CMS Price Transparency Data

Breast lump removal

Facility: Holyoke Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,094
Cash Discount Price: $3,738
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Holyoke Medical Center is $4,094. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,738. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.02x the Medicare baseline. Located in 575 Beech Street, Holyoke, MA.

Cash / Self-Pay

$3,738

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,094

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: $3,738 (93%)

Insurance Median: $4,094 (102%)

Cash: $3,738 (93% of Medicare)

Ins. Median: $4,094 (102% 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
Bmchp	$1,645	41%
Fallon	$1,645 - $4,503	41%
Health New England	$1,645 - $4,094	41%
Tufts Health Public Plans	$1,844 - $4,912	46%
Wellsense Direct Metals Silver	$2,057	51%
Harvard Pilgrim	$3,852	96%
UnitedHealthcare	$3,852 - $4,298	96%
Blue Cross Blue Shield	$4,087 - $4,541	102%
Aetna	$4,094	102%
Tufts Health Plan	$4,094 - $6,137	102%
Commonwealth Care Alliance	$4,298	107%
Wellsense Sco	$4,339	108%
Wellcare	$4,379	109%
Cigna	$4,639	116%
Senior Whole Health	$4,708	118%

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 $3,738.
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 Holyoke 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.