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Open Biopsy Of A Breast Lump

Ohio 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?

$4,046

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

Insurers have agreed to pay about $4,046 for this procedure. That total is two separate charges: $331 to the doctor who performs it, and $3,715 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 8 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 $447
Facility feeThe hospital or surgery center$3,715$1,660 to $5,012

How much rates vary

Facilitymedian $3,715 · 10th to 90th $347 to $10,715Professionalmedian $331 · 10th to 90th $195 to $692
$50$200$1K$5Kfacility $3,715professional $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
$346.74
Median
$3,715.35
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$331.13
Typical High
$2,951.21
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$3,548.13
Typical High
$15,135.61
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$309.03
Typical High
$575.44
CareSource
Setting
Facility
Modifier
Global
Typical Low
$213.80
Median
$218.78
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$354.81
Typical High
$21,379.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$346.74
Typical High
$588.84
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$21,379.62
Median
$21,379.62
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$354.81
Typical High
$602.56
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$107.15
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$354.81
Typical High
$660.69
United
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$4,168.69
Typical High
$7,762.47
United
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$323.59
Typical High
$549.54

Where Ohio 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

Ohio· 19th of 50

$4,046

$331 physician + $3,715 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.