CMS Price Transparency Data

Breast lump removal

Facility: Kaleida Health

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,839
Cash Discount Price: $1,586
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Kaleida Health is $4,839. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,586. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.21x the Medicare baseline. Located in 100 High Street, Buffalo, NY.

Cash / Self-Pay

$1,586

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,839

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: $1,586 (40%)

Insurance Median: $4,839 (121%)

Cash: $1,586 (40% of Medicare)

Ins. Median: $4,839 (121% 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
Ghi/Emblem Health	$469 - $6,598	12%
Ghi/Emblem Health - Wchob	$469 - $587	12%
Aetna	$489 - $5,181	12%
Magnacare	$489 - $3,420	12%
Magnacare - Wchob	$489 - $3,420	12%
Univera	$665 - $6,811	17%
Univera - Wchob	$665 - $6,624	17%
Independent Health Association	$2,844 - $7,735	71%
Independent Health Association - Wchob	$2,950 - $7,925	74%
Blue Cross Blue Shield	$3,333 - $18,238	83%
Tricare	$4,643	116%
Wellcare	$5,083	127%
Fidelis	$5,279	132%
UnitedHealthcare	$5,303	133%
Cigna	$5,718 - $6,940	143%

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 $1,586.
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 Kaleida Health 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.