CMS Price Transparency Data
Breast lump removal
Facility: Pennsylvania Hospital
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $2,703
- Cash Discount Price: $4,718
- vs. Medicare Baseline: 0.68x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Pennsylvania Hospital is $2,703. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,718. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.68x the Medicare baseline. Located in 800 Spruce Street, Philadelphia, PA.
Cash / Self-Pay
$4,718
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,703
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: $4,718 (118%)
Insurance Median: $2,703 (68%)
Cash: $4,718 (118% of Medicare)
Ins. Median: $2,703 (68% 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 |
|---|---|---|
| Gateway Health Plan | $173 - $5,078 | 4% |
| Medicaid / KanCare | $173 - $7,114 | 4% |
| Pa Medical Assistance | $173 - $833 | 4% |
| Keystone Mercy Health Plan | $221 | 6% |
| Upmc | $294 - $7,114 | 7% |
| Horizon Nj Health | $392 - $1,251 | 10% |
| UnitedHealthcare | $476 - $7,114 | 12% |
| Pgm - Regie De L'Assurance Maladie Quebec | $534 - $1,636 | 13% |
| Preferred Health Care Eliance | $604 - $1,850 | 15% |
| Blue Cross Blue Shield | $627 - $24,258 | 16% |
| Aetna | $646 - $7,114 | 16% |
| Cigna | $786 - $5,138 | 20% |
| Pgm - Kuwait Defense | $813 - $3,201 | 20% |
| Devon | $882 - $3,201 | 22% |
| Qualcare | $882 - $2,703 | 22% |
| Coventry | $929 - $3,628 | 23% |
| Pgm - Chop | $929 - $2,846 | 23% |
| Wissahickon Hospice | $929 - $2,846 | 23% |
| Ibc Commercial Hpn | $935 - $4,038 | 23% |
| Keystone Hmo Proactive | $958 - $4,599 | 24% |
| Healthamerica/Coventry | $1,045 - $3,486 | 26% |
| Olympus | $1,128 - $3,457 | 28% |
| First Health Global | $1,161 - $3,557 | 29% |
| Urn-Cancer Resource Services | $1,161 - $3,557 | 29% |
| Health Net | $1,393 - $4,268 | 35% |
| Pgm - Royal Embassy Of Saudi Arabia | $1,393 - $4,268 | 35% |
| Pgm - Embassy Of Qatar | $1,509 - $4,624 | 38% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $1,509 - $4,624 | 38% |
| Pgm - Embassy Of The United Emirates/Ipc | $1,625 - $4,980 | 41% |
| Devon Health Services Inc | $1,858 - $5,691 | 46% |
| Health America/Ccn | $1,858 - $5,691 | 46% |
| Humana | $1,858 - $5,691 | 46% |
| Intergroup | $1,858 - $5,691 | 46% |
| Pgm - Kuwait Health Division | $1,858 - $5,691 | 46% |
| Pgm - Kuwait Oil | $1,858 - $5,691 | 46% |
| Preferred Care | $1,858 - $5,691 | 46% |
| Commercial Other | $2,322 - $7,114 | 58% |
| Community Behavioral Health | $2,322 - $7,114 | 58% |
| Health Partners | $2,322 - $7,114 | 58% |
| International Pfs | $2,322 - $7,114 | 58% |
| Quest Behavioral Health | $2,322 - $7,114 | 58% |
| United Behavioral Health | $2,322 - $7,114 | 58% |
| Workers Compensation | $2,322 - $7,114 | 58% |
| Medicare (plans) | $4,095 - $4,177 | 102% |
| Philadelphia Va Medical Center | $4,095 | 102% |
| Tricare | $4,115 | 103% |
| Ibc | $4,177 | 104% |
| Geisinger Health Plan | $4,218 - $12,988 | 105% |
| Pa Health And Wellness | $4,300 - $6,757 | 107% |
| Penn Life (Living Independently For Elders) | $4,300 | 107% |
| Clover Health Plan | $4,423 | 111% |
| Keystone First | $4,546 | 114% |
| Us Family Health Plan | $4,733 | 118% |
| Elap | $5,815 | 145% |
| Claims Watcher | $6,552 - $7,372 | 164% |
| Oscar Health Plan | $6,962 | 174% |
| Centivo | $7,372 | 184% |
| Elap Services | $7,617 | 190% |
| Highmark | $8,612 | 215% |
| Penn Global Medicine | $10,853 | 271% |