CMS Price Transparency Data

Breast lump removal

Facility: Jefferson Einstein Philadelphia Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,138
Cash Discount Price: $3,356
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Jefferson Einstein Philadelphia Hospital is $4,138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,356. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.03x the Medicare baseline. Located in 5501 Old York Road, Philadelphia, PA.

Cash / Self-Pay

$3,356

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,138

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: $3,356 (84%)

Insurance Median: $4,138 (103%)

Cash: $3,356 (84% of Medicare)

Ins. Median: $4,138 (103% 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
Geisinger	$1,050 - $15,910	26%
Upmc	$2,734 - $4,099	68%
Ibc	$3,468 - $11,372	87%
Humana	$3,904	98%
United	$3,982 - $4,789	100%
Cigna	$4,060 - $6,865	101%
Highmark	$4,099	102%
Advantra	$4,138	103%
Aetna	$4,138 - $4,734	103%
Wellcare	$4,295	107%

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 $3,356.
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 Jefferson Einstein Philadelphia 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.