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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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