CMS Price Transparency Data

Breast lump removal

Facility: Duke University Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $925
Cash Discount Price: $829
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Duke University Hospital is $925. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $829. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.23x the Medicare baseline. Located in 2301 Erwin Rd, Durham, NC.

Cash / Self-Pay

$829

Average discount available for prompt cash payment at this facility.

Insurance Median

$925

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: $829 (21%)

Insurance Median: $925 (23%)

Cash: $829 (21% of Medicare)

Ins. Median: $925 (23% 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	$364 - $2,037	9%
Blue Cross Blue Shield	$377 - $1,860	9%
UnitedHealthcare	$377 - $3,183	9%
Humana	$386 - $3,131	10%
Amerihealth	$395 - $925	10%
Carolina Complete Health	$395 - $925	10%
Trillium	$395 - $925	10%
Alliance Health	$439 - $925	11%
Partners	$439 - $925	11%
Cigna	$904 - $3,804	23%
Medcost	$1,068 - $1,569	27%
Sentara	$1,530 - $2,295	38%
Troy Health	$3,730	93%
Voans	$3,730	93%
Liberty	$3,804	95%

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 $829.
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 Duke University 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.