CMS Price Transparency Data

Breast lump removal

Facility: Prosser Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $474
Cash Discount Price: $807
vs. Medicare Baseline: 0.12x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Prosser Memorial Hospital is $474. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $807. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.12x the Medicare baseline. Located in 723 Memorial Street, Prosser, WA.

Cash / Self-Pay

$807

Average discount available for prompt cash payment at this facility.

Insurance Median

$474

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: $807 (20%)

Insurance Median: $474 (12%)

Cash: $807 (20% of Medicare)

Ins. Median: $474 (12% 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	$239 - $474	6%
Coordinated Care	$239	6%
Kaiser Permanente	$239 - $862	6%
UnitedHealthcare	$239 - $474	6%
Molina	$251 - $474	6%
Amerigroup	$254	6%
Health Alliance Northwest	$474	12%
Humana	$474	12%
Wellcare	$474	12%
Cigna	$491	12%
Aetna	$533 - $559	13%
Premera	$563	14%
Asuris	$595	15%
Health Management Adminstrators	$595	15%
Regence	$595	15%
Ambetter / Centene	$852	21%
Multiplan	$1,248	31%

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 $807.
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 Prosser Memorial 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.