CMS Price Transparency Data

Breast lump removal

Facility: Metrohealth System

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $4,075
Cash Discount Price: $2,126
vs. Medicare Baseline: 1.02x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Metrohealth System is $4,075. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,126. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.02x the Medicare baseline. Located in 2500 Metrohealth Drive, Cleveland, OH.

Cash / Self-Pay

$2,126

Average discount available for prompt cash payment at this facility.

Insurance Median

$4,075

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: $2,126 (53%)

Insurance Median: $4,075 (102%)

Cash: $2,126 (53% of Medicare)

Ins. Median: $4,075 (102% 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	$1,371 - $5,927	34%
Summacare	$1,879	47%
Medical Mutual	$2,017 - $14,731	50%
Cigna	$2,577	64%
Aarp	$3,704	93%
Valor Health	$3,741	94%
Perennial Advantage	$3,778	94%
UnitedHealthcare	$4,054	101%
Mcgregor Pace	$4,075	102%
Buckeye Health Plan	$4,816	120%
Caresource	$5,186	130%
Health E Ohio	$7,779	194%
Blue Cross Blue Shield	$8,056 - $14,123	201%
Clarity Health	$9,631	241%

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 $2,126.
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 Metrohealth System 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.