CMS Price Transparency Data

Breast lump removal

Facility: Pullman Regional Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $617
Cash Discount Price: $1,035
vs. Medicare Baseline: 0.15x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Pullman Regional Hospital is $617. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,035. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.15x the Medicare baseline. Located in 835 S Bishop Blvd, Pullman, WA.

Cash / Self-Pay

$1,035

Average discount available for prompt cash payment at this facility.

Insurance Median

$617

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: $1,035 (26%)

Insurance Median: $617 (15%)

Cash: $1,035 (26% of Medicare)

Ins. Median: $617 (15% 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
Molina Hlthcare Mcaid-All Plans	$244	6%
Wellcare Mcaid -All Other Plans	$244	6%
Wellpoint Mcaid - All Plans	$244	6%
Community Health Plan Mcaid-All Plans	$306	8%
Medicaid / KanCare	$306	8%
Community Care Ntwrk Mcare-All Plans	$408	10%
Kaiser Mcare Advan	$408	10%
Sterling Mcr Adv-All Plans	$408	10%
Triwest - All Plans	$408	10%
Wellcare Mcr Adv	$444	11%
Blue Cross Blue Shield	$469 - $685	12%
Humana	$469	12%
Idaho Dshs-All Plans	$499	12%
Aetna	$533	13%
Premera First - All Plans	$563	14%
First Choice - All Other Plans	$671	17%
First Choice Admin	$671	17%
Kaiser - All Other Plans	$771	19%
Admin Wsu Student-All Plans	$1,035	26%
Multiplan - All Plans	$1,035	26%
Asuris Nw Hlth-All Plans	$1,096	27%
Cigna	$1,096	27%
Focus Hlthcare - All Plans	$1,096	27%
Northwest One - All Plans	$1,096	27%
UnitedHealthcare	$1,096	27%
Great West Hlth-All Plans	$1,157	29%
Integrated Hp - All Plans	$1,157	29%
Spokane Phco - All Plans	$1,157	29%
Provider Network Of America-All Plans	$1,194	30%

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 $1,035.
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 Pullman Regional 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.