CMS Price Transparency Data

Breast lump removal

Facility: Cheshire Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,045
Cash Discount Price: $1,086
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cheshire Medical Center is $2,045. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,086. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.51x the Medicare baseline. Located in 580 Court Street, Keene, NH.

Cash / Self-Pay

$1,086

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,045

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: $1,086 (27%)

Insurance Median: $2,045 (51%)

Cash: $1,086 (27% of Medicare)

Ins. Median: $2,045 (51% 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	$303 - $4,001	8%
Ambetter / Centene	$306 - $3,557	8%
Blue Cross Blue Shield	$306 - $12,986	8%
Cigna	$306 - $6,053	8%
Martin'S Point Generations Advantage	$306 - $4,001	8%
Mvp	$306 - $6,053	8%
UnitedHealthcare	$306 - $6,030	8%
Wellcare Health Plans	$306 - $4,001	8%
Wellsense Health Plan	$306 - $4,281	8%
Martin'S Point Health Care	$307 - $4,001	8%
Amerihealth Caritas Nh	$373 - $513	9%
Granite State Health Plan	$373 - $701	9%
Harvard Pilgrim Health Care Of Ne	$782 - $6,840	20%
Tufts Health Plan	$1,209 - $2,678	30%
Maine Community Health Options	$1,652 - $1,888	41%
Mass General Brigham Health Plan	$2,344 - $4,195	59%
First Health/Hcvm	$3,121 - $3,566	78%
Phcs	$3,305 - $3,776	83%

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 $1,086.
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 Cheshire 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.