CMS Price Transparency Data
Breast lump removal
Facility: Hospital of Univ of Pennsylvania
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $1,858
- Cash Discount Price: $2,322
- vs. Medicare Baseline: 0.46x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Hospital of Univ of Pennsylvania is $1,858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,322. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.46x the Medicare baseline. Located in 3400 Spruce St, Philadelphia, PA.
Cash / Self-Pay
$2,322
Average discount available for prompt cash payment at this facility.
Insurance Median
$1,858
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: $2,322 (58%)
Insurance Median: $1,858 (46%)
Cash: $2,322 (58% of Medicare)
Ins. Median: $1,858 (46% 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.
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 |
|---|---|---|
| Medicaid / KanCare | $173 - $2,322 | 4% |
| Pa Medical Assistance | $173 - $2,322 | 4% |
| Kaiser Permanente | $182 - $4,115 | 5% |
| Keystone Mercy Health Plan | $221 - $2,322 | 6% |
| Upmc | $294 - $4,115 | 7% |
| Horizon Nj Health | $392 - $408 | 10% |
| Preferred Health Care Eliance | $511 | 13% |
| Aetna | $527 - $4,362 | 13% |
| Pgm - Regie De L'Assurance Maladie Quebec | $534 | 13% |
| Blue Cross Blue Shield | $627 - $4,115 | 16% |
| Cigna | $804 - $5,138 | 20% |
| Pgm - Kuwait Defense | $813 - $1,045 | 20% |
| Qualcare | $882 | 22% |
| Olympus | $913 | 23% |
| Coventry | $929 - $1,184 | 23% |
| Pgm - Chop | $929 | 23% |
| Wissahickon Hospice | $929 | 23% |
| UnitedHealthcare | $938 - $4,362 | 23% |
| Healthamerica/Coventry | $1,045 - $1,138 | 26% |
| First Health Global | $1,161 | 29% |
| Ibc Commercial Hpn | $1,263 | 32% |
| Keystone Hmo Proactive | $1,295 | 32% |
| Health Net | $1,393 | 35% |
| Pgm - Royal Embassy Of Saudi Arabia | $1,393 | 35% |
| Paired Kidney Exchange | $1,416 | 35% |
| Pgm - Embassy Of Qatar | $1,509 | 38% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $1,509 | 38% |
| Interlink | $1,556 | 39% |
| Pgm - Embassy Of The United Emirates/Ipc | $1,625 | 41% |
| Health America/Ccn | $1,858 | 46% |
| Humana | $1,858 - $4,239 | 46% |
| Intergroup | $1,858 | 46% |
| Pgm - Kuwait Health Division | $1,858 | 46% |
| Pgm - Kuwait Oil | $1,858 | 46% |
| Preferred Care | $1,858 | 46% |
| Gspp And Wissahickon Hospice | $2,058 | 51% |
| Blue Quality Centers For Transplant (Bqct) | $2,322 | 58% |
| City Of Philadelphia Behavioral Health | $2,322 | 58% |
| Commercial Other | $2,322 | 58% |
| Health Partners | $2,322 - $4,239 | 58% |
| International Pfs | $2,322 | 58% |
| United Behavioral Health | $2,322 | 58% |
| Workers Compensation | $2,322 | 58% |
| Medicare (plans) | $4,115 - $4,198 | 103% |
| Philadelphia Va Medical Center | $4,115 | 103% |
| Tricare | $4,115 | 103% |
| Ibc | $4,198 | 105% |
| Geisinger Health Plan | $4,239 - $13,052 | 106% |
| Devoted Health | $4,321 | 108% |
| Pa Health And Wellness | $4,321 - $6,790 | 108% |
| Penn Life (Living Independently For Elders) | $4,321 | 108% |
| Clover Health Plan | $4,445 | 111% |
| Keystone First | $4,568 | 114% |
| Us Family Health Plan | $4,733 | 118% |
| Gateway Health Plan | $5,103 | 128% |
| Elap | $5,844 | 146% |
| Claims Watcher | $6,585 - $7,408 | 165% |
| Oscar Health Plan | $6,996 | 175% |
| Centivo | $7,408 | 185% |
| Elap Services | $7,655 | 191% |
| Highmark | $8,654 | 216% |
| Penn Global Medicine | $10,906 | 273% |