CMS Price Transparency Data

Breast lump removal

Facility: Jefferson Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $496
Cash Discount Price: $225
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Jefferson Hospital is $496. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $225. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.12x the Medicare baseline. Located in 565 Coal Valley Road, Jefferson Hills, PA.

Cash / Self-Pay

$225

Average discount available for prompt cash payment at this facility.

Insurance Median

$496

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: $225 (6%)

Insurance Median: $496 (12%)

Cash: $225 (6% of Medicare)

Ins. Median: $496 (12% 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
Univera	$64 - $448	2%
Amerihealth	$182 - $3,868	5%
University Of Pittsburgh Medical Center	$199 - $3,684	5%
Aetna	$208 - $8,974	5%
Pennsylvania Health And Wellness	$228 - $1,250	6%
Highmark Wholecare	$239 - $3,905	6%
Geisinger	$251 - $1,333	6%
UnitedHealthcare	$251 - $12,067	6%
Highmark	$367 - $6,050	9%
Life Pittsburgh	$394 - $3,684	10%
Medicare (plans)	$418 - $3,794	10%
American Health Plans	$434 - $3,684	11%
Cigna	$668 - $9,061	17%
Martin'S Point	$1,222 - $3,684	31%
Humana	$3,905	98%
Molina	$4,015	100%
Medical Mutual	$9,061	227%

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 $225.
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 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.