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Open Biopsy Of A Breast Lump

New Jersey 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?

$6,190

Typical total for the visit. In New Jersey, July 2026.

Insurers have agreed to pay about $6,190 for this procedure. That total is two separate charges: $302 to the doctor who performs it, and $5,888 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 5 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$302$209 to $407
Facility feeThe hospital or surgery center$5,888$4,365 to $7,943

How much rates vary

Facilitymedian $5,888 · 10th to 90th $603 to $10,471Professionalmedian $302 · 10th to 90th $186 to $832
$200$500$1K$2K$5K$10Kfacility $5,888professional $302

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
$602.56
Median
$5,888.44
Typical High
$10,471.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$281.84
Typical High
$3,715.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$371.54
Typical High
$776.25
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$416.87
Typical High
$660.69
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$7,943.28
Median
$13,803.84
Typical High
$19,498.45
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$354.81
Typical High
$707.95
United
Setting
Facility
Modifier
Global
Typical Low
$2,511.89
Median
$6,165.95
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$281.84
Typical High
$630.96

Where New Jersey 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

New Jersey· 6th of 50

$6,190

$302 physician + $5,888 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.