CMS Price Transparency Data

Breast lump removal

Facility: Atrium Health Cleveland

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,053
Cash Discount Price: $4,632
vs. Medicare Baseline: 1.01x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Atrium Health Cleveland is $4,053. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,632. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.01x the Medicare baseline. Located in 201 E Grover St, Shelby, NC.

Cash / Self-Pay

$4,632

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,053

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: $4,632 (116%)

Insurance Median: $4,053 (101%)

Cash: $4,632 (116% of Medicare)

Ins. Median: $4,053 (101% 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
Trillium	$284 - $1,372	7%
Amerihealth Caritas	$287 - $1,307	7%
Carolina Complete Health	$287 - $1,332	7%
Healthy Blue	$287 - $1,332	7%
Partners	$287 - $1,297	7%
UnitedHealthcare	$287 - $4,946	7%
Vaya	$287 - $1,345	7%
Wellcare	$287 - $1,332	7%
Alliance	$290 - $1,551	7%
Cigna	$384 - $7,410	10%
Humana	$392 - $3,668	10%
Aetna	$397 - $7,133	10%
Blue Cross Blue Shield	$982 - $2,845	25%
Ambetter / Centene	$2,959 - $3,362	74%
Employers Health Network	$4,094	102%
Physician Reach Out	$4,632	116%
Medcost	$5,169 - $6,141	129%
Magellan	$5,558	139%
Gmmi	$6,021	151%
Quik Trip	$6,021	151%
Carolina Behavioral Health	$6,669 - $7,410	167%
Healthgram	$7,410	185%
Choicecare	$7,596	190%
First Health	$7,874	197%
Lifesynch Community Choice Care	$7,874	197%
Private Health Care Systems	$8,337	208%
Beechstreet	$8,522	213%
Multiplan	$8,800	220%

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 $4,632.
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 Atrium Health Cleveland 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.