CMS Price Transparency Data

Breast lump removal

Facility: Fairfield Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $6,431
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.61x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Fairfield Medical Center is $6,431. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.61x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,431

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%)

Insurance Median: $6,431 (161%)

Ins. Median: $6,431 (161% 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
Medicaid / KanCare	$956	24%
Molina	$956 - $10,802	24%
UnitedHealthcare	$956 - $6,547	24%
Caresource	$966 - $8,511	24%
Blue Cross Blue Shield	$985 - $26,250	25%
Humana	$994 - $6,431	25%
Amerihealth Caritas Ohio	$1,004	25%
Buckeye Community Health	$1,004 - $10,148	25%
Aetna	$6,431	161%
Medical Mutual	$6,431 - $33,500	161%
Medicare (plans)	$6,431	161%
Medigold	$6,547	164%
Va Ccn	$6,547	164%
The Health Plan	$6,560	164%
Valor Health Plan	$6,560	164%
Bwc	$9,094	227%
Oscar	$9,756	244%

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 $X.
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 Fairfield 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.