CMS Price Transparency Data

Breast lump removal

Facility: Artesia General Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,391
Cash Discount Price: $920
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Artesia General Hospital is $1,391. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $920. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.35x the Medicare baseline. Located in 702 N 13Th Street, Artesia, NM.

Cash / Self-Pay

$920

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,391

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: $920 (23%)

Insurance Median: $1,391 (35%)

Cash: $920 (23% of Medicare)

Ins. Median: $1,391 (35% 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
Zelis	$415 - $4,453	10%
First Health	$587 - $4,775	15%
Blue Cross Blue Shield	$912 - $3,710	23%
Geha	$1,064 - $3,710	27%
Omni Networks	$1,064 - $1,082	27%
Three Rivers Provider Network	$1,140 - $1,160	28%
Cigna	$1,292 - $1,391	32%
Galaxy Health	$1,368 - $1,391	34%
One Health Plan	$1,368 - $1,391	34%
Multiplan	$1,383 - $1,407	35%
United Payors & United Providers	$1,413 - $1,438	35%
Providence Risk & Insurance Services	$1,444 - $7,421	36%
Molina Healthcare Of New Mexico	$2,023 - $6,234	51%
Presbyterian Health Plan	$2,023 - $3,710	51%
UnitedHealthcare	$2,023 - $3,710	51%
Triwest	$3,636	91%
Humana	$3,710 - $4,082	93%
Vistacare Hospice	$3,710	93%
New Mexico Health Connections	$6,308	158%

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 $920.
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 Artesia General 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.