CMS Price Transparency Data

Breast lump removal

Facility: Teton Valley Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $576
Cash Discount Price: $758
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Teton Valley Hospital is $576. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $758. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 120 East Howard Ave, Driggs, ID.

Cash / Self-Pay

$758

Average discount available for prompt cash payment at this facility.

Insurance Median

$576

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: $758 (19%)

Insurance Median: $576 (14%)

Cash: $758 (19% of Medicare)

Ins. Median: $576 (14% 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	$369	9%
Medicare (plans)	$369	9%
Prime Health Services-All Other Plans	$369	9%
Triwest-All Plans	$369	9%
UnitedHealthcare	$369	9%
Blue Cross Blue Shield	$397 - $947	10%
Town And Country-All Plans	$461	12%
Cigna	$553 - $627	14%
Moda-All Plans	$646	16%
Brightpath-All Plans	$742	19%
Select Health-All Other Plans	$742	19%
Pacific Source-All Plans	$744	19%
First Choice-All Plans	$828	21%
St Lukes Brightpath-All Plans	$1,014	25%

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 $758.
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 Teton Valley Hospital 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.