CMS Price Transparency Data

Breast lump removal

Facility: SSM Health St Anthony Hospital - Oklahoma City

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,310
Cash Discount Price: $6,175
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at SSM Health St Anthony Hospital - Oklahoma City is $4,310. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,175. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.08x the Medicare baseline. Located in 1000 North Lee Avenue, Oklahoma City, OK.

Cash / Self-Pay

$6,175

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,310

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: $6,175 (154%)

Insurance Median: $4,310 (108%)

Cash: $6,175 (154% of Medicare)

Ins. Median: $4,310 (108% 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
Medica	$635 - $3,066	16%
Phcs	$1,459	36%
Cigna	$2,891	72%
Blue Cross Blue Shield	$3,766 - $3,879	94%
UnitedHealthcare	$3,821 - $4,233	96%
Humana	$3,830	96%
Oscar	$4,387 - $4,954	110%
Ambetter / Centene	$5,084	127%
Healthchoice	$6,893	172%
Community Care	$6,967 - $9,414	174%
Kempton	$7,343	184%
Global Health	$8,059 - $8,247	201%

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 $6,175.
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 SSM Health St Anthony Hospital - Oklahoma City 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.