CMS Price Transparency Data

Breast lump removal

Facility: Crystal Clinic Orthopaedic Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $916
Cash Discount Price: $926
vs. Medicare Baseline: 0.23x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Crystal Clinic Orthopaedic Center is $916. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $926. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.23x the Medicare baseline. Located in 444 North Main Street, Akron, OH.

Cash / Self-Pay

$926

Average discount available for prompt cash payment at this facility.

Insurance Median

$916

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: $926 (23%)

Insurance Median: $916 (23%)

Cash: $926 (23% of Medicare)

Ins. Median: $916 (23% 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
Bc Mcr Adv	$394 - $3,711	10%
Summacare Mcr Adv	$394 - $3,711	10%
UnitedHealthcare	$399 - $3,711	10%
Summacare Comm - All Other Plans	$429 - $2,823	11%
Aultcare - All Plans	$433 - $488	11%
The Health Plan - All Plans	$512 - $7,423	13%
Cigna	$526 - $2,567	13%
Bc Blue Access	$532 - $2,911	13%
Bc Ohi/Ohii	$532 - $2,620	13%
Bc Pathway	$532 - $1,908	13%
Bc Preferred	$532 - $2,911	13%
Bc Trad - All Other Plans	$532 - $2,911	13%
Health Oh Network - All Plans	$566 - $916	14%
Ohio Health Choice - All Plans	$566 - $916	14%
Multiplan - All Plans	$622 - $1,007	16%
Med Mutual Nas	$716 - $952	18%
Healthsmart - All Plans	$802 - $1,297	20%
Med Mutual Medflex	$2,857	71%
Med Mutual Aca	$3,249	81%
Med Mutual Ppo/Pos/Hmo - All Other Plans	$3,571	89%
Aetna	$3,617	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 $926.
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 Crystal Clinic Orthopaedic 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.