CMS Price Transparency Data

Breast lump removal

Facility: Central Vermont Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,169
Cash Discount Price: $2,938
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Central Vermont Medical Center is $1,169. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,938. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.29x the Medicare baseline. Located in Box 547, Barre, VT.

Cash / Self-Pay

$2,938

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,169

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: $2,938 (73%)

Insurance Median: $1,169 (29%)

Cash: $2,938 (73% of Medicare)

Ins. Median: $1,169 (29% 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
Humana	$381 - $3,643	10%
Aetna	$389 - $3,794	10%
Coventry	$389	10%
Veterans Affairs Community Care Network	$389 - $3,794	10%
Blue Cross Blue Shield	$397 - $5,453	10%
Mvp	$397 - $3,589	10%
Martins Point	$486 - $3,794	12%
UnitedHealthcare	$486 - $3,794	12%
Capital District Physicians' Health Plan	$788	20%
Cigna	$1,126	28%
Wellpath	$1,616	40%
Harvard Pilgrim	$2,350	59%

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 $2,938.
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 Central Vermont 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.