CMS Price Transparency Data

Breast lump removal

Facility: Astria Toppenish Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,549
Cash Discount Price: $1,007
vs. Medicare Baseline: 0.39x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Astria Toppenish Hospital is $1,549. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,007. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.39x the Medicare baseline. Located in 502 W Fourth Ave, Toppenish, WA.

Cash / Self-Pay

$1,007

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,549

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: $1,007 (25%)

Insurance Median: $1,549 (39%)

Cash: $1,007 (25% of Medicare)

Ins. Median: $1,549 (39% 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
Medicaid / KanCare	$237 - $6,804	6%
Premera_Affordable_Care	$584	15%
Chpw_Cascade_Care	$976	24%
First_Choice	$1,069	27%
Tpsc	$1,208	30%
Ambetter / Centene	$1,261	32%
UnitedHealthcare	$1,261 - $1,279	32%
Medicare (plans)	$1,279 - $3,888	32%
Molina	$1,286	32%
Aetna	$1,363 - $3,888	34%
Va	$1,421	36%
Bcchp	$1,549	39%
Great_Rivers	$1,549	39%
Healthcomp	$1,549	39%
Humana	$1,549 - $3,888	39%
Washington_State_Hca	$1,549	39%
Molina_Exchange	$1,639	41%
Li	$3,354	84%
Cigna	$3,888	97%
Tricare	$3,888	97%
Zenith	$3,927	98%
Kaiser	$12,828	321%

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 $1,007.
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 Astria Toppenish 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.