CMS Price Transparency Data

Breast lump removal

Facility: Prisma Health Tuomey Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$4,091

about 1.0× the $4,000 Medicare rate · typically $3,164–$6,313

modeled estimate · not a bill or quote

What this hospital charges insurers

$3,842

About the fair price

about $249 under the fair price · 1.0× Medicare

Medicare pays $4,000 Fair price $4,091 This hospital $3,842 Cash price $7,110 Hospital's list price $10,939

How we calculate the fair BaseRate →

How this hospital compares to other SC hospitals

Highest price of the 9 SC hospitals we have prices for — worth calling around.

Cheapest $496 Priciest $3,842

Black dot = this hospital, among the 9 SC hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $4,091 (about 1.0× the $4,000 Medicare rate). Prisma Health Tuomey Hospital charges insurers about $3,842, or about $7,110 in cash — about the fair price. Located in Sumter, SC.

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	$1,685 - $12,943	42%
Blue Cross Blue Shieldmajor	$2,184 - $4,573	55%
Aetnamajor	$3,842 - $8,642	96%
Cignamajor	$3,659 - $8,390	91%
Humanamajor	$1,091 - $8,204	27%
Ambetter (Centene)	$6,733	168%
Molina	$3,842	96%
WellCare	$3,842	96%
+ 16 smaller / regional plans	$2,184 - $12,943

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 7,110), 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 Prisma Health Tuomey Hospital 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 Prisma Health Tuomey Hospital

Compare: Breast lump removal at other SC hospitals

Anmed Health · Anderson $496
Piedmont Medical Center · Rock Hill $2,595
Prisma Health Greer Memorial Hospital · Spartanburg $3,452
MUSC Medical Center · Charleston $3,714
Roper Hospital · Charleston $3,714
Coastal Carolina Hospital · Hardeeville $3,722
East Cooper Medical Center · Mount Pleasant $3,751
Novant Health Hilton Head Medical Center · Hilton Head Island $3,787

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