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Open Biopsy Of A Breast Lump

West Virginia 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?

$1,931

Typical total for the visit. In West Virginia, July 2026.

Insurers have agreed to pay about $1,931 for this procedure. That total is two separate charges: $309 to the doctor who performs it, and $1,622 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$309$229 to $380
Facility feeThe hospital or surgery center$1,622$309 to $3,890

How much rates vary

Facilitymedian $1,622 · 10th to 90th $219 to $3,890Professionalmedian $309 · 10th to 90th $195 to $447
$200$500$1K$2K$5K$10Kfacility $1,622professional $309

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
$218.78
Median
$1,621.81
Typical High
$3,890.45
Aetna
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$309.03
Typical High
$446.68
CareSource
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$234.42
Typical High
$288.40
CareSource
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$257.04
Typical High
$257.04
Cigna
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$354.81
Typical High
$1,949.84
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$18,197.01
Median
$18,197.01
Typical High
$18,197.01
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$501.19
United
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$2,951.21
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$281.84
Typical High
$501.19

Where West Virginia 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

West Virginia· 38th of 50

$1,931

$309 physician + $1,622 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.