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Open Biopsy Of A Breast Lump

North Carolina 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?

$1,160

Typical total for the visit. In North Carolina, July 2026.

Insurers have agreed to pay about $1,160 for this procedure. That total is two separate charges: $347 to the doctor who performs it, and $813 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 7 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$347$251 to $501
Facility feeThe hospital or surgery center$813$331 to $4,677

How much rates vary

Facilitymedian $813 · 10th to 90th $240 to $6,918Professionalmedian $347 · 10th to 90th $219 to $776
$200$500$1K$2K$5K$10Kfacility $813professional $347

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
$295.12
Median
$1,230.27
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$323.59
Typical High
$645.65
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$426.58
Typical High
$891.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$416.87
Typical High
$707.95
Medcost
Setting
Facility
Modifier
Global
Typical Low
$218.78
Median
$338.84
Typical High
$562.34
Medcost
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$338.84
Typical High
$870.96
United
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$6,918.31
Typical High
$12,882.50
United
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$323.59
Typical High
$630.96
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$8,912.51
Median
$8,912.51
Typical High
$28,840.32
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,238.72
Median
$2,238.72
Typical High
$2,754.23

Where North Carolina 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

North Carolina· 46th of 50

$1,160

$347 physician + $813 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.