CMS Price Transparency Data

Breast lump removal

Facility: St Clair Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $8,534
Cash Discount Price: $2,457
vs. Medicare Baseline: 2.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St Clair Hospital is $8,534. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,457. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.13x the Medicare baseline. Located in 1000 Bower Hill Road, Pittsburgh, PA.

Cash / Self-Pay

$2,457

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,534

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: $2,457 (61%)

Insurance Median: $8,534 (213%)

Cash: $2,457 (61% of Medicare)

Ins. Median: $8,534 (213% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 213% of the Medicare baseline (a markup of 113%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Upmc	$474 - $3,814	12%
Highmark	$3,398 - $8,534	85%
Amerihealth	$3,814	95%
Humana	$3,814	95%
UnitedHealthcare	$3,814 - $12,515	95%
Aetna	$3,928 - $10,221	98%
Geisinger	$3,928	98%
Cigna	$3,966 - $8,751	99%
Pa Health And Wellness	$3,966	99%
Health Partners	$4,004	100%
The Health Plan	$4,004 - $9,153	100%
Lantern	$8,200	205%

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 $2,457.
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 St Clair 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.