Mast mod rad
Modified radical mastectomy billing varies dramatically from $1,132 at Medicare facilities to $6,521 at hospital outpatients, making immediate verification of your specific charges essential before payment.
About the analyst
Kevin Nyk analyzes hospital pricing data at BillRazor Research. He specializes in Medicare reimbursement patterns and chargemaster pricing across U.S. hospitals. Expertise: hospital pricing, Medicare rates, chargemaster analysis.
A modified radical mastectomy removes the entire breast, nearby lymph nodes, and chest muscle lining to treat breast cancer. This procedure is typically performed on patients with invasive breast cancer that has spread to lymph nodes. Code 19307 carries substantial reimbursement variations, with facility charges often reaching 10-15 times the Medicare benchmark depending on the treatment setting.
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Facility rate
$1,132
National Medicare benchmark
Non-facility rate
$99
Office setting benchmark
Data sources
4
24 data points
Key insights for CPT 19307
ASC vs hospital outpatient savings
$3,839Having this done at an ambulatory surgery center costs $2,682 vs $6,521 at a hospital outpatient
Facility vs office setting
$1,033 differenceNon-facility setting is less expensive for this procedure
What this procedure costs across different settings
The same procedure can cost very different amounts depending on where it's performed. These are the Medicare-allowed amounts — what hospitals actually charge can be 3-10x higher.
| Setting | Medicare rate | vs lowest |
|---|---|---|
| Facility (physician office) | $1,132 | +1044% |
| Non-facility (office) | $99 | Lowest |
| Outpatient (APC) | $6,521 | +6487% |
| Ambulatory surgery (ASC) | $2,682 | +2609% |
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About this data
Rates shown are from the 2026 Medicare Physician Fee Schedule, Hospital Outpatient Prospective Payment System (OPPS), Ambulatory Surgery Center Payment System, Clinical Laboratory Fee Schedule, Durable Medical Equipment Fee Schedule, and CMS Inpatient Prospective Payment System (DRG weights). Regional adjustments use CMS Geographic Practice Cost Indices (GPCI). Hospital charges are from CMS Hospital Price Transparency machine-readable files. All data is publicly available under federal law (45 CFR Part 180).
This data is for informational purposes only and does not constitute medical or financial advice. Actual costs depend on insurance coverage, negotiated rates, and individual circumstances.
Data: Medicare Physician Fee Schedule, CMS Inpatient PPS (IPPS), Outpatient PPS (OPPS), ASC Payment System, Clinical Lab Fee Schedule (CLFS), National Average Drug Acquisition Cost (NADAC). FY 2024 data. All publicly available from CMS.
Methodology: Facility rate applies when the procedure is performed in a hospital or ASC. Non-facility rate applies in a physician office. GPCI adjustments reflect regional cost-of-living differences.
This information is for educational purposes only and is not medical, financial, or legal advice. Actual costs depend on your insurance and provider. We recommend verifying costs directly with your provider. Full methodology · Terms of use