CMS Price Transparency Data
Breast lump removal
Facility: Physicians Care Surgical Hospital
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $7,644
- Cash Discount Price: $6,550
- vs. Medicare Baseline: 1.91x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Physicians Care Surgical Hospital is $7,644. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,550. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.91x the Medicare baseline. Located in 454 Enterprise Drive, Royersford, PA.
Cash / Self-Pay
$6,550
Average discount available for prompt cash payment at this facility.
Insurance Median
$7,644
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: $6,550 (164%)
Insurance Median: $7,644 (191%)
Cash: $6,550 (164% of Medicare)
Ins. Median: $7,644 (191% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| PA Health and Wellness | $900 - $2,850 | 22% |
| Straight Access | $900 - $2,850 | 22% |
| Medicaid / KanCare | $900 - $2,850 | 22% |
| Keystone First Healthplan | $900 - $2,850 | 22% |
| Keystone First Vip Choice | $900 - $2,850 | 22% |
| Keystone First | $900 - $2,850 | 22% |
| Humana | $977 - $12,772 | 24% |
| Tricare | $977 - $12,772 | 24% |
| UPMC | $2,971 - $19,295 | 74% |
| Connecticare | $3,097 - $19,575 | 77% |
| Cwi Benefits | $3,183 - $18,977 | 80% |
| Cigna | $3,183 - $18,977 | 80% |
| Freedom Life Insurance Company | $3,183 - $18,977 | 80% |
| Healthgram | $3,183 - $18,977 | 80% |
| Nalc Health | $3,183 - $18,977 | 80% |
| Apwu | $3,183 - $18,977 | 80% |
| Sana Benefits | $3,183 - $18,977 | 80% |
| Loomis | $3,183 - $18,977 | 80% |
| Health Partners | $3,183 - $18,977 | 80% |
| Central PA Teamsters | $3,512 - $21,231 | 88% |
| Aarp | $3,603 - $12,772 | 90% |
| Shenandoah Life | $3,603 - $12,772 | 90% |
| Vibra Health Plan | $3,603 - $12,772 | 90% |
| Unified Health Services | $3,603 - $12,772 | 90% |
| Aetna | $3,603 - $23,230 | 90% |
| Blue Cross Blue Shield | $3,603 - $23,941 | 90% |
| Medicare (plans) | $3,603 - $12,772 | 90% |
| UnitedHealthcare | $3,603 - $27,099 | 90% |
| Personal Choice 65 | $3,603 - $12,363 | 90% |
| Keystone 65 HMO | $3,603 - $12,772 | 90% |
| Devon Health Services | $3,603 - $12,772 | 90% |
| Gpm Health and Life Insurance Mc Supplement | $3,603 - $12,772 | 90% |
| Pcsh Aarp | $3,603 - $12,772 | 90% |
| Ibc Security 65 | $3,603 - $12,363 | 90% |
| Allied Benefits Systems | $3,618 - $23,230 | 90% |
| Premier Care Network | $3,618 - $23,230 | 90% |
| Continental Benefits | $3,618 - $23,230 | 90% |
| Coventry | $3,618 - $23,230 | 90% |
| Lucent Health | $3,618 - $23,230 | 90% |
| Marpai Health | $3,618 - $23,230 | 90% |
| Geha | $3,618 - $23,230 | 90% |
| Meritain Health | $3,618 - $23,230 | 90% |
| Allied Benefit Systems | $3,618 - $23,230 | 90% |
| Ag Administrators Inc | $3,618 - $23,230 | 90% |
| Healthez | $3,618 - $23,230 | 90% |
| Trustmark | $3,618 - $23,230 | 90% |
| Ag Administrators | $3,618 - $23,230 | 90% |
| Independence Federal | $3,891 - $18,753 | 97% |
| Ibc - Local | $3,891 - $18,753 | 97% |
| Amerihealth New Jersey HMO | $3,891 - $18,753 | 97% |
| Independence Bc | $3,891 - $18,753 | 97% |
| Ibc 2021 | $3,891 - $18,753 | 97% |
| Keystone Direct POS | $3,891 - $18,753 | 97% |
| Keystone Healthplan East | $3,891 - $18,753 | 97% |
| Carefirst Administrators | $3,891 - $18,753 | 97% |
| Keystone HMO | $3,891 - $18,753 | 97% |
| Personal Choice | $3,891 - $18,753 | 97% |
| Ibc | $3,891 - $18,753 | 97% |
| Amerihealth Administrators | $3,891 - $18,753 | 97% |
| Independence Administrators | $3,891 - $18,753 | 97% |
| Regence Blue Shield | $3,891 - $18,753 | 97% |
| Pcsh Ibc | $3,891 - $18,753 | 97% |
| Empire Plan | $3,891 - $18,753 | 97% |
| Horizon of New Jersey | $3,891 - $18,753 | 97% |
| Ibc Local | $3,891 - $18,753 | 97% |
| Highmark | $6,723 - $23,941 | 168% |
| Golden Rule Op | $7,644 - $27,099 | 191% |
| Surest | $7,644 - $27,099 | 191% |
| Allsavers | $7,644 - $27,099 | 191% |
| Oxford Life Insurance Company | $7,644 - $27,099 | 191% |
| Oxford Health Plan | $7,644 - $27,099 | 191% |