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Open Biopsy Of A Breast Lump

Illinois rates for HCPCS 19101

A surgeon makes a small incision in the breast and removes a piece of a lump or abnormal area so it can be examined under a microscope. Only part of the abnormality is taken, enough to reach a diagnosis, rather than the whole of it. It is used when needle sampling has not given a clear answer or when a larger piece of tissue is needed.

Rates data updated July 2026.

How much does Open Biopsy Of A Breast Lump cost?

$1,916

Typical total for the visit. In Illinois, July 2026.

Insurers have agreed to pay about $1,916 for this procedure. That total is two separate charges: $331 to the doctor who performs it, and $1,585 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$331$251 to $490
Facility feeThe hospital or surgery center$1,585$447 to $4,074

How much rates vary

Facilitymedian $1,585 · 10th to 90th $224 to $6,026Professionalmedian $331 · 10th to 90th $195 to $617
$1$10$100$1K$10Kfacility $1,585professional $331

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$1,318.26
Typical High
$5,888.44
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$295.12
Typical High
$660.69
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$5,011.87
Typical High
$6,760.83
BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$371.54
Typical High
$602.56
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$478.63
Typical High
$1,148.15
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$288.40
Typical High
$446.68
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,548.13
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$234.42
Median
$363.08
Typical High
$660.69

Where Illinois sits

The same service costs 18.2 times more in Delaware than in Maryland. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

Illinois· 39th of 50

$1,916

$331 physician + $1,585 facility

DE $9,628MD $528

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.