CMS Price Transparency Data

Breast lump removal

Facility: Novant Health Presbyterian Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,752
Cash Discount Price: $3,832
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Novant Health Presbyterian Medical Center is $4,752. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,832. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.19x the Medicare baseline. Located in 200 Hawthorne Lane Box 33549, Charlotte, NC.

Cash / Self-Pay

$3,832

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,752

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: $3,832 (96%)

Insurance Median: $4,752 (119%)

Cash: $3,832 (96% of Medicare)

Ins. Median: $4,752 (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
Carolina Complete	$1,335	33%
Nc Department Of Public Safety	$1,335 - $7,610	33%
Amerihealth	$1,362	34%
Blue Cross Blue Shield	$1,362 - $5,518	34%
UnitedHealthcare	$1,362 - $4,476	34%
Wellcare	$1,362	34%
Caresource North Carolina	$2,529	63%
Atlantic Corporation Dba Atlantic Packaging	$3,525	88%
Humana	$3,805 - $5,518	95%
Pace Of The Southern Piedmont	$3,805	95%
Aetna	$3,900 - $6,131	97%
Cigna	$3,919 - $3,947	98%
Liberty Health	$3,995	100%
Amps	$4,215	105%
Plotkin Health	$4,598	115%
Medcost	$5,441 - $5,748	136%
Primary Physician Care	$5,671	142%
Multiplan	$5,748	144%
Phcs	$5,748	144%
Employers Choice Network	$7,434	186%
Three Rivers Provider Network	$7,434	186%

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 $3,832.
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 Novant Health Presbyterian 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.