CMS Price Transparency Data

Breast lump removal

Facility: Cambridge Health Alliance

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,204
Cash Discount Price: $3,839
vs. Medicare Baseline: 0.55x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cambridge Health Alliance is $2,204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,839. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.55x the Medicare baseline. Located in 1493 Cambridge Street, Cambridge, MA.

Cash / Self-Pay

$3,839

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,204

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: $3,839 (96%)

Insurance Median: $2,204 (55%)

Cash: $3,839 (96% of Medicare)

Ins. Median: $2,204 (55% 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
Blue Cross Blue Shield	$260 - $6,573	6%
United Behavioral Health [40003]	$260	6%
United Behaviorial Health [40094]	$260	6%
Mass Bh Partnership [70098]	$318	8%
Wc [90001]	$922	23%
Mass General Brigham [50021]	$1,402	35%
Wellpoint [50012]	$1,433	36%
Multiplan [50010]	$1,499	37%
Aetna	$1,917 - $2,204	48%
Other Tufts Health Public Plan [75002]	$2,181	55%
Altus Dental [99011]	$2,204	55%
Beacon Health Strategies [50002]	$2,204	55%
Cbhc Uninsured Crisis Alt Payer [70097]	$2,204	55%
Cbhc Uninsured Crisis [70096]	$2,204	55%
Celticare [50004]	$2,204	55%
Cigna	$2,204	55%
Commonwealth Care Alliance Dental [99004]	$2,204	55%
Coverage Discovery [90004]	$2,204	55%
Delta Dental Of Ma [99007]	$2,204	55%
Dominion National Dental [99012]	$2,204	55%
Dph Tb Payor [85004]	$2,204	55%
Esp Dental [99003]	$2,204	55%
Eyemed Alt Payor [13001]	$2,204	55%
First Health [50007]	$2,204	55%
Global Medical Management [50024]	$2,204	55%
Government Employee Health Association [50023]	$2,204	55%
Guardian Dental [99013]	$2,204	55%
Health Safety Net Dental [99002]	$2,204	55%
Humana	$2,204	55%
Ma Laborers Health And Welfare Fund [50022]	$2,204	55%
Magellan Health Services [65098]	$2,204	55%
Mass Health Dental [99001]	$2,204	55%
Medical Mutual Of Ohio [50019]	$2,204	55%
Medicare (plans)	$2,204	55%
Metlife Dental [99008]	$2,204	55%
Modern Assistance Program [30098]	$2,204	55%
Mva [90002]	$2,204	55%
Neighborhood Health Plan [50011]	$2,204	55%
Other Bh Payor [50014]	$2,204	55%
Other Commercial Payor [50015]	$2,204	55%
Other Dental Payor [99014]	$2,204	55%
Other Dual Eligible Payer [65004]	$2,204	55%
Other Gov'T Alt [85006]	$2,204	55%
Other Vision Payor [50013]	$2,204	55%
Ri Neighborhood Health Plan [50017]	$2,204	55%
Tricare	$2,204	55%

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 $3,839.
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 Cambridge Health Alliance 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.