Removal Of Growth And Tissue Of Breast, Duct, Or Nipple
What Medicare pays for 19120, what providers bill, and how the price varies across 47 states, drawn from CMS 2023 claims data.
19120 · the short answer
For removal of growth and tissue of breast, duct, or nipple, Medicare pays about $401.73 while providers bill $2,158.62 on average, a 5.4× markup, a below-median markup. State-level Medicare rates range 129% from lowest to highest.
- Medicare pays
- $401.73
- Providers bill
- $2,158.62
- Markup
- 5.4×
- Markup percentile
- 47th
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
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.
Where this markup sits nationally
Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate
5 more affordable than 47% of 8,901 procedures
Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.
Source CMS Medicare Physician & Other Practitioners · 2023
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Alaska | $641.71 | $6,180.47 |
| Wyoming | $558.96 | $3,753.50 |
| New Jersey | $515.92 | $2,972.61 |
| Arkansas | $504.48 | $1,617.17 |
| Colorado | $489.12 | $3,122.84 |
| Oregon | $467.37 | $2,247.31 |
| Indiana | $464.84 | $3,642.82 |
| California | $452.64 | $3,197.40 |
| Kansas | $451.44 | $2,359.85 |
| Utah | $426.21 | $2,242.45 |
| Mississippi | $421.70 | $1,660.00 |
| Louisiana | $416.26 | $2,278.77 |
| Tennessee | $411.77 | $1,544.17 |
| Maryland | $411.46 | $1,834.75 |
| Pennsylvania | $404.14 | $1,862.50 |
| New York | $402.45 | $2,728.17 |
| Texas | $398.92 | $2,864.59 |
| Florida | $397.37 | $2,127.07 |
| Iowa | $397.33 | $1,874.32 |
| North Carolina | $395.30 | $1,904.18 |
| Illinois | $391.73 | $2,039.26 |
| Nebraska | $391.39 | $1,943.11 |
| Washington | $389.53 | $1,605.87 |
| Arizona | $383.20 | $1,983.12 |
| New Hampshire | $381.30 | $2,300.11 |
| Alabama | $380.63 | $1,369.36 |
| Georgia | $377.49 | $2,134.54 |
| Minnesota | $374.27 | $2,553.66 |
| Delaware | $363.09 | $1,301.05 |
| Montana | $361.45 | $882.28 |
| Michigan | $361.23 | $1,343.64 |
| Virginia | $351.09 | $1,514.99 |
| Kentucky | $347.70 | $1,318.50 |
| South Dakota | $347.47 | $1,888.47 |
| Ohio | $347.36 | $1,466.85 |
| District of Columbia | $347.18 | $1,274.72 |
| Wisconsin | $342.21 | $2,672.88 |
| Massachusetts | $339.97 | $1,601.23 |
| Oklahoma | $339.31 | $1,230.97 |
| New Mexico | $335.42 | $1,428.19 |
| Missouri | $333.53 | $1,665.14 |
| Maine | $324.79 | $1,299.67 |
| South Carolina | $320.15 | $1,992.66 |
| Connecticut | $308.14 | $1,567.61 |
| Nevada | $306.66 | $1,809.29 |
| Idaho | $282.31 | $984.88 |
| West Virginia | $280.53 | $1,366.34 |
What the Data Says About Removal Of Growth And Tissue Of Breast, Duct, Or Nipple
Across 47 states with reporting providers, CPT code 19120 (Removal Of Growth And Tissue Of Breast, Duct, Or Nipple) shows a national average Medicare payment of $401.73 against an average billed charge of $2,158.62. That gap, a 5.4x markup, or 437% above the Medicare allowed amount, is narrower than most procedures in our dataset, suggesting providers price this code closer to what payers actually reimburse.
Skin/Integumentary Surgery procedures like this one saw 6.6K services billed to Medicare in 2023 by 3.7K distinct providers, serving 5.9K unique beneficiaries. State-level variation is significant: West Virginia reports the lowest average payment at $280.53, while Alaska reports the highest at $641.71. A 129% spread this wide is typically a GPCI story: practice-expense and malpractice-premium components of the fee formula diverge sharply by locality even though the procedure code never changes.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Skin/Integumentary Surgery category (2.24x), the estimated commercial insurance price lands near $1,140.34, with self-pay cash discounts commonly bringing the figure closer to $975.43. Within Skin/Integumentary Surgery, Removal Of Growth And Tissue Of Breast, Duct, Or Nipple ranks #104 of 395 tracked procedures by national average Medicare payment.
What to do with this
If you may have removal of growth and tissue of breast, duct, or nipple done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare removal of growth and tissue of breast, duct, or nipple costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Removal Of Growth And Tissue Of Breast, Duct, Or Nipple cost?
Removal Of Growth And Tissue Of Breast, Duct, Or Nipple (CPT 19120) shows unusually wide state-to-state pricing: Medicare pays $401.73 on average nationally, but the $280.53-$641.71 range across states spans more than double from cheapest to priciest.
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 Removal Of Growth And Tissue Of Breast, Duct, Or Nipple cost with insurance?
With commercial insurance, removal of growth and tissue of breast, duct, or nipple costs an estimated $1,140.34 on average (range: $798.24-$1,596.48), a moderate premium over Medicare's $401.73. Without insurance, the estimated cash price is $975.43.
Which state has the lowest cost for Removal Of Growth And Tissue Of Breast, Duct, Or Nipple?
West Virginia has by far the lowest average Medicare payment for Removal Of Growth And Tissue Of Breast, Duct, Or Nipple at $280.53, while Alaska pays more than double at $641.71 - a $361.18 gap.
How many providers perform Removal Of Growth And Tissue Of Breast, Duct, Or Nipple?
A moderate provider base performs Removal Of Growth And Tissue Of Breast, Duct, Or Nipple: 3.7K providers nationally, totaling 6.6K Medicare-billed services (5.9K beneficiaries) across 47 states in 2023.
What is the billed-to-Medicare markup for Removal Of Growth And Tissue Of Breast, Duct, Or Nipple?
Providers bill 5.4x what Medicare pays for Removal Of Growth And Tissue Of Breast, Duct, Or Nipple - a below-median markup at 437% above the Medicare rate.
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
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.