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Etensive Hyteretctomy

DETAIL FOR SERVICES: Surgery Procedure Hospital Stay (4 days) Anesthesia Physician Services
2020 CPT/HCPCS Primary Code 58150 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Negotiated Private Fee $4,504.00 $2,088.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Prossam $4,560.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Champva Diagnostic Related Group (DRG) Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
First Medical $2,600.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
First Medical Vital $2,415.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Plan de Salud Menonita $3,600.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Menonita Vital $2,520.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Humana Gold Plus / Gold Choice Diagnostic Related Group (DRG) Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Humana $2,460.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Mapfre $2,996.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Mcsclassicare $3,748.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
MCS Life $3,140.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Medicare Diagnostic Related Group (DRG) Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
MMM $3,380.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
MMM Vital $2,415.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Panamerican Life $2,752.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
PMC $3,380.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Tricare Diagnostic Related Group (DRG) Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Triple S Salud $3,200.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Triple S Vital $2,520.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Triple S Advantage Diagnostic Related Group (DRG) Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Negotiated Minimum Charge $2,415.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Negotiated Maximum Charge $4,560.00 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)
Discounted Cash Price $3,603.20 $1,670.40 Not provided by Hospital (may be billed separately) Not provided by Hospital (may be billed separately)

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