CMS Price Transparency Data

Breast lump removal

Facility: Spanish Peaks Regional Health Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $773
Cash Discount Price: $773
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Spanish Peaks Regional Health Center is $773. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $773. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.19x the Medicare baseline. Located in 23500 Us Highway 160, Walsenburg, CO.

Cash / Self-Pay

$773

Average discount available for prompt cash payment at this facility.

Insurance Median

$773

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: $773 (19%)

Insurance Median: $773 (19%)

Cash: $773 (19% of Medicare)

Ins. Median: $773 (19% 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
Humana	$300	7%
Medicare (plans)	$300	7%
Devoted Health Mcr - All Plans	$315	8%
Blue Cross Blue Shield	$421 - $773	11%
UnitedHealthcare	$421 - $799	11%
Apostrophe - All Plans	$773	19%
Cigna	$773	19%
Friday Hp Chp - All Plans	$773	19%
Kaiser Ppo - All Other Plans	$773	19%
Prov Ntwrk Of America - All Plans	$773	19%
Cofinity - All Plans	$790	20%
Connect For Health - All Plans	$799	20%
Rmhp - All Plans	$799	20%
Multiplan Phcs - All Plans	$816	20%
Kaiser Ppo Mcr	$859	21%
Beacon Health Op Only-All Plans	$2,020	50%

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 $773.
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 Spanish Peaks Regional Health Center 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.