CMS Price Transparency Data

Breast lump removal

Facility: Penn State Health Lancaster Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,938
Cash Discount Price: $7,216
vs. Medicare Baseline: 0.98x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Penn State Health Lancaster Medical Center is $3,938. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,216. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.98x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$7,216

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,938

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: $7,216 (180%)

Insurance Median: $3,938 (98%)

Cash: $7,216 (180% of Medicare)

Ins. Median: $3,938 (98% 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
[Amerihealth Caritas]	$3,266 - $3,842	82%
[Highmark Wholecare]	$3,266 - $3,842	82%
[Geisinger]	$3,458 - $16,587	86%
[Health Partners Plans]	$3,573 - $3,919	89%
[Pa Health & Wellness]	$3,592 - $3,957	90%
[Highmark]	$3,804 - $16,791	95%
UnitedHealthcare	$3,842 - $15,581	96%
[Cbc]	$3,842 - $12,525	96%
Aetna	$3,880 - $14,956	97%
Humana	$3,880	97%
[Healthspring]	$3,880	97%
[Upmc]	$3,919 - $18,389	98%
[Point Comfort Underwriters]	$4,803	120%
[Highmark Choice Blue]	$13,433	336%
[Highmark Aca]	$14,105	353%
Cigna	$15,270	382%
[First Health]	$19,912	498%
[Multiplan]	$19,912	498%

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 $7,216.
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 Penn State Health Lancaster Medical Center 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.