CMS Price Transparency Data

Breast lump removal

Facility: South Peninsula Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,977
Cash Discount Price: $2,481
vs. Medicare Baseline: 0.74x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at South Peninsula Hospital is $2,977. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,481. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.74x the Medicare baseline. Located in 4300 Bartlett St, Homer, AK.

Cash / Self-Pay

$2,481

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,977

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$4,000.24

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $4,000.24 (100%)

Cash / Self-Pay: $2,481 (62%)

Insurance Median: $2,977 (74%)

Cash: $2,481 (62% of Medicare)

Ins. Median: $2,977 (74% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $4,000.24 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Liberty Healthshare - All Plans	$740	18%
UnitedHealthcare	$1,233	31%
Premera First - All Plans	$1,800	45%
Blue Cross Blue Shield	$2,082	52%
Aetna	$2,811	70%
Geha - All Plans	$2,977	74%
Meritain - All Plans	$2,977	74%
Teamsters Emply - All Plans	$2,977	74%
Ufcw - All Plans	$2,977	74%
Cigna	$3,142	79%
Great West - All Plans	$3,142	79%
Moda - All Plans	$3,142	79%
Multiplan Phcs - All Plans	$3,142	79%
Pmcs - All Plans	$3,142	79%
First Choice Health - All Plans	$3,241	81%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $2,481.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 19120.

Insurance In-Network Protection Plan

Contact your insurance company to confirm South Peninsula Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 19120.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.