Removal of gallbladder using an endoscope
| DETAIL FOR SERVICES: | Surgery Procedure | Anesthesia | Physician Services |
| 2020 CPT/HCPCS Primary Code | 47562 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $5,110.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Prossam | $1,460.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| First Medical | $1,092.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $1,027.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $1,100.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $1,567.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Humana Gold Plus / Gold Choice | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Humana | $1,210.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Mapfre | $1,457.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Mcsclassicare | $1,200.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| MCS Life | $1,200.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| MMM | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| MMM Vital | $1,100.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Panamerican Life | $1,318.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| PMC | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Triple S Salud | $1,250.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $1,050.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Triple S Advantage | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Negotiated Minimum Charge | $1,027.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $1,567.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $4,088.00 | Not provided by Hospital (may be billed separately) | Not provided by Hospital (may be billed separately) |
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