CMS Price Transparency Data

Breast lump removal

Facility: Jefferson Healthcare

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,404
Cash Discount Price: $5,334
vs. Medicare Baseline: 0.85x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Jefferson Healthcare is $3,404. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,334. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.85x the Medicare baseline. Located in 834 Sheridan Street, Port Townsend, WA.

Cash / Self-Pay

$5,334

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,404

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: $5,334 (133%)

Insurance Median: $3,404 (85%)

Cash: $5,334 (133% of Medicare)

Ins. Median: $3,404 (85% 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
Chpw Mcaid	$252 - $3,404	6%
Molina Mcaid	$252 - $3,478	6%
Amerigroup Mcaid-All Plans	$325 - $3,579	8%
Tricare	$408 - $3,813	10%
Chpw Mcr Adv	$440 - $4,118	11%
Aetna	$469 - $9,806	12%
Medicare (plans)	$469 - $3,890	12%
Molina Mcr Adv	$469 - $3,813	12%
Molina Marketplace-All Other Plans	$509 - $4,767	13%
Chpw Commercial-All Other Plans	$611 - $9,261	15%
Coord Care Comm/Exchge-All Other Plans	$652 - $9,806	16%
Regence-All Other Plans	$1,281 - $8,171	32%
Premera-All Plans	$1,452 - $9,261	36%
Cigna	$1,537 - $9,806	38%
Coord Care Mcaid Ip/Op Only	$2,232 - $3,647	56%
UnitedHealthcare	$3,734 - $6,101	93%
Coord Care Cascade Ip/Op Only	$6,001 - $9,806	150%

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 $5,334.
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 Jefferson Healthcare 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.