CMS Price Transparency Data

Breast lump removal

Facility: Sunrise Hospital and Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $521
Cash Discount Price: $1,891
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Sunrise Hospital and Medical Center is $521. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,891. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.13x the Medicare baseline. Located in 3186 S Maryland Pkwy, Las Vegas, NV.

Cash / Self-Pay

$1,891

Average discount available for prompt cash payment at this facility.

Insurance Median

$521

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: $1,891 (47%)

Insurance Median: $521 (13%)

Cash: $1,891 (47% of Medicare)

Ins. Median: $521 (13% 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
Humana	$253 - $3,466	6%
Amerigroup	$255 - $472	6%
Health Plan Nevada	$255 - $496	6%
Molina	$268 - $521	7%
Silver Summit	$268 - $629	7%
Culinary Health Fund	$316 - $755	8%
Community Care Health	$388 - $967	10%
Molina Healthcare	$388 - $1,006	10%
Sierra Hpn	$388 - $967	10%
Healthcare Partners Of Nv	$397 - $671	10%
Aetna	$405 - $2,599	10%
Alignment Health Plan	$405 - $503	10%
Blue Cross Blue Shield	$405 - $4,589	10%
United	$414 - $3,129	10%
Caremore	$426 - $528	11%
Hometown Health Providers	$466 - $2,619	12%
Sierra	$534 - $2,814	13%
Cigna	$538 - $6,461	13%
Multiplan	$538 - $3,500	13%
Select Health	$816 - $5,307	20%
Caresource	$1,006	25%
Legacy Provider Network	$1,491	37%
Corvel	$1,574 - $1,738	39%
Comp-Med Workers Comp	$1,607	40%
Olympus Medsave Usa	$1,657 - $1,830	41%
Ambetter / Centene	$2,626 - $3,076	66%
Health Services Coalition	$4,260	106%

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 $1,891.
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 Sunrise Hospital and 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.