CMS Price Transparency Data

Breast lump removal

Facility: Erlanger Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $733
Cash Discount Price: $480
vs. Medicare Baseline: 0.18x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Erlanger Medical Center is $733. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $480. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.18x the Medicare baseline. Located in 975 E 3Rd St, Chattanooga, TN.

Cash / Self-Pay

$480

Average discount available for prompt cash payment at this facility.

Insurance Median

$733

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: $480 (12%)

Insurance Median: $733 (18%)

Cash: $480 (12% of Medicare)

Ins. Median: $733 (18% 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
Bluecare	$291 - $3,653	7%
Amerigroup	$306 - $1,113	8%
Caresource	$306 - $7,025	8%
Peach State Hlth Plan	$306	8%
UnitedHealthcare	$343 - $3,950	9%
Blue Cross Blue Shield	$351 - $3,513	9%
Cigna	$389 - $3,513	10%
Humana	$392 - $3,513	10%
Alexian	$537 - $3,513	13%
Clover	$537 - $3,513	13%
Medicare (plans)	$537	13%
Upmc	$537 - $3,513	13%
Aetna	$540 - $3,618	13%
Pruitthealth Premier	$550	14%
American Health	$553 - $3,618	14%
Devoted Health	$559 - $3,653	14%
Nhc	$564 - $3,688	14%
Atrio Health	$591 - $3,864	15%
Simpra Advantage	$591	15%
Bluecard - Network S	$663 - $1,126	17%
Ambetter / Centene	$671 - $4,391	17%
Bluecard - Network P	$702 - $1,126	18%
Caresource Ga	$733 - $1,315	18%
Caresource Tn	$733 - $1,315	18%
Olympus	$806 - $913	20%
Alliant	$859	21%
Pnoa	$865 - $8,782	22%
Caresource Nc	$885 - $1,315	22%
Occunet	$940 - $3,337	23%
Point Comfort Underwriters	$943 - $967	24%
Wellpoint	$3,225	81%

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 $480.
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 Erlanger 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.