CMS Price Transparency Data

Breast lump removal

Facility: Atrium Health Navicent the Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,261
Cash Discount Price: $5,135
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Atrium Health Navicent the Medical Center is $3,261. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,135. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.82x the Medicare baseline. Located in 777 Hemlock Street, Macon, GA.

Cash / Self-Pay

$5,135

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,261

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: $5,135 (128%)

Insurance Median: $3,261 (82%)

Cash: $5,135 (128% of Medicare)

Ins. Median: $3,261 (82% 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	$398 - $3,731	10%
Blue Cross Blue Shield	$398 - $3,731	10%
Georgia Health Advantage	$398 - $3,731	10%
Humana	$398 - $4,453	10%
UnitedHealthcare	$398 - $5,936	10%
Care Source	$406 - $3,806	10%
Clover	$406 - $3,806	10%
Eon Health	$406 - $3,806	10%
Pruitt Health	$418 - $3,731	10%
Alliant	$478 - $4,477	12%
Ambetter / Centene	$538 - $5,238	13%
Cigna	$747 - $3,157	19%
Securehealth	$879 - $3,594	22%
Kaiser	$1,000 - $2,707	25%
Multiplan	$6,676 - $8,216	167%
Ibg	$7,261	182%
Novanet	$8,216	205%
Three Rivers Provider Network	$8,730	218%
Beechstreet	$9,551	239%

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 $5,135.
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 Atrium Health Navicent the Medical 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.