CMS Price Transparency Data

Breast lump removal

Facility: Legacy Meridian Park Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $8,848
Cash Discount Price: $959
vs. Medicare Baseline: 2.21x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Legacy Meridian Park Medical Center is $8,848. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $959. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.21x the Medicare baseline. Located in 19300 Sw 65Th Avenue, Tualatin, OR.

Cash / Self-Pay

$959

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,848

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: $959 (24%)

Insurance Median: $8,848 (221%)

Cash: $959 (24% of Medicare)

Ins. Median: $8,848 (221% 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 221% of the Medicare baseline (a markup of 121%). 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
Kaiser	$4,352 - $8,704	109%
Atrio	$4,483	112%
Aetna	$4,570 - $13,320	114%
Healthnet	$4,613 - $9,105	115%
Careoregon	$4,700	117%
Ageright	$4,787	120%
Moda	$4,874 - $16,832	122%
Blue Cross Blue Shield	$8,539 - $12,516	213%
Cigna	$8,991 - $11,555	225%
First Health	$10,243	256%
UnitedHealthcare	$11,261	282%

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 $959.
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 Legacy Meridian Park Medical Center 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.