CMS Price Transparency Data

Breast lump removal

Facility: Multicare Valley Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $5,481
  • Cash Discount Price: $5,534
  • vs. Medicare Baseline: 1.37x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Multicare Valley Hospital is $5,481. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,534. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.37x the Medicare baseline. Located in 12606 East Mission Avenue, Spokane Valley, WA.
Cash / Self-Pay
$5,534

Average discount available for prompt cash payment at this facility.

Insurance Median
$5,481

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: $5,534 (138%)
Insurance Median: $5,481 (137%)
Cash: $5,534 (138% of Medicare)
Ins. Median: $5,481 (137% 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
Molina $949 - $7,869 24%
Coordinated Care $958 24%
Wellpoint $958 24%
UnitedHealthcare $977 - $11,418 24%
Community Health Plan Of Washington $1,005 - $6,750 25%
Pacificsource $3,706 - $4,393 93%
Blue Cross Blue Shield $4,004 100%
Aetna $4,124 - $14,313 103%
Regence $4,124 103%
Wellcare $4,204 105%
First Choice $5,304 - $9,643 133%
Cigna $5,481 137%
Premera $5,697 - $10,086 142%
Ambetter / Centene $7,407 185%
Regence/Asuris $8,397 210%
First Health $9,961 249%
Multiplan/Phcs $9,961 249%
Kaiser $12,595 315%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 12606 East Mission Avenue, Spokane Valley, WA 99216
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals