CMS Price Transparency Data

Breast lump removal

Facility: Penn State Health St. Joseph

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,540
Cash Discount Price: $6,474
vs. Medicare Baseline: 1.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Penn State Health St. Joseph is $4,540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,474. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.13x the Medicare baseline. Located in 2500 Bernville Road, Reading, PA.

Cash / Self-Pay

$6,474

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,540

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: $6,474 (162%)

Insurance Median: $4,540 (113%)

Cash: $6,474 (162% of Medicare)

Ins. Median: $4,540 (113% 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]	$3,385 - $3,982	85%
[Highmark Wholecare]	$3,385 - $3,982	85%
[Geisinger]	$3,584 - $17,956	90%
[Health Partners Plans]	$3,703 - $4,062	93%
[Pa Health & Wellness]	$3,723 - $4,102	93%
[Highmark]	$3,942 - $21,644	99%
UnitedHealthcare	$3,982 - $16,851	100%
[Cbc]	$3,982 - $13,157	100%
[Ibc]	$3,982 - $12,370	100%
Aetna	$4,022 - $12,713	101%
Humana	$4,022	101%
[Healthspring]	$4,022	101%
[Upmc]	$4,062 - $18,389	102%
[Point Comfort Underwriters]	$4,978	124%
Cigna	$15,270	382%
[Highmark Choice Blue]	$17,315	433%
[Highmark Aca]	$18,181	454%
[Preferred Healthcare Systems]	$18,668	467%
[First Health]	$19,912	498%
[Multiplan]	$19,912	498%

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 $6,474.
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 Penn State Health St. Joseph 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.