CMS Price Transparency Data

Breast lump removal

Facility: St. Vincent's East

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,760
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St. Vincent's East is $3,760. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.94x the Medicare baseline. Located in 50 Medical Park East Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,760

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%)

Insurance Median: $3,760 (94%)

Ins. Median: $3,760 (94% 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
Ambetter / Centene	$366 - $4,924	9%
Viva	$496 - $3,581	12%
Aetna	$972 - $3,920	24%
Behavioral Health Systems	$2,744	69%
UnitedHealthcare	$3,214 - $3,760	80%
Blue Cross Blue Shield	$3,438	86%
Cooper Green	$3,581	90%
Humana	$3,617 - $4,939	90%
Cigna	$3,689	92%
Prime Health Services	$3,760 - $6,597	94%
Seven Corners	$4,835	121%
Construction Claims Management	$5,664	142%
Corvel	$5,664	142%
Alamed	$5,997	150%
Multiplan	$6,271	157%
Pnoa	$6,271	157%

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 $X.
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 St. Vincent's East 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.