CMS Price Transparency Data

Breast lump removal

Facility: Valley Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $7,917
  • Cash Discount Price: $9,862
  • vs. Medicare Baseline: 1.98x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Valley Medical Center is $7,917. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9,862. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.98x the Medicare baseline. Located in 400 S 43Rd St, Renton, WA.
Cash / Self-Pay
$9,862

Average discount available for prompt cash payment at this facility.

Insurance Median
$7,917

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: $9,862 (247%)
Insurance Median: $7,917 (198%)
Cash: $9,862 (247% of Medicare)
Ins. Median: $7,917 (198% 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.

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
Great West [190102] $905 23%
Christian Brother Employee Benefit Trust [110100] $1,075 27%
Pacificsource [130122] $1,075 27%
Soundpath Health-Termed [210113] $3,101 78%
Benefit Md [150113] $7,917 198%
Carpenters Trust [150122] $7,917 198%
Cement Masons And Plasterers [150127] $7,917 198%
Coresource [150109] $7,917 198%
Employee Benefit Management Services [150108] $7,917 198%
Fc Moda Health [150139] $7,917 198%
First Choice Health Administrators [150110] $7,917 198%
First Choice Health Comp [150112] $7,917 198%
First Choice [150134] $7,917 198%
Health Net [150111] $7,917 198%
Here [150114] $7,917 198%
Hotel Employees Health Trust [150115] $7,917 198%
International Longshore & Warehouse Union [150116] $7,917 198%
Kitsap Physician Services [150118] $7,917 198%
Loomis Benefits West [150119] $7,917 198%
Mega [150120] $7,917 198%
Midwest [150121] $7,917 198%
Nw Administrators [150123] $7,917 198%
Operating Engineers [150125] $7,917 198%
Painters Trust [150126] $7,917 198%
Puget Sound Electric [150131] $7,917 198%
Seattle Plumb And Pipe [150132] $7,917 198%
Trusteed Plan [150101] $7,917 198%
United Employee Benefit Trust [150137] $7,917 198%
UnitedHealthcare $7,917 198%
Washington Bakers Trust [150102] $7,917 198%
Washington Employers Trust [150103] $7,917 198%
Washington State Health Ins Pool [150104] $7,917 198%
Welfare Pension Administration Services [150105] $7,917 198%
Zenith Admin [150106] $7,917 198%
Zzjohn Alden [150117] $7,917 198%
Zzprincipal Financial Group [150128] $7,917 198%
Zzprovidence [150129] $7,917 198%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 400 S 43Rd St, Renton, WA 98055
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals