CMS Price Transparency Data

Breast lump removal

Facility: Fisher-Titus Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $849
Cash Discount Price: $1,045
vs. Medicare Baseline: 0.21x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Fisher-Titus Hospital is $849. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,045. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.21x the Medicare baseline. Located in 272 Benedict Avenue, Norwalk, OH.

Cash / Self-Pay

$1,045

Average discount available for prompt cash payment at this facility.

Insurance Median

$849

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: $1,045 (26%)

Insurance Median: $849 (21%)

Cash: $1,045 (26% of Medicare)

Ins. Median: $849 (21% 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
Humana	$215 - $399	5%
Perennial Advantage	$283 - $3,772	7%
UnitedHealthcare	$283 - $3,664	7%
Sidecar	$289 - $7,181	7%
Aetna	$318 - $3,592	8%
Martin'S Point	$339 - $399	8%
Blue Cross Blue Shield	$399 - $3,592	10%
Buckeye	$399 - $3,592	10%
Caresource	$399 - $3,592	10%
Devoted	$399	10%
Medical Mutual Of Ohio	$399 - $3,592	10%
Medigold	$399	10%
Meridan	$399	10%
Paramount	$399 - $3,592	10%
Summacare	$399 - $3,592	10%
Zinghealth	$407	10%
Valor Health	$411 - $3,700	10%
Gateway	$419	10%
Perennial	$419	10%
Wellcare	$419 - $3,592	10%
Health Scope	$479	12%
Coresource	$495	12%
First Health	$495 - $1,136	12%
Emerald Health	$499 - $1,224	12%
Frontpath	$518	13%
Ohio Health Choice	$518 - $1,136	13%
Cigna	$558 - $1,010	14%
Clarity Health	$558	14%
Multiplan	$558 - $1,136	14%
Health Ohio Network	$598 - $883	15%
Amerihealth	$655	16%
Molina	$655	16%
Tricare	$796 - $1,010	20%
Claimsdoc	$849 - $1,010	21%
Healthscope	$966 - $1,148	24%
Zing Health	$3,592	90%

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 $1,045.
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 Fisher-Titus Hospital 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.