CMS Price Transparency Data

Breast lump removal

Facility: The East Alabama Healthcare Authority

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,020
Cash Discount Price: $3,741
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at The East Alabama Healthcare Authority is $1,020. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,741. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.25x the Medicare baseline. Located in 2000 Pepperell Parkway, Opelika, AL.

Cash / Self-Pay

$3,741

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,020

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: $3,741 (94%)

Insurance Median: $1,020 (25%)

Cash: $3,741 (94% of Medicare)

Ins. Median: $1,020 (25% 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
Aetna	$263 - $7,253	7%
Blue Cross Blue Shield	$263 - $3,470	7%
Cigna	$263 - $6,828	7%
Humana	$263 - $6,757	7%
Simpra	$263 - $3,470	7%
Viva	$263 - $8,623	7%
Novanet	$1,020	25%
Beechstreet	$3,200 - $5,782	80%
Alabama Crime Victims	$3,401	85%
Mcm Maxcare	$5,442	136%
Mega Life	$5,442	136%
UnitedHealthcare	$5,442	136%
Coventry First Health	$5,782	145%
Geha	$5,782	145%
Multiplan	$5,782	145%
Workers Comp	$5,782	145%
Trpn	$6,122	153%

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 $3,741.
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 The East Alabama Healthcare Authority 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.