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Biopsy Breast, including ultrasound guidance

DETAIL FOR SERVICES: Facility Fee Post Mammography Pathology/Interpretation of results Physician Services
2020 CPT/HCPCS Primary Code 19083 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 $895.00 $28.93 $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 $800.00 $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 $1,218.00 $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 $37.00 $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 $1,000.00 $67.75 $16.86 Not provided by Hospital (may be billed separately)
Panamerican Life $493.02 $22.50 Not contracted Not provided by Hospital (may be billed separately)
PMC $1,300.00 $87.11 $54.33 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 Min Charge    $493.02 $21.06 $16.86 Not provided by Hospital (may be billed separately)
Negotiated Maxi Charge  $1400.00 $87.11 $70.00 Not provided by Hospital (may be billed separately)
Discounted Cash Price $584.00 $80.00 $7200 Not provided by Hospital (may be billed separately)

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