CMS Price Transparency Data

Breast lump removal

Facility: Avita Ontario

Billing Code: 19120 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$3,477

about 0.9× the $4,000 Medicare rate · typically $3,157–$3,477

modeled estimate · not a bill or quote

Medicare pays $4,000 Fair price $3,477 Cash price $6,355 Hospital's list price $7,476

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$945 - $5,401	24%
Blue Cross Blue Shieldmajor	$945 - $5,330	24%
Aetnamajor	$4,000 - $7,476	100%
Cignamajor	$5,824	146%
Humanamajor	$945 - $4,000	24%
AmeriHealth	$383	10%
CareSource	$945	24%
Medical Mutual	$4,000 - $5,981	100%
Molina	$945 - $4,000	24%
+ 2 smaller / regional plans	$945 - $4,000

Government programs also on file: Medicare, Medicaid.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 6,355), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Avita Ontario is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Avita Ontario

Compare: Breast lump removal at other OH hospitals

Insurance negotiated median for the same procedure, sorted lowest first.