CMS Price Transparency Data

Breast lump removal

Facility: St Claire Regional Medical Center

Billing Code: 19120 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$1,795

about 0.4× the $4,000 Medicare rate · typically $403–$3,984

modeled estimate · not a bill or quote

What this hospital charges insurers

$482

Below the fair price — a good deal

about $1,313 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $1,795 This hospital $482 Cash price $3,273 Hospital's list price $4,364

How we calculate the fair BaseRate →

How this hospital compares to other KY hospitals

Lowest price of the 9 KY hospitals we have prices for — a strong deal.

Cheapest $482 Priciest $3,538

Black dot = this hospital, among the 9 KY hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Breast lump removal is about $1,795 (about 0.4× the $4,000 Medicare rate). St Claire Regional Medical Center charges insurers about $482, or about $3,273 in cash — below the fair price — a good deal. Located in Morehead, KY.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ Blue Cross Blue Shield✓ Aetna✓ Humana UnitedHealthcareCignaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
Blue Cross Blue Shieldmajor	$385 - $4,059	10%
Aetnamajor	$264 - $5,001	7%
Humanamajor	$385 - $4,059	10%
CareSource	$385 - $5,277	10%
HealthLink	$408 - $3,025	10%
WellCare	$482 - $5,101	12%
+ 2 smaller / regional plans	$277 - $5,673

Government programs also on file: Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 3,273), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm St Claire Regional Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Claire Regional Medical Center

Compare: Breast lump removal at other KY hospitals

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