CMS Price Transparency Data

Breast lump removal

Facility: Cleveland Clinic Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,386
Cash Discount Price: $3,880
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cleveland Clinic Hospital is $1,386. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,880. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.35x the Medicare baseline. Located in 3100 Weston Rd, Weston, FL.

Cash / Self-Pay

$3,880

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,386

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: $3,880 (97%)

Insurance Median: $1,386 (35%)

Cash: $3,880 (97% of Medicare)

Ins. Median: $1,386 (35% 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	$358 - $8,689	9%
UnitedHealthcare	$383	10%
Medicaid / KanCare	$403	10%
United	$403 - $3,844	10%
Avmed	$449 - $8,303	11%
Doctors Health Plan	$449 - $3,844	11%
Wellcare	$449 - $3,844	11%
Independent Living Systems	$471 - $4,036	12%
Clear Spring Health	$485 - $546	12%
Cigna	$532 - $2,736	13%
Aetna	$556 - $6,482	14%
Maritime	$1,066 - $4,904	27%
Multiplan	$1,066 - $8,336	27%
Clarity Health	$1,386 - $6,375	35%
The Legacy Companies	$1,386 - $6,375	35%
Consociate Health	$1,599	40%
Humana	$3,844	96%
Devoted Health	$4,228	106%
Bmi	$5,394	135%

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 $3,880.
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 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.