CMS Price Transparency Data

Breast lump removal

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,751
Cash Discount Price: $11,542
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at UMass Memorial Healthalliance Hospitals is $4,751. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $11,542. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.19x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$11,542

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,751

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: $11,542 (289%)

Insurance Median: $4,751 (119%)

Cash: $11,542 (289% of Medicare)

Ins. Median: $4,751 (119% 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
Medicaid / KanCare	$167 - $5,243	4%
Hsno/Free Care [10801]	$294	7%
Fallon Connectorcare [10503]	$578	14%
Workers Compensation [20501]	$922	23%
Harvard Pilgrim [10701]	$2,534	63%
Blue Cross Blue Shield	$3,220 - $4,908	80%
UnitedHealthcare	$3,418 - $10,083	85%
Tufts [11201]	$3,597 - $5,630	90%
Cigna	$3,957 - $6,193	99%
Champva [11001]	$4,093	102%
Institution [10406]	$4,692 - $5,344	117%
Medicare (plans)	$4,692 - $4,751	117%
Tufts Dual [10111]	$4,692 - $4,751	117%
Correctional Care [11003]	$4,751	119%
Tufts Us Family [11203]	$4,751	119%
Aetna	$4,927 - $6,594	123%
Commonwealth Care Mcr [10115]	$4,927 - $4,988	123%
Fallon Mcr Supp [20202]	$4,927 - $4,988	123%
Mgb Mcr [10124]	$4,927 - $4,988	123%
Tufts Mcr [10112]	$4,927 - $4,988	123%
Harvard Pilgrim Mcr [10106]	$4,988	125%
Senior Whole Health [10110]	$5,083	127%
Hne [11108]	$5,625	141%
Wellpoint [11112]	$7,425	186%
First Health Network [11120]	$7,562	189%
Multiplan [11109]	$7,562	189%
Tufts Connectorcare [10507]	$7,982 - $8,081	200%
Connecticare [11105]	$10,083	252%
Fallon Carelon Hlth [28]	$10,083	252%
Fallon Mcaid Carelon Hlth [29]	$10,083	252%
Grants [20507]	$10,083	252%

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 $11,542.
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 UMass Memorial Healthalliance Hospitals 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.