CMS Price Transparency Data
Breast lump removal
Facility: Mount Carmel East & West
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $2,984
- Cash Discount Price: $4,153
- vs. Medicare Baseline: 0.75x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Mount Carmel East & West is $2,984. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,153. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.75x the Medicare baseline. Located in 6001 East Broad Street, Columbus, OH.
Cash / Self-Pay
$4,153
Average discount available for prompt cash payment at this facility.
Insurance Median
$2,984
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: $4,153 (104%)
Insurance Median: $2,984 (75%)
Cash: $4,153 (104% of Medicare)
Ins. Median: $2,984 (75% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Crime Victim Assistance | $632 | 16% |
| Ohio Safe Program | $632 | 16% |
| Aetna | $1,912 - $6,389 | 48% |
| Geha | $1,912 - $8,089 | 48% |
| Gravie Admin Services | $1,912 - $2,869 | 48% |
| Healthez | $1,912 - $2,869 | 48% |
| Meritain | $1,912 - $2,869 | 48% |
| Webtpa | $1,912 - $2,869 | 48% |
| Access Health | $1,989 - $2,984 | 50% |
| Acclaim | $1,989 - $2,984 | 50% |
| Administrative Concepts | $1,989 - $2,984 | 50% |
| Allegeant | $1,989 - $2,984 | 50% |
| Allied Benefit Systems | $1,989 - $2,984 | 50% |
| American Family | $1,989 - $2,984 | 50% |
| American Healthcare Alliance | $1,989 - $2,984 | 50% |
| American National | $1,989 - $2,984 | 50% |
| American Republic | $1,989 - $2,984 | 50% |
| Amerihealth | $1,989 - $2,984 | 50% |
| Aultcare | $1,989 - $2,984 | 50% |
| Automated Benefit Services | $1,989 - $2,984 | 50% |
| Auxiant | $1,989 - $2,984 | 50% |
| Benefit Administrative Systems,Llc | $1,989 - $2,984 | 50% |
| Boon Chapman | $1,989 - $2,984 | 50% |
| Cam Administrative Services | $1,989 - $2,984 | 50% |
| Christian Brother Services | $1,989 - $2,984 | 50% |
| Christian Brothers Holy Cross | $1,989 - $2,984 | 50% |
| Claimchoice Adminstrators | $1,989 - $2,984 | 50% |
| Comprehensive Benefits | $1,989 - $2,984 | 50% |
| Continental Life Insurance | $1,989 - $2,984 | 50% |
| Coventry | $1,989 - $2,984 | 50% |
| Custom Benefit Administrators | $1,989 - $2,984 | 50% |
| Cypress Benefit Administrators | $1,989 - $2,984 | 50% |
| Employee Benefit Concepts | $1,989 - $2,984 | 50% |
| Employee Benefit Management | $1,989 - $2,984 | 50% |
| Forest County Potawatomi | $1,989 - $2,984 | 50% |
| Freedom Life Insurance Company | $1,989 - $2,984 | 50% |
| Group Administrators | $1,989 - $2,984 | 50% |
| Group Marketing Services | $1,989 - $2,984 | 50% |
| Group Pension Administrators | $1,989 - $2,984 | 50% |
| Guardian | $1,989 - $2,984 | 50% |
| Health America | $1,989 - $2,984 | 50% |
| Health Choices | $1,989 - $2,984 | 50% |
| Healthcare Management Admin | $1,989 - $2,984 | 50% |
| Insight | $1,989 - $2,984 | 50% |
| Intercare | $1,989 - $2,984 | 50% |
| Jfp Benefit Management | $1,989 - $2,984 | 50% |
| Jp Farley Corporation | $1,989 - $2,984 | 50% |
| Key Benefit Administrator | $1,989 - $2,984 | 50% |
| Liberty Union Life Assurance Co | $1,989 - $2,984 | 50% |
| Lucent Health | $1,989 - $2,984 | 50% |
| Luminare Health | $1,989 - $2,984 | 50% |
| Magnacare | $1,989 - $2,984 | 50% |
| Medcost | $1,989 - $2,984 | 50% |
| Mutual Health Services | $1,989 - $2,984 | 50% |
| Mutual Of Omaha | $1,989 - $2,984 | 50% |
| Ncas | $1,989 - $2,984 | 50% |
| Nippon Life Ins | $1,989 - $2,984 | 50% |
| Nova | $1,989 - $2,984 | 50% |
| Painters Union Insurance Fund | $1,989 - $2,984 | 50% |
| Physicians Mutual | $1,989 - $2,984 | 50% |
| Plumbers Local 98 Insurance Fund | $1,989 - $2,984 | 50% |
| Prairie States | $1,989 - $2,984 | 50% |
| Preferred One | $1,989 - $2,984 | 50% |
| Primary Physician Care | $1,989 - $2,984 | 50% |
| Professional Benefit Administrators | $1,989 - $2,984 | 50% |
| Secureone Preferred United Plans | $1,989 - $2,984 | 50% |
| Siho Insurance Services | $1,989 - $2,984 | 50% |
| Sisco Benefits | $1,989 - $2,984 | 50% |
| The Loomis Company | $1,989 - $2,984 | 50% |
| Trustmark Small Business Benefits | $1,989 - $2,984 | 50% |
| U Of M Health Plan | $1,989 - $2,984 | 50% |
| Unicare | $1,989 - $2,984 | 50% |
| Unified Group Services | $1,989 - $2,984 | 50% |
| Us Health And Life | $1,989 - $2,984 | 50% |
| Valenz | $1,989 - $2,984 | 50% |
| Varipro | $1,989 - $2,984 | 50% |
| Wps | $1,989 - $2,984 | 50% |
| Humana | $2,178 - $6,389 | 54% |
| First Health | $2,244 - $3,367 | 56% |
| Medben | $2,555 - $4,792 | 64% |
| Consociate | $2,602 - $3,904 | 65% |
| Health Ohio Network | $2,602 - $3,904 | 65% |
| The Health Plan | $2,798 - $4,198 | 70% |
| Caresource | $3,109 - $4,664 | 78% |
| Healthlink Inc | $3,194 - $4,792 | 80% |
| Medical Benefits Mutual | $3,194 - $4,792 | 80% |
| Ohio Health Choice | $3,194 - $4,792 | 80% |
| Ohio Ppo Connect | $3,194 - $4,792 | 80% |
| Medical Mutual | $3,241 - $12,885 | 81% |
| Medicare (plans) | $3,256 - $3,890 | 81% |
| Medi Share | $3,403 - $5,105 | 85% |
| Multiplan | $3,403 - $5,105 | 85% |
| Phcs | $3,403 - $5,105 | 85% |
| Philadelphia American Life Insurance | $3,403 - $5,105 | 85% |
| Ameriben | $3,407 - $5,111 | 85% |
| Luminare Health (Detroit) | $3,407 - $5,111 | 85% |
| Ohiohealthy | $3,407 - $5,111 | 85% |
| Osu Not Independent Choice | $3,407 - $5,111 | 85% |
| Twin Valley Psychiatric | $3,407 - $5,111 | 85% |
| Health Smart | $3,620 - $5,431 | 90% |
| Blue Cross Blue Shield | $3,630 - $14,083 | 91% |
| UnitedHealthcare | $3,703 - $8,089 | 93% |
| Hospice Mount Carmel | $3,704 | 93% |
| Bccp | $4,259 - $6,389 | 106% |
| Medicaid / KanCare | $4,259 - $6,389 | 106% |
| Optima Health | $4,259 - $6,389 | 106% |
| American Postal Workers Secondary | $4,382 | 110% |
| Cigna | $4,382 | 110% |
| Health Partners | $4,382 | 110% |
| Healthgram | $4,382 | 110% |
| Mvp | $4,382 | 110% |
| Priority Health | $4,382 | 110% |
| Rural Carrier Health Benefit Plan | $5,706 | 143% |
| Oscar | $6,112 | 153% |
| Enterprise Group Planning | $7,149 | 179% |
| Custom Design Benefits | $7,742 | 194% |
| Quality Care Partners | $8,372 | 209% |
| Western & Southern Financial Group | $12,885 | 322% |
| Blue Benefit Administrators Of Massachusetts | $14,083 | 352% |
| Blue Care Network | $14,083 | 352% |
| Blue Distinction Transplant | $14,083 | 352% |
| Blue Shield - Ca | $14,083 | 352% |
| Blue Shield - Id (Regence) | $14,083 | 352% |
| Blue Shield - Ny Highmark Northeastern | $14,083 | 352% |
| Blue Shield - Ny Highmark Western | $14,083 | 352% |
| Blue Shield - Pa (Highmark) | $14,083 | 352% |
| Blue Shield - Wa (Regence) | $14,083 | 352% |