CMS Price Transparency Data

Breast lump removal

Facility: Capital Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,929
Cash Discount Price: $5,539
vs. Medicare Baseline: 1.73x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Capital Medical Center is $6,929. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,539. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.73x the Medicare baseline. Located in 3900 Capital Mall Dr Sw, Olympia, WA.

Cash / Self-Pay

$5,539

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,929

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: $5,539 (138%)

Insurance Median: $6,929 (173%)

Cash: $5,539 (138% of Medicare)

Ins. Median: $6,929 (173% 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
Community Health Plan Of Washington	$1,045 - $7,018	26%
Coordinated Care	$1,064	27%
Molina	$1,064 - $7,700	27%
UnitedHealthcare	$1,064 - $19,172	27%
Wellpoint	$1,548	39%
Regence	$4,204	105%
Aetna	$4,287 - $12,432	107%
Wellcare	$4,370	109%
Pacificsource	$4,846 - $6,993	121%
First Choice	$5,726 - $9,089	143%
Premera	$6,038 - $10,017	151%
Cigna	$6,866	172%
Ambetter / Centene	$7,700	192%
Multiplan/Phcs	$10,108 - $11,078	253%
First Health	$11,770	294%
Kaiser	$12,595	315%

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 $5,539.
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 Capital Medical Center 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.