CMS Price Transparency Data

Breast lump removal

Facility: Bertrand Chaffee Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $488
Cash Discount Price: $512
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Bertrand Chaffee Hospital is $488. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $512. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.12x the Medicare baseline. Located in 224 East Main Street, Springville, NY.

Cash / Self-Pay

$512

Average discount available for prompt cash payment at this facility.

Insurance Median

$488

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: $512 (13%)

Insurance Median: $488 (12%)

Cash: $512 (13% of Medicare)

Ins. Median: $488 (12% 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
Medicare (plans)	$391 - $488	10%
Tricare	$391 - $488	10%
Iha Encompass 65	$393	10%
Blue Cross Blue Shield	$481 - $2,202	12%
Advantra-Mcr Advantage	$488	12%
Aetna	$488 - $603	12%
Centers Plan Hlty Living	$488	12%
Champva	$488	12%
Cigna	$488 - $603	12%
Ctrs Plan For Hlthy Livng	$488	12%
Geisinger Health Plan	$488	12%
Humana	$488	12%
Lifetime Benefits	$488	12%
Mutual Of Omaha	$488	12%
Optimum Healthcare - Mcr	$488	12%
Todays Option - Amer Prog	$488	12%
United Hc Mcr Solutions	$488	12%
UnitedHealthcare	$488	12%
Wellcare	$488	12%
Private Pay	$512	13%
American Progressive Ins.	$603	15%
Commercial / Misc	$603	15%
Global Excel Mgt	$603	15%
Guardian Life Ins. Co.	$603	15%
Mvp Commercial	$603	15%
No Amer Meritian Health	$603	15%
No-Fault	$603	15%
Nova Healthcare	$603	15%
Univera Healthcare	$988	25%
Univera Senior Choice	$988	25%
Senior Blue - Bc	$1,608	40%

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 $512.
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 Bertrand Chaffee 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.