CMS Price Transparency Data

Breast lump removal

Facility: Cleveland Clinic Indian River Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $649
Cash Discount Price: $1,386
vs. Medicare Baseline: 0.16x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cleveland Clinic Indian River Hospital is $649. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,386. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.16x the Medicare baseline. Located in 1000 36Th St, Vero Beach, FL.

Cash / Self-Pay

$1,386

Average discount available for prompt cash payment at this facility.

Insurance Median

$649

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: $1,386 (35%)

Insurance Median: $649 (16%)

Cash: $1,386 (35% of Medicare)

Ins. Median: $649 (16% 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
Blue Cross Blue Shield	$383 - $3,844	10%
UnitedHealthcare	$383	10%
Amerihealth	$403	10%
Medicaid / KanCare	$403	10%
Molina	$403	10%
Value Options	$403 - $449	10%
Wellcare	$403 - $3,844	10%
Avmed	$449 - $8,802	11%
Careplus	$449 - $3,844	11%
Magellan	$449	11%
United	$449 - $6,534	11%
Freedom Health	$471 - $3,844	12%
Independent Living Systems	$471 - $4,036	12%
Wellmed	$471 - $3,844	12%
Clear Spring Health	$485	12%
Cigna	$532 - $682	13%
Aetna	$538 - $7,079	13%
Clarity Health	$1,386	35%
The Legacy Companies	$1,386	35%
National Provider Network	$1,492	37%
Three Rivers	$1,492	37%
Consociate Health	$1,599	40%
Carelon Bh Strategies	$3,844	96%
Humana	$3,844	96%
Devoted Health	$4,228	106%

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 $1,386.
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 Cleveland Clinic Indian River 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.