CMS Price Transparency Data

Breast lump removal

Facility: OHSU Hospital and Clinics

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $8,299
Cash Discount Price: $13,093
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at OHSU Hospital and Clinics is $8,299. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $13,093. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.07x the Medicare baseline. Located in 3181 Sw Sam Jackson Park Road, Portland, OR.

Cash / Self-Pay

$13,093

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,299

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: $13,093 (327%)

Insurance Median: $8,299 (207%)

Cash: $13,093 (327% of Medicare)

Ins. Median: $8,299 (207% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 207% of the Medicare baseline (a markup of 107%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Community Health Plan Of Washington	$2,462 - $6,155	62%
Care Oregon	$3,517 - $5,188	88%
Intercommunity Health Network	$3,517	88%
Kaiser Foundation Hospitals	$3,517 - $10,222	88%
Medicare (plans)	$3,517 - $7,035	88%
Pacific Source	$3,517 - $20,149	88%
Humana	$4,397 - $4,661	110%
Trillium	$4,397	110%
Moda	$4,617 - $15,966	115%
UnitedHealthcare	$4,661 - $17,919	117%
Aetna	$4,748 - $20,201	119%
Health Net Health Plan Of Oregon, Inc.	$5,056 - $20,058	126%
Providence Health Plan	$5,276 - $22,014	132%
Samaritan Health Plan	$7,913 - $14,244	198%
Tuality Health	$7,914	198%
Blue Cross Blue Shield	$8,633 - $15,539	216%
Coventry First Health	$10,791 - $19,424	270%
First Choice	$10,902 - $19,623	273%
Cigna	$13,151 - $23,671	329%
Molina Exchange	$14,388 - $25,898	360%

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 $13,093.
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 OHSU Hospital and Clinics 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.