CMS Price Transparency Data

Breast lump removal

Facility: Uva Health Culpeper Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,240
Cash Discount Price: $10,613
vs. Medicare Baseline: 1.06x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Uva Health Culpeper Medical Center is $4,240. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,613. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.06x the Medicare baseline. Located in 501 Sunset Lane, Culpeper, VA.

Cash / Self-Pay

$10,613

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,240

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: $10,613 (265%)

Insurance Median: $4,240 (106%)

Cash: $10,613 (265% of Medicare)

Ins. Median: $4,240 (106% 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
Champva [50002]	$416	10%
Tricare	$416	10%
Aetna	$1,244 - $4,091	31%
Cigna	$2,430 - $10,951	61%
Multiplan Generic [40035]	$2,591	65%
Vhn Generic [40040]	$2,591	65%
Kaiser Permenente [40014]	$3,068	77%
Carefirst [30007]	$3,859 - $4,369	96%
UnitedHealthcare	$3,914 - $13,659	98%
Blue Cross Blue Shield	$4,051 - $11,731	101%
Medicare (plans)	$4,051	101%
VA Ccn [99926]	$4,051	101%
VA Ccn [99927]	$4,051	101%
Veterans Administration [99910]	$4,051	101%
Humana	$4,132	103%
Geha [40009]	$4,349 - $10,648	109%

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 $10,613.
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 Uva Health Culpeper 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.