CMS Price Transparency Data

Breast lump removal

Facility: Island Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $941
Cash Discount Price: $1,141
vs. Medicare Baseline: 0.24x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Island Hospital is $941. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,141. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.24x the Medicare baseline. Located in 1211 24Th Street, Anacortes, WA.

Cash / Self-Pay

$1,141

Average discount available for prompt cash payment at this facility.

Insurance Median

$941

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: $1,141 (29%)

Insurance Median: $941 (24%)

Cash: $1,141 (29% of Medicare)

Ins. Median: $941 (24% 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
Kaiser Comm - All Other Plans	$389 - $750	10%
UnitedHealthcare	$504 - $5,550	13%
Premera Comm - All Other Plans	$548 - $4,324	14%
Cigna	$555 - $5,223	14%
First Choice - All Plans	$570 - $5,550	14%
First Health - All Plans	$590 - $5,550	15%
Regence Comm - All Other Plans	$595 - $4,897	15%
Aetna	$679 - $6,203	17%
Aarp Mcr Adv - All Plans	$694 - $2,350	17%
Chpw Mcaid - All Plans	$694 - $2,514	17%
Coordinated Care Mcaid - All Plans	$694 - $2,628	17%
Humana	$694 - $5,550	17%
Kaiser Mcr Adv	$694 - $2,350	17%
Molina Mcaid - All Plans	$694 - $2,285	17%
Samish Indian Health - All Plans	$694 - $2,350	17%
Swinomish Indian Health - All Plans	$694 - $2,350	17%
Tricare	$694 - $2,350	17%
Premera Mcr Adv	$729 - $1,407	18%
Amerigroup Mcaid - All Plans	$736 - $1,420	18%
Regence Mcr Adv	$736 - $2,491	18%
Multiplan - All Plans	$5,550	139%

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 $1,141.
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 Island Hospital 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.