CMS Price Transparency Data

Breast lump removal

Facility: North Carolina Baptist Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,775
Cash Discount Price: $2,470
vs. Medicare Baseline: 0.44x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at North Carolina Baptist Hospital is $1,775. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,470. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.44x the Medicare baseline. Located in Medical Center Boulevard, Winston-Salem, NC.

Cash / Self-Pay

$2,470

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,775

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: $2,470 (62%)

Insurance Median: $1,775 (44%)

Cash: $2,470 (62% of Medicare)

Ins. Median: $1,775 (44% 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	$810 - $3,707	20%
Medcost	$952 - $3,373	24%
Amerihealth	$1,086 - $1,367	27%
Carolina Complete	$1,086 - $1,146	27%
Health Blue	$1,086 - $1,146	27%
Partners	$1,086 - $1,146	27%
Vaya	$1,097 - $1,158	27%
UnitedHealthcare	$1,100 - $4,925	27%
Wellcare	$1,100 - $3,707	27%
Alliance	$1,108 - $1,169	28%
Trillium	$1,119 - $1,181	28%
Aetna	$1,139 - $4,311	28%
Ambetter / Centene	$1,298 - $1,369	32%
Oscar	$1,442 - $1,826	36%
Cigna	$1,471 - $3,707	37%
Humana	$2,629 - $3,744	66%
Directnet	$2,841 - $2,998	71%
Cone Health	$3,365 - $3,550	84%
Healthgram	$3,365 - $3,550	84%
Apex	$3,707	93%
Devoted	$3,707	93%
Healthteam	$3,707	93%
Medicare (plans)	$3,744	94%
First Carolina Care	$3,846 - $4,058	96%
Private Healthcare Systems	$3,942 - $4,159	99%
Liberty	$4,263	107%
Multiplan	$4,326 - $4,565	108%

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 $2,470.
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 North Carolina Baptist 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.