CMS Price Transparency Data

Breast lump removal

Facility: South Pointe Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,834
Cash Discount Price: $5,099
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at South Pointe Hospital is $3,834. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,099. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.96x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$5,099

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,834

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: $5,099 (127%)

Insurance Median: $3,834 (96%)

Cash: $5,099 (127% of Medicare)

Ins. Median: $3,834 (96% 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
UnitedHealthcare	$930 - $4,864	23%
Paramount	$1,008	25%
Blue Cross Blue Shield	$1,028 - $6,147	26%
Buckeye	$1,028	26%
Molina	$1,028	26%
Caresource	$1,047	26%
United	$1,047 - $5,553	26%
Amerihealth	$1,077	27%
Oscar	$2,364 - $3,016	59%
Summacare	$2,683 - $3,550	67%
Mmo	$3,004 - $4,707	75%
Cc Ehp	$3,130 - $3,177	78%
Aultcare	$3,373	84%
Aetna	$3,550 - $7,845	89%
Devoted Health	$3,550	89%
Humana	$3,550 - $6,668	89%
The Health Plan	$3,550 - $4,707	89%
Upmc	$3,550 - $4,707	89%
Valor	$3,550	89%
Cigna	$3,656 - $6,276	91%
Communicare	$3,727	93%
Ohcp	$3,813	95%
Perennial Health	$3,834	96%
Pphp	$3,905	98%
Omas	$3,922	98%
Ohio Healthy	$4,236	106%
Healthsmart	$4,315	108%
Php	$4,707	118%
Gms	$5,492	137%
Medical Benefit Corp	$5,492	137%
Quality Care Partners	$5,492	137%
Consociate Health	$5,884	147%
Frontpath	$7,060	176%
Managed Care Services	$7,060	176%
Multiplan	$7,060	176%
Tertiary Care Network	$7,060	176%
Three Rivers	$7,060	176%

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 $5,099.
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 South Pointe 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.