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Open Biopsy Of A Breast Lump

South Dakota 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?

$1,307

Typical total for the visit. In South Dakota, July 2026.

Insurers have agreed to pay about $1,307 for this procedure. That total is two separate charges: $437 to the doctor who performs it, and $871 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$437$275 to $617
Facility feeThe hospital or surgery center$871$398 to $4,365

How much rates vary

Facilitymedian $871 · 10th to 90th $288 to $4,365Professionalmedian $437 · 10th to 90th $209 to $724
$200$500$1K$2K$5Kfacility $871professional $437

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$4,365.16
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$275.42
Typical High
$331.13
Cigna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$630.96
Typical High
$912.01
Medica
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$446.68
Typical High
$870.96
Medica
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$645.65
Typical High
$2,398.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$501.19
Typical High
$758.58
Midlands
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$691.83
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$478.63
Typical High
$616.60
United
Setting
Facility
Modifier
Global
Typical Low
$2,691.53
Median
$2,691.53
Typical High
$7,943.28
United
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$501.19
Typical High
$851.14
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$501.19
Typical High
$812.83

Where South Dakota 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

South Dakota· 43rd of 50

$1,307

$437 physician + $871 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.