CMS Price Transparency Data

Breast lump removal

Facility: Univ. of Vermont - Fletcher Allen Health Care

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,880
Cash Discount Price: $3,971
vs. Medicare Baseline: 0.47x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Univ. of Vermont - Fletcher Allen Health Care is $1,880. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,971. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.47x the Medicare baseline. Located in 111 Colchester Ave, Burlington, VT.

Cash / Self-Pay

$3,971

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,880

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: $3,971 (99%)

Insurance Median: $1,880 (47%)

Cash: $3,971 (99% of Medicare)

Ins. Median: $1,880 (47% 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
Mvp	$330 - $3,956	8%
UnitedHealthcare	$339 - $3,909	8%
Blue Cross Blue Shield	$361 - $3,936	9%
Aetna	$389 - $3,859	10%
Humana	$389 - $3,859	10%
St. Regis	$389 - $3,859	10%
Veterans Affairs Community Care Network	$389 - $3,859	10%
Fidelis Care	$447 - $4,245	11%
Capital District Physicians' Health Plan	$486 - $3,859	12%
Martins Point	$486 - $3,956	12%
Wellpath	$544 - $5,789	14%
Ebpa	$1,633 - $3,415	41%
Harvard Pilgrim	$1,697 - $3,177	42%
Magnacare	$1,697 - $3,177	42%
Coventry	$1,803 - $3,375	45%
Cigna	$1,855 - $3,872	46%
Nppn	$1,909 - $3,574	48%

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 $3,971.
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 Univ. of Vermont - Fletcher Allen Health Care 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.