CMS Price Transparency Data

Breast lump removal

Facility: Medstar Health Physical Therapy

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,219

about 0.3× the $4,000 Medicare rate · typically $611–$3,400

modeled estimate · not a bill or quote

What this hospital charges insurers

$4,205

Well above the fair price

about $2,986 over the fair price · 1.1× Medicare

Medicare pays $4,000 Fair price $1,219 This hospital $4,205 Cash price $3,428 Hospital's list price $5,274

How we calculate the fair BaseRate →

How this hospital compares to other DC hospitals

Lowest price of the 3 DC hospitals we have prices for — a strong deal.

Cheapest $4,205 Priciest $4,718

Black dot = this hospital, among the 3 DC hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $1,219 (about 0.3× the $4,000 Medicare rate). Medstar Health Physical Therapy charges insurers about $4,205, or about $3,428 in cash — well above the fair price. Located in Washington, DC.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $1,219. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$3,586 - $4,219	90%
Blue Cross Blue Shieldmajor	$2,584 - $4,102	65%
Aetnamajor	$3,692 - $4,225	92%
Cignamajor	$4,483	112%
Humanamajor	$4,307	108%
Kaiser Permanentemajor	$2,513 - $4,307	63%
+ 2 smaller / regional plans	$3,744 - $4,307

Government programs also on file: Military & VA.

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,428), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Medstar Health Physical Therapy is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Medstar Health Physical Therapy

Compare: Breast lump removal at other DC hospitals

Insurance negotiated median for the same procedure, sorted lowest first.