CMS Price Transparency Data

Breast lump removal

Facility: The University of Vermont Health Network - Champl

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $626
Cash Discount Price: $1,463
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at The University of Vermont Health Network - Champl is $626. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,463. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.16x the Medicare baseline. Located in 75 Beekman Street, Plattsburgh, NY.

Cash / Self-Pay

$1,463

Average discount available for prompt cash payment at this facility.

Insurance Median

$626

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: $1,463 (37%)

Insurance Median: $626 (16%)

Cash: $1,463 (37% of Medicare)

Ins. Median: $626 (16% 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
Mvp	$333 - $4,679	8%
UnitedHealthcare	$339 - $4,679	8%
Blue Cross Blue Shield	$361 - $22,219	9%
Aetna	$391 - $4,679	10%
Fidelis Care	$391 - $4,679	10%
Humana	$391 - $4,445	10%
Veterans Affairs Community Care Network	$391 - $4,679	10%
Capital District Physicians' Health Plan	$484 - $4,679	12%
Martins Point	$484 - $5,011	12%
Highmark Blueshield	$544 - $3,443	14%
Wellpath	$548 - $7,018	14%
Harvard Pilgrim	$1,170	29%
Magnacare	$1,170	29%
St. Regis	$1,170 - $4,679	29%
Coventry	$1,317	33%
Multiplan	$1,390	35%

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 $1,463.
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 The University of Vermont Health Network - Champl 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.