CMS Price Transparency Data

Breast lump removal

Facility: St Claire Regional Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,029
Cash Discount Price: $3,273
vs. Medicare Baseline: 0.26x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St Claire Regional Medical Center is $1,029. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,273. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.26x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.

Cash / Self-Pay

$3,273

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,029

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: $3,273 (82%)

Insurance Median: $1,029 (26%)

Cash: $3,273 (82% of Medicare)

Ins. Median: $1,029 (26% 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
Aetna	$264 - $5,001	7%
Beacon Bh - All Plans	$277	7%
Blue Cross Blue Shield	$385 - $4,059	10%
Caresource Mcr Adv	$385 - $4,059	10%
Humana	$385 - $4,059	10%
Healthlink - All Plans	$408 - $3,025	10%
Wellcare Comm - All Other Plans	$482 - $3,709	12%
Ky Health Co-Op - All Plans	$501 - $5,673	13%
Caresource Just4Me - All Other Plans	$539 - $5,277	13%
Medicaid / KanCare	$637 - $5,001	16%
Wellcare Mcaid	$650 - $5,101	16%

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 $3,273.
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 St Claire Regional Medical Center 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.