CMS Price Transparency Data

Breast lump removal

Facility: Forks Community Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,214
Cash Discount Price: $4,816
vs. Medicare Baseline: 0.80x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Forks Community Hospital is $3,214. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,816. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.80x the Medicare baseline. Located in 530 Bogachiel Way, Forks, WA.

Cash / Self-Pay

$4,816

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,214

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: $4,816 (120%)

Insurance Median: $3,214 (80%)

Cash: $4,816 (120% of Medicare)

Ins. Median: $3,214 (80% 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
Medicare (plans)	$318	8%
Medicaid / KanCare	$1,694 - $2,618	42%
Coordinated Care (Mco) Mcd-All Plans	$1,829 - $2,668	46%
UnitedHealthcare	$2,180 - $6,072	54%
Community Health Network Mcr-All Other Plans	$2,204 - $3,214	55%
Humana	$2,204 - $3,214	55%
Tricare	$2,204 - $3,214	55%
Triwest-All Plans	$2,204 - $3,214	55%
Ambetter / Centene	$2,557 - $3,729	64%
Wellcare Med Adv - All Plans	$2,557 - $3,729	64%
Regence-All Other Plans	$2,820 - $4,113	70%
Community Health Exchange	$3,184 - $4,643	80%
Molina Commercial-All Other Plans	$4,506 - $6,572	113%
Blue Cross Blue Shield	$4,653 - $6,786	116%
Aetna	$4,898 - $7,143	122%
Cigna	$4,898 - $7,143	122%
First Choice-All Plans	$4,898 - $7,143	122%

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 $4,816.
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 Forks Community 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.