CMS Price Transparency Data

Breast lump removal

Facility: Cincinnati Children's Hospital Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $1,413
  • Cash Discount Price: $1,176
  • vs. Medicare Baseline: 0.35x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Cincinnati Children's Hospital Medical Center is $1,413. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,176. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.35x the Medicare baseline. Located in 3333 Burnet Avenue, Cincinnati, OH.
Cash / Self-Pay
$1,176

Average discount available for prompt cash payment at this facility.

Insurance Median
$1,413

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: $1,176 (29%)
Insurance Median: $1,413 (35%)
Cash: $1,176 (29% of Medicare)
Ins. Median: $1,413 (35% 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
Blue Cross Blue Shield $192 - $2,305 5%
Caresource_Oh $192 - $226 5%
Humana $192 - $277 5%
Amerihealth_Caritas_Oh $197 - $232 5%
Aetna $198 - $2,305 5%
Molina_Oh $201 - $237 5%
Wellcare_Ky $208 - $277 5%
United_Health_Care_Ky $209 - $278 5%
Buckeye_Oh $210 - $247 5%
United_Health_Care_Oh $229 - $269 6%
Passport_Ky $274 7%
Caresource_In $327 - $436 8%
Caresource_Oh_Insurance $1,152 29%
United_Health_Care_Insurance $1,176 - $2,305 29%
Medical_Mutual_Of_Ohio_Insurance $1,234 - $2,098 31%
Parkview_Signature_Care_Insurance $1,413 - $1,662 35%
Point_Comfort_Insurance $1,498 37%
Margaret_Mary_Health_Insurance $1,528 - $1,798 38%
Cigna $1,567 - $1,844 39%
Health_Ohio_Network_Insurance $1,844 - $2,190 46%
Beechstreet_Insurance $1,861 - $2,190 47%
Evolutions_Health_Care_Systems $2,074 52%
Galaxy_Health_Insurance $2,074 52%
Custom_Design_Benefits_Insurance $2,190 55%
First_Health_Group_Insurance $2,190 55%
Health_Link_Insurance $2,190 55%
Health_Smart_Preferred_Insurance $2,190 55%
Medical_Benefit_Administrators_Insurance $2,190 55%
Ohio_Health_Choice_Insurance $2,190 55%
Private_Health_Care_Systems_Insurance $2,305 58%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 3333 Burnet Avenue, Cincinnati, OH 45229
  • CMS Rating: No CMS Rating
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Childrens