72,281,126   $65,354  
11. 27100  Transfer external oblique muscle to greater trochanter including fascial or tendon extension (graft)  52 $3,391,127   $65,214  
12. Q2043  Sipuleucel-t, minimum of 50 million autologous cd54+ cells activated with pap-gm-csf, including leukapheresis and all other preparatory procedures, per infusion  59  $3,639,414   $61,685  
13. 22220  Osteotomy of spine, including discectomy, anterior approach, single vertebral segment; cervical  46  $2,762,442   $60,053  
14. 69930  Cochlear device implantation, with or without mastoidectomy  1,510  $90,505,426   $59,937  
15. 33249  Insertion or replacement of permanent implantable defibrillator system, with transvenous lead(s), single or dual chamber  2,734  $158,861,667   $58,106  
16. J3385  Injection, velaglucerase alfa, 100 units  21  $1,198,256   $57,060  
17. 33263  Removal of implantable defibrillator pulse generator with replacement of implantable defibrillator pulse generator; dual lead system  685  $37,349,965   $54,525  
18. L8614  Cochlear device, includes all internal and external components  554 $30,091,977   $54,318  
19. 0408T  Insertion or replacement of permanent cardiac contractility modulation system, including contractility evaluation when performed, and programming of sensing and therapeutic parameters; pulse generator with transvenous electrodes  31  $1,680,313   $54,204  
20. C9604  Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting intracoronary stent, atherectomy and angioplasty, including distal protection when performed; single vessel  133 $7,123,302   $53,559  
21. Q4254  Novafix dl, per square centimeter  74  $3,660,488   $49,466  
22. 32664  Thoracoscopy, surgical; with thoracic sympathectomy  36  $1,753,085   $48,697  
23. L8687  Implantable neurostimulator pulse generator, dual array, rechargeable, includes extension  1,813  $86,276,487   $47,588  
24. C1882  Cardioverter-defibrillator, other than single or dual chamber (implantable)  229  $10,864,624   $47,444  
25. 22857  Total disc arthroplasty (artificial disc), anterior approach, including discectomy to prepare interspace (other than for decompression), single interspace, lumbar  372  $17,554,621   $47,190  

Fig. 1 – Data from Definitive Healthcare’s ClaimsMx product representing claims from January – November 2021. Procedures with fewer than a total of 20 procedures were excluded. Commercial claims data is sourced from multiple medical claims clearinghouses in the United States and updated monthly. Data accessed January 7, 2022. 

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