CMS Price Transparency Data

Breast lump removal

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,167
Cash Discount Price: $1,018
vs. Medicare Baseline: 0.29x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Nationwide Children's Hospital Toledo, LLC is $1,167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,018. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.29x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$1,018

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,167

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: $1,018 (25%)

Insurance Median: $1,167 (29%)

Cash: $1,018 (25% of Medicare)

Ins. Median: $1,167 (29% 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
Caresource	$222 - $4,200	6%
UnitedHealthcare	$224 - $1,167	6%
Amerihealth	$226 - $1,178	6%
Bchp	$226 - $1,178	6%
Mcclaren Health Plan - Michigan	$280 - $4,120	7%
Paramount	$394	10%
Blue Cross Blue Shield	$413 - $1,178	10%
Tricare	$463 - $3,638	12%
Mcclaren Health Plan	$551	14%
Aetna	$683	17%
Cigna	$702	18%
Front Path Health Coalition	$708 - $12,001	18%
Molina	$1,167 - $4,595	29%
Humana	$1,178	29%
Ohc	$1,272	32%
Ohio Ppo Connect	$1,272	32%
Mmo	$1,696	42%

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 $1,018.
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 Nationwide Children's Hospital Toledo, LLC 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.