Exploration Of Breast Nipple
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Skin/Integumentary Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| North Carolina | $383.19 | $1,688.76 |
| Virginia | $365.59 | $1,371.18 |
| Pennsylvania | $361.20 | $1,881.90 |
| California | $345.96 | $1,786.45 |
| New Jersey | $318.20 | $2,297.38 |
| Louisiana | $317.50 | $1,741.14 |
| Illinois | $298.83 | $2,097.60 |
| New York | $290.95 | $2,367.15 |
| Texas | $283.53 | $1,669.25 |
| Oklahoma | $265.69 | $1,255.91 |
| Florida | $260.05 | $1,378.87 |
| Washington | $247.08 | $1,119.58 |
What the Data Says About Exploration Of Breast Nipple
Across 12 states with reporting providers, CPT code 19110 (Exploration Of Breast Nipple) shows a national average Medicare payment of $310.69 against an average billed charge of $1,722.16. That gap — a 5.5x markup, or 454% above the Medicare allowed amount — reflects chargemaster pricing, not what most insured patients actually pay. Medicare's negotiated rate is the statutory benchmark; commercial insurers typically settle between the two figures based on network contracts.
Skin/Integumentary Surgery procedures like this one saw 385 services billed to Medicare in 2023 by 305 distinct providers, serving 358 unique beneficiaries. State-level variation is significant: Washington reports the lowest average payment at $247.08, while North Carolina reports the highest at $383.19. Geographic Practice Cost Indices (GPCIs) explain much of that spread — local malpractice premiums, practice expense, and physician work adjustments all shift the allowed amount even when the procedure is identical.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Skin/Integumentary Surgery category (2.24x), the estimated commercial insurance price lands near $882.12, with self-pay cash discounts commonly bringing the figure closer to $768.95. Uninsured patients facing the full billed charge have the strongest leverage to negotiate — the Hospital Price Transparency Rule (effective January 2021) requires providers to publish standard charges, cash rates, and payer-specific negotiated prices. This data is for educational reference; confirm coverage and out-of-pocket exposure with your insurer before any procedure.
Frequently Asked Questions
How much does Exploration Of Breast Nipple cost?
The national average Medicare payment for Exploration Of Breast Nipple (CPT 19110) is $310.69, while providers typically bill $1,722.16. Prices vary significantly by state, ranging from $247.08 to $383.19.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Exploration Of Breast Nipple cost with insurance?
With commercial insurance, Exploration Of Breast Nipple costs an estimated $882.12 on average (range: $617.48 – $1,234.96). Without insurance, the estimated cash price is $768.95. These estimates are based on RAND 2024 research on commercial-to-Medicare price ratios. Your actual cost depends on your insurer, plan, and provider.
Which state has the lowest cost for Exploration Of Breast Nipple?
Washington has the lowest average Medicare payment for Exploration Of Breast Nipple at $247.08, while North Carolina has the highest at $383.19. This $136.11 difference reflects geographic variation in healthcare costs, local cost of living, and provider market dynamics.
How many providers perform Exploration Of Breast Nipple?
Nationally, 305 providers billed Medicare for Exploration Of Breast Nipple in 2023, performing 385 total services for 358 beneficiaries across 12 states and territories.
What is the billed-to-Medicare markup for Exploration Of Breast Nipple?
Providers bill 5.5x what Medicare pays for Exploration Of Breast Nipple — a 454% markup. This gap between billed charges and actual payment is common across healthcare. Uninsured patients may face charges closer to the billed amount, while insured patients pay negotiated rates between the Medicare and billed figures.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Related Data Sources
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology — how this data is sourced, computed, and verified.