CMS Price Transparency Data

Breast lump removal

Facility: Medstar Health Physical Therapy

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,169
Cash Discount Price: $3,428
vs. Medicare Baseline: 1.04x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Medstar Health Physical Therapy is $4,169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,428. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.04x the Medicare baseline. Located in 102 Irving St Nw, Washington, DC.

Cash / Self-Pay

$3,428

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,169

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: $3,428 (86%)

Insurance Median: $4,169 (104%)

Cash: $3,428 (86% of Medicare)

Ins. Median: $4,169 (104% 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
Kaiser Permanente	$2,513 - $4,307	63%
Carefirst Blue Choice Inc	$2,584 - $3,375	65%
Jhhc	$3,428	86%
Pfc	$3,428	86%
UnitedHealthcare	$3,586 - $4,219	90%
Aetna	$3,692 - $4,225	92%
Medstar Family Choice Inc	$3,744	94%
Carefirst Advantage Inc	$4,102	103%
Kaiser	$4,124	103%
Tricare	$4,169	104%
Health Care Service Corporation	$4,307	108%
Humana	$4,307	108%
Cigna	$4,483	112%
First Health	$4,483	112%
Private Healthcare Systems (Phcs)	$4,483	112%

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 $3,428.
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 Medstar Health Physical Therapy 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.