CMS Price Transparency Data

Breast lump removal

Facility: Magee Womens Hospital of UPMC Health System

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,274
Cash Discount Price: $4,093
vs. Medicare Baseline: 0.82x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Magee Womens Hospital of UPMC Health System is $3,274. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,093. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.82x the Medicare baseline. Located in 300 Halket Street, Pittsburgh, PA.

Cash / Self-Pay

$4,093

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,274

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: $4,093 (102%)

Insurance Median: $3,274 (82%)

Cash: $4,093 (102% of Medicare)

Ins. Median: $3,274 (82% 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
UnitedHealthcare	$190 - $3,943	5%
Upmc Health Plan	$190 - $3,745	5%
Aetna	$225 - $4,016	6%
Highmark Wholecare (Prev Gateway)	$257 - $3,942	6%
Geisinger	$269	7%
Amerihealth Caritas	$274 - $3,943	7%
Pa Health & Wellness	$295	7%
Upmc Work Partners	$698	17%
Blue Cross Blue Shield	$845 - $4,910	21%
Cigna	$2,729 - $3,616	68%
Intergroup	$3,411	85%
Coventry/First Health	$4,775	119%
Preferred Healthcare System	$5,458	136%
Humana	$5,799	145%
Private Health Care Systems	$5,799	145%
Multiplan	$6,276	157%

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 $4,093.
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 Magee Womens Hospital of UPMC Health System 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.