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Open Biopsy Of A Breast Lump

Montana 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?

$951

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

Insurers have agreed to pay about $951 for this procedure. That total is two separate charges: $389 to the doctor who performs it, and $562 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$389$331 to $562
Facility feeThe hospital or surgery center$562$389 to $575

How much rates vary

Facilitymedian $562 · 10th to 90th $372 to $7,943Professionalmedian $389 · 10th to 90th $209 to $1,202
$100$1K$10K$100Kfacility $562professional $389

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
$4,365.16
Median
$4,365.16
Typical High
$12,589.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$331.13
Typical High
$1,819.70
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$524.81
Cigna
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$354.81
Typical High
$354.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$354.81
Typical High
$562.34
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$562.34
Typical High
$602.56
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$562.34
Typical High
$602.56
Providence
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$323.59
Typical High
$537.03
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$346.74
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$446.68
Median
$446.68
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$478.63
Typical High
$831.76

Where Montana 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

Montana· 48th of 50

$951

$389 physician + $562 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.