CMS Price Transparency Data

Breast lump removal

Facility: OHSU Hospital and Clinics

Billing Code: 19120 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$4,483

about 1.1× the $4,000 Medicare rate · typically $3,510–$8,702

modeled estimate · not a bill or quote

What this hospital charges insurers

$4,661

About the fair price

about $178 over the fair price · 1.2× Medicare

Medicare pays $4,000 Fair price $4,483 This hospital $4,661 Cash price $13,093 Hospital's list price $20,143

How we calculate the fair BaseRate →

How this hospital compares to other OR hospitals

Highest price of the 9 OR hospitals we have prices for — worth calling around.

Cheapest $492 Priciest $4,661

Black dot = this hospital, among the 9 OR hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $4,483 (about 1.1× the $4,000 Medicare rate). OHSU Hospital and Clinics charges insurers about $4,661, or about $13,093 in cash — about the fair price. Located in Portland, OR.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

6 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana✓ Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$4,661 - $17,919	117%
Blue Cross Blue Shieldmajor	$8,633 - $15,539	216%
Aetnamajor	$4,748 - $20,201	119%
Cignamajor	$13,151 - $23,671	329%
Humanamajor	$4,397 - $4,661	110%
Kaiser Permanentemajor	$3,517 - $10,222	88%
Health Net	$3,517 - $20,058	88%
Moda Health	$4,617 - $15,966	115%
Molina	$14,388 - $25,898	360%
Providence Health Plan	$5,276 - $22,014	132%
+ 7 smaller / regional plans	$2,462 - $20,149

Government programs also on file: Medicare.

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 13,093), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm OHSU Hospital and Clinics is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at OHSU Hospital and Clinics

Compare: Breast lump removal at other OR hospitals

Insurance negotiated median for the same procedure, sorted lowest first.