CMS Price Transparency Data

Breast lump removal

Facility: Westfield Memorial Hospital Inc

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $510
Cash Discount Price: $260
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Westfield Memorial Hospital Inc is $510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.13x the Medicare baseline. Located in 189 E Main St, Westfield, NY.

Cash / Self-Pay

$260

Average discount available for prompt cash payment at this facility.

Insurance Median

$510

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: $260 (6%)

Insurance Median: $510 (13%)

Cash: $260 (6% of Medicare)

Ins. Median: $510 (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
Univera	$64 - $448	2%
Amerihealth	$182 - $4,758	5%
Pennsylvania Health And Wellness	$228 - $1,250	6%
Geisinger	$251 - $1,333	6%
UnitedHealthcare	$251 - $4,894	6%
Jefferson Health Plans	$265 - $1,274	7%
Highmark	$367 - $7,514	9%
Life Pittsburgh	$394 - $4,531	10%
Medicare (plans)	$418 - $4,667	10%
American Health Plans	$434 - $4,531	11%
Cigna	$668	17%
Martin'S Point	$1,222 - $4,531	31%
Aetna	$4,713 - $8,700	118%
Humana	$4,803	120%
Molina	$4,939	123%

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 $260.
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 Westfield Memorial Hospital Inc 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.