CMS Price Transparency Data

Breast lump removal

Facility: Adventist Health Tillamook

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,613
Cash Discount Price: $1,069
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Adventist Health Tillamook is $1,613. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,069. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.40x the Medicare baseline. Located in 1000 Third Street, Tillamook, OR.

Cash / Self-Pay

$1,069

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,613

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: $1,069 (27%)

Insurance Median: $1,613 (40%)

Cash: $1,069 (27% of Medicare)

Ins. Median: $1,613 (40% 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
Blue Cross Blue Shield	$298 - $4,997	7%
Medicare (plans)	$298 - $2,700	7%
Moda Health Plan - All Plans	$298 - $2,700	7%
Hvhs Mcare - All Plans	$301 - $2,727	8%
Sterling Life - All Plans	$310 - $2,808	8%
Devoted Health	$319 - $2,916	8%
Aetna	$393 - $5,342	10%
Pacificsource - All Plans	$714 - $5,514	18%
UnitedHealthcare	$832 - $5,457	21%
Ods Health Plan - All Other Plans	$900 - $5,572	22%
Lifewise - All Plans	$1,163 - $5,181	29%
Ah Employee Health Plan - All Plans	$1,212 - $5,399	30%
First Choice Health- All Plans	$1,212 - $5,399	30%
Health Net - All Plans	$1,212 - $5,399	30%
Providence Preferred - All Plans	$1,263 - $5,629	32%
Cigna	$1,281 - $5,457	32%
Phcs Preferred - All Plans	$1,281 - $5,457	32%
Workers Comp	$1,289 - $5,744	32%

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 $1,069.
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 Adventist Health Tillamook 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.