CMS Price Transparency Data

Breast lump removal

Facility: Methodist Hospitals of Memphis

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,506
Cash Discount Price: $4,804
vs. Medicare Baseline: 0.88x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Methodist Hospitals of Memphis is $3,506. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,804. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.88x the Medicare baseline. Located in 1265 Union Ave Suite 700, Memphis, TN.

Cash / Self-Pay

$4,804

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,506

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: $4,804 (120%)

Insurance Median: $3,506 (88%)

Cash: $4,804 (120% of Medicare)

Ins. Median: $3,506 (88% 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
Medicaid / KanCare	$297 - $4,236	7%
UnitedHealthcare	$1,072 - $5,540	27%
Blue Cross Blue Shield	$1,074 - $3,506	27%
Cigna	$1,872 - $7,320	47%
Molina Healthcare [350012]	$2,824 - $5,295	71%
Tricare	$3,410	85%
American Health Advantage Mcr Adv [450117]	$3,506	88%
Carecentrix [450200]	$3,506	88%
Generic Hospice Vbid [10940000101]	$3,506	88%
Humana	$3,506	88%
Medicare (plans)	$3,506	88%
Va Hospital [600005]	$3,506	88%
Devoted Health [450111]	$3,612	90%
Langston Performance Health [100405]	$4,283 - $6,424	107%
Select Specialty Hospital [100298]	$4,558	114%
United Food & Commercial Workers [100309]	$7,320	183%

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 $4,804.
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 Methodist Hospitals of Memphis 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.