Biopsy Breast, including stereotactic guidance
| DETAIL FOR SERVICES: | Facility Fee | Post Mammography | Pathology/Interpretation of results | Physician Services |
| 2020 CPT/HCPCS Primary Code | 19081 | 77065 | 88305 | Not provided by Hospital (may be billed separately) |
| Negotiated Private Fee | $730.00 | $100.00 | $90.00 | Not provided by Hospital (may be billed separately) |
| Prossam | $1,150.00 | $32.50 | $75.00 | Not provided by Hospital (may be billed separately) |
| Champva | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| First Medical | $1,350.00 | $25.00 | $35.00 | Not provided by Hospital (may be billed separately) |
| First Medical Vital | $939.75 | $66.71 | $35.00 | Not provided by Hospital (may be billed separately) |
| Plan de Salud Menonita | $1,400.00 | $42.50 | $50.00 | Not provided by Hospital (may be billed separately) |
| Menonita Vital | $945.00 | $62.37 | $50.00 | 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 | $1,060.00 | $42.50 | $37.00 | Not provided by Hospital (may be billed separately) |
| Mapfre | $1,180.00 | $43.50 | $70.00 | Not provided by Hospital (may be billed separately) |
| Mcsclassicare | $536.00 | $39.00 | $59.73 | Not provided by Hospital (may be billed separately) |
| MCS Life | $536.00 | $39.00 | $59.73 | Not provided by Hospital (may be billed separately) |
| Medicare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| MMM | $1,300.00 | $87.11 | $54.33 | Not provided by Hospital (may be billed separately) |
| MMM Vital | $800.00 | $67.75 | $16.86 | Not provided by Hospital (may be billed separately) |
| Panamerican Life | $467.28 | $22.50 | Not contracted | Not provided by Hospital (may be billed separately) |
| PMC | $1,300.00 | $87.11 | $54.30 | Not provided by Hospital (may be billed separately) |
| Tricare | Ambulatory Payment classification (APC) | Not provided by Hospital (may be billed separately) | ||
| Triple S Salud | $902.00 | $32.50 | $58.00 | Not provided by Hospital (may be billed separately) |
| Triple S Vital | $939.00 | $21.06 | $53.63 | 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 | $467.28 | $21.06 | $16.86 | Not provided by Hospital (may be billed separately) |
| Negotiated Maximum Charge | $1,400.00 | $87.11 | $70.00 | Not provided by Hospital (may be billed separately) |
| Discounted Cash Price | $584.00 | $80.00 | $72.00 | Not provided by Hospital (may be billed separately) |
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