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Open Biopsy Of A Breast Lump

Pennsylvania 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?

$3,837

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

Insurers have agreed to pay about $3,837 for this procedure. That total is two separate charges: $288 to the doctor who performs it, and $3,548 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 10 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$288$209 to $372
Facility feeThe hospital or surgery center$3,548$1,514 to $5,370

How much rates vary

Facilitymedian $3,548 · 10th to 90th $407 to $8,318Professionalmedian $288 · 10th to 90th $195 to $513
$200$500$1K$2K$5K$10Kfacility $3,548professional $288

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
$407.38
Median
$3,630.78
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$288.40
Typical High
$512.86
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$5,248.07
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$457.09
Typical High
$616.60
Cigna
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$331.13
Typical High
$549.54
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$575.44
Typical High
$616.60
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$1,584.89
Typical High
$1,584.89
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$398.11
Typical High
$588.84
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$10,232.93
Typical High
$12,882.50
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$537.03
Median
$3,090.30
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$309.03
Typical High
$933.25
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$549.54
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$1,698.24
Typical High
$2,951.21
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$234.42
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$3,890.45
Typical High
$11,481.54
United
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$309.03
Typical High
$549.54

Where Pennsylvania 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

Pennsylvania· 22nd of 50

$3,837

$288 physician + $3,548 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.