CMS Price Transparency Data

Breast lump removal

Facility: Temple University Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,198
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Temple University Hospital is $4,198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.05x the Medicare baseline. Located in 3401 North Broad Street, Philadelphia, PA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,198

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%)

Insurance Median: $4,198 (105%)

Ins. Median: $4,198 (105% 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
Amerihealth Caritas	$242	6%
Pennsylvania Health And Wellness	$386 - $4,527	10%
Upmc Health Plan	$588 - $4,404	15%
Blue Cross Blue Shield	$651 - $13,113	16%
UnitedHealthcare	$1,476 - $6,368	37%
Health Partners Plans	$1,670 - $4,198	42%
Keystone First	$2,634 - $4,321	66%
Aetna	$3,748 - $4,445	94%
Humana	$4,115	103%
Innovage	$4,198	105%
Cigna	$4,321 - $5,429	108%
Clover Health	$4,362	109%
Geisinger	$4,527 - $5,397	113%
Elder Health	$4,939	123%
Gateway Health Plan	$5,144	129%
Wtc Health Program	$5,144	129%
Naphcare	$6,173	154%
Oscar Health	$6,173	154%
Prime Health Services	$6,551	164%
Occunet	$6,790	170%

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 $X.
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 Temple University Hospital 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.