CMS Price Transparency Data

Breast lump removal

Facility: F F Thompson Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $459
Cash Discount Price: $6,230
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at F F Thompson Hospital is $459. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,230. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.11x the Medicare baseline. Located in 350 Parrish Street, Canandaigua, NY.

Cash / Self-Pay

$6,230

Average discount available for prompt cash payment at this facility.

Insurance Median

$459

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: $6,230 (156%)

Insurance Median: $459 (11%)

Cash: $6,230 (156% of Medicare)

Ins. Median: $459 (11% 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
Blue Cross Blue Shield	$153 - $13,544	4%
Medicaid / KanCare	$156 - $521	4%
UnitedHealthcare	$274 - $4,888	7%
Aetna	$333 - $4,888	8%
Excellus 2201	$333 - $809	8%
Medicare (plans)	$333 - $5,376	8%
Mvp 2900	$356 - $10,714	9%
Fidelis 5155	$459 - $670	11%
Cigna	$491 - $11,427	12%
Independent Health 5156	$512 - $745	13%
Capital District Physicians Health Plan (Cdphp) 5149	$1,018 - $1,267	25%
Elderplan 1316	$4,888	122%
Humana	$4,888	122%

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 $6,230.
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 F F Thompson 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.