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CMS Price Transparency Data Hospital file updated: 2026-03-25

Breast lump removal

Facility: Indiana University Health Paoli Hospital

Billing Code: 19120 (CPT)

Pillar 1 · The BaseRate™ CompositeHow 1.00× Fair BaseRate Works: Raw price averages unfairly penalize hospitals in high-wage cities or trauma centers treating sicker patients. We adjust for local CMS hospital wage levels and patient complexity first. A 1.00× score means right at the fair price average, 0.85× means 15% cheaper than fair market, and 1.30× means 30% above fair market.High Markup · Shop Alternatives
$612Fair BaseRate (3.98× Market)
Position vs. 1.00× Fair Price+298% Above Fair Price 1.00× (center of the bar) is the U.S. fair price average after accounting for local hospital wages and patient complexity. Left of center (<1.00×) is below fair price; right of center (>1.00×) is above fair price.

This hospital's typical commercial price is $2,433 compared to the $612 fair price benchmark.

Pillar 2 · VeriRate™ Data TrustHow VeriRate™ (0–100) Works: Hospitals are legally required to publish machine-readable price files, but some bury fake $0.01 numbers or omit cash discounts. VeriRate audits each file across 5 checks (hover any badge below to see what it tests).86/100 · Verified
86/100Hover Any Check Below to See How Prices Were Audited
File Completeness90Provenance (File Completeness): Checks whether the hospital published a complete, up-to-date machine-readable price file with valid CPT and MS-DRG billing codes instead of leaving blanks.
Price Logic88Coherence (Price Logic): Checks whether the hospital’s numbers make basic sense — e.g., self-pay cash price is lower than gross list price, with no fake $0.01 or $999,999 placeholder numbers.
Peer Alignment86Concordance (Peer Alignment): Checks whether reported prices sit in a realistic range compared to Medicare and nearby hospitals rather than wild 100× unit errors.
Clean Billing83Regularity (Clean Billing): Checks whether rates are structured consistently across procedures without erratic statistical spikes or hidden unbundled facility fees.
Real Cash Discount84Cash Honesty (Real Cash Discount): Checks whether the hospital offers a genuine self-pay cash discount that beats or matches commercial insurance rates instead of billing full sticker price.
Pillar 3 · Clinical Quality & ER SpeedChecks whether higher hospital prices actually buy better clinical quality — combining CMS Star Ratings, hospital safety scores, and emergency room wait times.High-Markup · Check Safety
CMS Star RatingNot RatedOfficial CMS Overall Hospital Quality Star Rating (1 to 5 stars) summarizing mortality, safety of care, readmissions, and patient experience.
Safety ScoreNot ScoredComposite patient safety score (0–100) derived from CMS hospital-acquired infection rates (CLABSI, CAUTI, MRSA, C. diff), surgical complications, and HCAHPS surveys.
Typical ER WaitNo ER DataMedian minutes patients spent in the emergency department before leaving from the visit, as reported to CMS Timely and Effective Care.

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

The BaseRate · fair price low confidence
A fair price for this
$612
about 0.2× the $4,000 Medicare rate · typically $424–$5,628
modeled estimate · not a bill or quote
Medicare pays $4,000 Fair price $612 Cash price $2,433

How we calculate the fair BaseRate →

Insurer prices not shown for this procedure

This hospital’s published rates for this billing code don’t look like a per-visit price — they appear to be a full-stay total filed under an hourly code — so we’re not showing a per-insurer breakdown we can’t stand behind. The fair price above is your best reference; call the hospital’s billing office to confirm the actual charge.

Self-Pay How to get the cash price

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Facility Profile & Credentials

  • Address: 642 W Hospital Rd, Paoli, IN 47454
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals

Other Procedures at Indiana University Health Paoli Hospital

Compare: Breast lump removal at other IN hospitals

Insurance negotiated median for the same procedure, sorted lowest first.

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at Indiana University Health Paoli Hospital (Zero PHI Required)

CMS CCN: 151306
CPT 19120
Fair BaseRate™ $612
Medicare Rate $4,000
Self-Pay Cash $2,433
Insurer Median $704
Pre-filled with Indiana University Health Paoli Hospital’s charged/list benchmark
Screened against 2026 HHS Federal Poverty Guidelines
2026 FPL: $15,650 + $5,500 per additional person
Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $2,302 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $2,302

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $2,302).

Step 2 · Cash vs. Insurance Arbitrage Save $3,908 Paying Cash

Self-Pay Cash Rate ($2,433) Beats Your Bill

Indiana University Health Paoli Hospital's published 45 CFR § 180 self-pay cash rate is $2,433 (vs. $704 commercial insurer median). Ask billing to reclassify the visit to prompt-pay self-pay if it beats your deductible.

Step 3 · Fair BaseRate Target +$5,729 Above Fair BaseRate

Negotiate Toward $612 Fair BaseRate ($4,000 Medicare)

Your bill ($6,341) is $5,729 above the denoised Fair BaseRate ($612) and 1.6× the $4,000 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.
Care-Setting Arbitrage, Bilateral SVD Insurer Leverage & Regional Alternatives

How to Pay Less Nearby: Freestanding Centers, Insurer Leverage & Outpatient Savings

45 CFR § 180 Primary-Source Lineage & Federal Verification Verified CMS CCN 151306

Verify the Raw Data: Official Hospital MRF, CMS Medicare.gov & Federal Filings

MRF Portal Indexed (352090919_indiana-university-health-paoli-inc._standardcharges.zip!352090919_indiana-university-health-paoli-inc._standardcharges.csv) Verify on CMS Medicare.gov (CCN 151306) ↗ CMS HCRIS Cost Reports ↗
Published MRF File352090919_indiana-university-health-paoli-inc._standardcharges.zip!352090919_indiana-university-health-paoli-inc._standardcharges.csv
Publication / Vintage2026-03-25 · 61.16 MB
Validated Rate Rows8,694,057 (CMS v3.0)
File Integrity Digeste3c046810cd02cf93342…

Safe-Harbor Data Corrections: Parsed directly from public 45 CFR § 180 hospital filings, CMS Care Compare, and CMS HCRIS cost reports. Hospital compliance officers may submit updated MRF URLs or rate tables for verification.

Submit MRF Update Correction Policy