CMS Price Transparency Data

Breast lump removal

Facility: Cleveland Clinic

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $2,156
  • Cash Discount Price: $5,099
  • vs. Medicare Baseline: 0.54x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Cleveland Clinic is $2,156. 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 0.54x the Medicare baseline. Located in 9500 Euclid Avenue, Cleveland, OH.
Cash / Self-Pay
$5,099

Average discount available for prompt cash payment at this facility.

Insurance Median
$2,156

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: $2,156 (54%)
Cash: $5,099 (127% of Medicare)
Ins. Median: $2,156 (54% 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.

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 $204 - $5,256 5%
Paramount $222 - $1,109 6%
Buckeye $226 - $1,131 6%
Caresource $226 - $1,077 6%
United $230 - $6,987 6%
Amerihealth $237 6%
Molina $237 - $1,131 6%
Summacare $259 - $3,742 6%
Aetna $399 - $7,845 10%
Blue Cross Blue Shield $399 - $6,663 10%
Devoted Health $399 - $3,550 10%
Humana $399 - $6,668 10%
The Health Plan $399 - $4,707 10%
Upmc $399 - $4,707 10%
Valor $399 - $3,550 10%
Cigna $411 - $6,276 10%
Communicare $419 - $3,727 10%
Perennial Health $431 - $3,834 11%
Pphp $431 - $3,905 11%
Zing Health $439 - $3,905 11%
Oscar $569 - $3,016 14%
Cc Ehp $758 - $4,895 19%
Ohcp $829 - $3,813 21%
Ohio Healthy $853 - $5,492 21%
Aultcare $917 - $3,844 23%
Amish Community Aid Plan $959 - $3,922 24%
Mmo $965 - $8,227 24%
Omas $1,066 - $3,922 27%
Healthsmart $1,173 - $4,315 29%
United Bh $1,185 30%
Phphi $1,279 - $4,707 32%
Clarity Health $1,386 - $5,099 35%
Gms $1,492 - $5,492 37%
Quality Care Partners $1,492 - $5,492 37%
Consociate Health $1,599 - $5,884 40%
Multiplan $1,919 - $7,060 48%
Three Rivers $1,919 - $7,060 48%
Usa Managed Care $1,919 48%
Php $4,707 118%
Medical Benefit Corp $5,492 137%
Parkview Health Plan $5,492 137%
Community Health Alliance $6,276 157%
Frontpath $7,060 176%
Managed Care Services $7,060 176%
Tertiary Care Network $7,060 176%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 9500 Euclid Avenue, Cleveland, OH 44195
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals