CMS Price Transparency Data

Breast lump removal

Facility: Arthur G James Cancer Hospital and Research Institute

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,022
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.76x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Arthur G James Cancer Hospital and Research Institute is $3,022. 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 0.76x the Medicare baseline. Located in 460 W 10Th Ave, Columbus, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,022

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: $3,022 (76%)

Ins. Median: $3,022 (76% 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
Ohio Dept Of Health	$501 - $4,289	13%
Healthspan	$1,199 - $5,413	30%
Medigold	$1,199	30%
Upper Ohio Valley	$1,199 - $5,413	30%
Medicare (plans)	$1,211 - $5,467	30%
Humana	$1,223 - $5,521	31%
Medicaid / KanCare	$1,385 - $1,903	35%
Aetna	$1,455 - $5,388	36%
United	$1,524 - $4,981	38%
Caresource	$1,806 - $2,702	45%
Mmo	$1,806 - $4,623	45%
Molina	$1,806 - $5,388	45%
Odrc	$1,903 - $2,226	48%
Blue Cross Blue Shield	$2,010 - $5,189	50%
Buckeye Community	$2,020 - $2,683	50%
Amerihealth	$2,037 - $2,949	51%
Osu Health Plan	$2,500 - $3,623	62%
Cigna	$3,022 - $3,967	76%
Lifetrac	$3,558 - $3,722	89%
Ohio Ppo	$3,592	90%
Ohiohealth	$3,941 - $3,996	99%
Frontpath	$4,379	109%
Healthsmart	$4,927	123%
Multiplan	$5,091	127%

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 Arthur G James Cancer Hospital and Research Institute 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.