Two very different groups of people search for this price, and the healthcare system charges them in the same wildly inconsistent way. Some are transgender women and nonbinary people having a bilateral orchiectomy as a standalone gender-affirming procedure, often years before or instead of anything larger. Others are men with advanced prostate cancer, for whom removing the testicles is a permanent alternative to indefinite hormone injections.
The operation is broadly the same. The price is not, and the biggest variable is not which reason brought you there. It is whether the surgery happens in an ambulatory surgery center, a hospital outpatient department, or a hospital that has decided not to discount for self-pay at all.
This is also the one procedure in gender-affirming care where a real, posted, all-inclusive cash price genuinely exists. That makes it worth shopping.
What Does an Orchiectomy Cost Without Insurance?
All figures verified September 4, 2026. Hospital cash prices come from each hospital’s own machine-readable price file. Medicare rates come from the July 2026 payment files and reset on October 1, 2026.
| Setting / source | Low | Typical | High |
|---|---|---|---|
| All-inclusive cash package, Surgery Center of Oklahoma | $4,165 | $4,165 | $4,165 |
| Hospital posted cash price, CPT 54520, three hospitals (facility only) | $2,872.98 | $7,836.40 | $8,773 |
| Hospital posted cash price, bilateral (St. Luke’s Boise, modifier 50) | $17,546 | $17,546 | $17,546 |
| Medicare surgery center facility rate, CPT 54520 (July 2026 ASC) | $1,723.02 | $1,723.02 | $1,723.02 |
| Medicare hospital outpatient facility rate, CPT 54520 (July 2026 OPPS) | $3,601.33 | $3,601.33 | $3,601.33 |
| Average Medicare allowed amount, surgeon side, CPT 54520 (2024 claims) | n/a | $407.89 | n/a |
| Average submitted charge, surgeon side, CPT 54520 (2024 claims) | n/a | $1,938.30 | n/a |
| Total episode cost, commercial claims (OptumLabs) | n/a | $8,177 | n/a |
| Testicular implant add-on, CPT 54660 (Medicare ASC vs. hospital) | $3,681.87 | n/a | $5,477.93 |
| Laparoscopic orchiectomy, CPT 54690 (Medicare ASC vs. hospital) | $3,030.97 | n/a | $6,176.47 |
The $4,165 from the Surgery Center of Oklahoma is the cleanest number on the page. The center’s own procedure page lists it against CPT 54530 and states that its single all-inclusive price carries “no separate surgeon, facility, or anesthesia bills.” Its broader price list also shows a radical orchiectomy at $4,967.
Medicare’s arithmetic gives you a floor to argue from. At an ambulatory surgery center the facility gets $1,723.02 and the surgeon’s national average allowed amount in 2024 claims was $407.89, for a total near $2,130. Move the identical operation to a hospital outpatient department and the facility payment jumps to $3,601.33, for a total near $4,010.
What Drives the Price
The setting, more than anything else. Same code, same surgeon, same day: a surgery center facility fee is 48% of a hospital’s under Medicare rates. This is the lever worth pulling before any other.
Whether the hospital discounts for self-pay at all. We pulled six hospitals’ machine-readable price files in September 2026 and got several different answers for CPT 54520. Ochsner Clinic Foundation (file dated 3/26/2026) posts a gross charge of $13,059 and a discounted cash price of $2,872.98, about 22% of gross. Oregon Health & Science University (3/23/2026) posts $12,056 gross against a cash price of $7,836.40, a 35% discount. St. Luke’s Regional Medical Center in Boise (3/25/2026) posts $8,773 gross and encodes the identical $8,773 as its cash price, meaning no self-pay discount whatsoever. Three other files, including two at large academic centers, list negotiated payer rates for the code but publish neither a gross charge nor a cash price.
That is roughly a 3x spread on posted cash prices for the same procedure, driven purely by hospital policy. Nothing about your case changes it.
Simple versus radical versus laparoscopic. A simple orchiectomy (CPT 54520) is the least expensive. A radical inguinal orchiectomy (54530), the standard approach when testicular cancer is suspected, pays the facility $3,657.95 at a hospital and $1,744.22 at a surgery center. A laparoscopic orchiectomy (54690) is the most expensive of the three at $6,176.47 hospital outpatient and $3,030.97 at a surgery center. On the cash side the same pattern holds: Ochsner posts $8,598.69 as its self-pay price for 54530 against $2,872.98 for 54520.
Unilateral versus bilateral. Bilateral is billed with a modifier and roughly doubles the facility charge at some hospitals. St. Luke’s posts $8,773 for one side and $17,546 for both.
Implants. Testicular prostheses (CPT 54660) are a separate code and a separate line on the bill, at $3,681.87 at a surgery center and $5,477.93 at a hospital under Medicare’s July 2026 rates. St. Luke’s posts a cash price of $12,489 for the code with no discount off gross, while OHSU posts $4,590 against a $14,434 gross charge.
Cash Price vs. Insurance
CMS’s 2024 national claims file shows how far apart billed and negotiated prices sit. For CPT 54520 in a facility setting, providers submitted an average charge of $1,938.30 and Medicare allowed $407.89, a 4.75x gap. In an office setting the submitted charge averaged $1,265.79 against $340.50 allowed. For the radical code 54530, the submitted average was $2,478.65 against $578.85 allowed.
That gap is your negotiating room. A hospital sending an uninsured patient a $13,000 charge for a procedure Medicare values around $4,000 all-in is not describing a market price, it is describing a chargemaster.
With insurance, orchiectomy is cheap in absolute terms but expensive as a share of the bill. In OptumLabs commercial claims the mean total cost was $8,177 per procedure with $1,250 of that falling on the patient, which works out to 15.3% out of pocket, the highest patient share of any gender-affirming procedure in that analysis. Aetna’s clinical policy bulletin covers gonadectomy as medically necessary with a mental health professional’s letter, documented and sustained gender dysphoria, and six months of continuous hormone therapy (twelve months for patients under 18).
For Prostate Cancer: Surgery vs. Ongoing Hormone Therapy
For metastatic prostate cancer, bilateral orchiectomy and drug-based androgen deprivation are two routes to the same endpoint, and the cost curves cross quickly.
A single-institution study of billing data from 2014 to 2019, summarized in Translational Andrology and Urology, found median and mean surgical charges of about $13,000 for orchiectomy including the pre-operative visit and testing. Patients on chemical androgen deprivation surpassed that cumulative figure by 38 weeks of treatment, and the most expensive drug arm reached $167,000. Despite that, national use of surgical castration fell from 8.5% of cases in 2004 to 3.5% in 2016.
This is a cost comparison, not a recommendation. The two options differ in reversibility, side effect profile and follow-up burden, and that conversation belongs with your urologist or oncologist. If you are managing prostate cancer costs more broadly, see PSA test costs and Xtandi costs.
How to Pay Less
Get a bundled cash quote from an ambulatory surgery center. This is the single highest-value move, worth roughly half the facility bill. Ask specifically whether surgeon, facility, anesthesia and pathology all sit inside one number, and get the answer in writing.
Pull the hospital’s own price file before accepting a hospital quote. Every US hospital must publish gross charges, discounted cash prices and negotiated rates in a machine-readable file. As shown above, some encode a real discount and some encode none at all. Our guide to hospital price transparency explains how to find and read it, and the fair-price checker shows what the procedure should cost in your area.
Ask for the cash price before you hand over an insurance card. On a procedure this size a self-pay package can beat a deductible outright. Compare the quoted cash total against your remaining deductible and coinsurance before you decide.
Apply for hospital financial assistance if a hospital bills you. Nonprofit hospitals must have a written charity care policy and many discount well above the federal poverty line. Start at hospital charity care and run the charity care check tool.
Negotiate anything billed near the chargemaster. With a 4.75x billed-to-allowed ratio on this code there is real room. Our guide to negotiating medical bills has the scripts, and requesting an itemized hospital bill covers requesting the line-item bill first so you can see which charge is doing the damage.
Price the implant separately if you want one. The posted cash spread on CPT 54660 runs from $4,590 to $12,489 across two hospitals, which is a larger swing than the orchiectomy itself.
The Bottom Line
Orchiectomy is the affordable end of gender-affirming surgery and one of the few procedures in this category with a published, all-inclusive cash price attached. Plan on $2,000 to $9,000, treat $4,165 as the benchmark a good surgery center package should land near, and treat any hospital quote much above $9,000 as an opening offer rather than a price.
Related reading: vaginoplasty costs, phalloplasty costs, top surgery costs, facial feminization surgery costs, hormone therapy costs and estradiol costs.