Transurether Resection of Bladder Large bladder tumor(s)
| DETAIL FOR SERVICES: | Facility Fee | Post Mammography | Pathology/Interpretation of results | Physician Services |
| 2020 CPT/HCPCS Primary Code | 522440 | 77065 | 88305 | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $4504.00 | Not provided by Hospital (may be billed separately) | ||
| Prossam | $1300.00 | Not provided by Hospital (may be billed separately) | ||
| Champva | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| First Medical | $728.00 | Not provided by Hospital (may be billed separately) | ||
| First Medical Vital | $710.85 | Not provided by Hospital (may be billed separately) | ||
| Plan de Salud Menonita | $1,100.00 | Not provided by Hospital (may be billed separately) | ||
| Menonita Vital | $739.00 | 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) | ||
| Humana | $725.00 | Not provided by Hospital (may be billed separately) | ||
| Mapfre | $781.00 | Not provided by Hospital (may be billed separately) | ||
| Mcsclassicare | $890.00 | Not provided by Hospital (may be billed separately) | ||
| MCS Life | $923.00 | Not provided by Hospital (may be billed separately) | ||
| Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| MMM | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| MMM Vital | $710.85 | Not provided by Hospital (may be billed separately) | ||
| Panamerican Life | $734.00 | Not provided by Hospital (may be billed separately) | ||
| PMC | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| Triple S Salud | $900.00 | Not provided by Hospital (may be billed separately) | ||
| Triple S Vital | $739.00 | Not provided by Hospital (may be billed separately) | ||
| Triple S Advantage | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| Negotiated Minimum Charge | $710.85 | Not provided by Hospital (may be billed separately) | ||
| Negotiated Maximum Charge | $1,300.00 | Not provided by Hospital (may be billed separately) | ||
| Discounted Cash Price | $3603.00 | Not provided by Hospital (may be billed separately) | ||
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