Price Checker / CPT 19101
CPT 19101 — Biopsy of breast open
2026 Medicare Physician Fee Schedule rates and hospital pricing data
$216
What Medicare pays in a hospital/ASC setting
$350
What Medicare pays in a physician's office
$49,804
Based on 49 hospital(s) in our database
What do these numbers mean?
The Medicare rateis what the federal government determines is a fair payment for this procedure. It's based on the Relative Value Unit (RVU) system, which accounts for physician work, practice expense, and malpractice cost. Hospitals and providers often charge 3-20x this amount. If your bill is significantly higher than the Medicare rate, you may have grounds to negotiate.
Hospital Charges for CPT 19101
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| INTEGRIS Health Baptist Medical Center , OK | — | — | 22683% |
| INTEGRIS Health Baptist Medical Center Oklahoma City, OK | — | — | 22683% |
| INTEGRIS Health Baptist Medical Center Portland Ave , OK | — | — | 22683% |
| INTEGRIS Health Baptist Medical Center Portland Ave Oklahoma City, OK | — | — | 22683% |
| INTEGRIS Health Canadian Valley Hospital , OK | — | — | 22683% |
| INTEGRIS Health Canadian Valley Hospital Yukon, OK | — | — | 22683% |
| INTEGRIS Health Cancer Institute Hospital , OK | — | — | 22683% |
| INTEGRIS Health Cancer Institute Hospital Oklahoma City, OK | — | — | 22683% |
| INTEGRIS Health Edmond Hospital Edmond, OK | — | — | 22683% |
| INTEGRIS Health Edmond Hospital , OK | — | — | 22683% |
| INTEGRIS Health Enid Hospital Enid, OK | — | — | 22683% |
| INTEGRIS Health Enid Hospital , OK | — | — | 22683% |
| INTEGRIS Health Grove Hospital Grove, OK | — | — | 22683% |
| INTEGRIS Health Grove Hospital , OK | — | — | 22683% |
| INTEGRIS Health Health Woodward Hospital , OK | — | — | 22683% |
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About CPT 19101
CPT code 19101 refers to “Biopsy of breast open”. Under the 2026 Medicare Physician Fee Schedule, this procedure is reimbursed at $216 in a facility (hospital or ambulatory surgery center) and $350in a non-facility (physician's office) setting.
These rates are set by CMS (Centers for Medicare & Medicaid Services) and represent what the government considers a fair payment for this service. While commercial insurance typically pays somewhat more than Medicare, many hospitals charge significantly higher amounts — sometimes 10-50x the Medicare rate.
What to do if you were overcharged
- Upload your bill— we'll identify this code and compare it against the rates shown above.
- Get a dispute letter— citing the Medicare rate and your hospital's own published pricing data.
- Negotiate or let us handle it — 25% of savings, no savings = no fee.