CMS Price Transparency Data

Breast lump removal

Facility: Witham Health Services

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,098
Cash Discount Price: $817
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Witham Health Services is $1,098. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $817. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.27x the Medicare baseline. Located in 2605 N Lebanon St, Lebanon, IN.

Cash / Self-Pay

$817

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,098

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: $817 (20%)

Insurance Median: $1,098 (27%)

Cash: $817 (20% of Medicare)

Ins. Median: $1,098 (27% 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	$724 - $4,143	18%
Aetna	$864 - $4,267	22%
UnitedHealthcare	$911	23%
Phcs/Multiplan-All Plans	$1,063	27%
Sagamore-All Plans	$1,074	27%
Humana	$1,086	27%
Beech Street-All Plans	$1,098	27%
Encore-All Plans	$1,109	28%
Mhs Comml Exch-All Plans	$2,919	73%
Mdwise Health In-All Plans	$4,143	104%
Caresource Mcr Adv	$4,225	106%
Caresource Indiana Marketplace-All Other Plans	$7,871	197%

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 $817.
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 Witham Health Services 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.