CMS Price Transparency Data

Breast lump removal

Facility: Ohio Valley Surgical Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $3,650
  • Cash Discount Price: $7,917
  • vs. Medicare Baseline: 0.91x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Ohio Valley Surgical Hospital is $3,650. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,917. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.91x the Medicare baseline. Located in 100 West Main Street, Springfield, OH.
Cash / Self-Pay
$7,917

Average discount available for prompt cash payment at this facility.

Insurance Median
$3,650

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: $7,917 (198%)
Insurance Median: $3,650 (91%)
Cash: $7,917 (198% of Medicare)
Ins. Median: $3,650 (91% 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
Aetna $545 - $3,650 14%
Geha $545 14%
Genworth $545 14%
Mail Handlers $545 14%
Meritain $545 14%
Meritain Heatlh $545 14%
Mhbp $545 14%
Ngs Coresource $545 14%
Nippon Life $545 14%
Pacific Source $545 14%
Personify Health $545 14%
Aarp $3,650 91%
Aarp Supplemental $3,650 91%
American Continental Insurance $3,650 91%
American Continental Life $3,650 91%
American Republic $3,650 91%
American Retirement $3,650 91%
Aultcare Primetime Health Plan $3,650 91%
Bankers Fidelity $3,650 91%
Bankers Life And Casualty $3,650 91%
Blue Cross Blue Shield $3,650 - $12,997 91%
Central States $3,650 91%
Champus $3,650 91%
Cigna $3,650 - $5,695 91%
Communicare Advantage $3,650 91%
Everest $3,650 91%
Gateway Health Plan $3,650 91%
Humana $3,650 91%
Medicare (plans) $3,650 - $7,917 91%
Medigold $3,650 91%
Mmoh $3,650 - $8,313 91%
Molina $3,650 91%
Molina Dual Mcr $3,650 91%
Molina Marketplace $3,650 91%
Molina Dual Mcr $3,650 91%
Molina Mcr $3,650 91%
Molina Mcr Mcd $3,650 91%
Molina Mcr+Mcd $3,650 91%
Patient No Pay $3,650 91%
Prosperity Supplement $3,650 91%
Self Pay Imaging $3,650 91%
UnitedHealthcare $3,650 - $5,431 91%
Wellcare By Allwell $3,650 91%
Wraparound Pl Supp $3,650 91%
The Health Plan $3,832 96%
Devoted Health $3,869 97%
Employer Direct $4,197 105%
Caresource $5,474 137%
Caresourse $5,474 137%
Medicaid / KanCare $5,474 137%
Healthgram $5,695 142%
Nalc $5,695 142%
Samba $5,695 142%
Sbma $5,695 142%
Unified Group $5,695 142%
Mmoh (Supermed) $6,136 153%
Mmo Cin. Hmo $8,313 208%
Luminare Health $11,876 297%
Medben $11,876 297%
Ohio Health $11,876 297%
Preferred Health $11,876 297%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 100 West Main Street, Springfield, OH 45502
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals