CMS Price Transparency Data

Breast lump removal

Facility: Mon Health Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $870
Cash Discount Price: $449
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Mon Health Medical Center is $870. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $449. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.22x the Medicare baseline. Located in 1200 Jd Anderson Drive, Morgantown, WV.

Cash / Self-Pay

$449

Average discount available for prompt cash payment at this facility.

Insurance Median

$870

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: $449 (11%)

Insurance Median: $870 (22%)

Cash: $449 (11% of Medicare)

Ins. Median: $870 (22% 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
Unison_Plan	$173	4%
Gateway_Health_Plan	$190	5%
Maryland_Physicians_Care_Plan	$628	16%
Aetna	$718 - $3,787	18%
The_Health_Plan_Murray_Energy_Commercial_Aso_Plan	$718	18%
The_Health_Plan_Plan	$772	19%
Acpn_Plan	$808	20%
Cigna	$808	20%
Humana	$808 - $3,787	20%
Mon_County_Commission_Plan	$808	20%
Uhc_Plan	$808	20%
Health_Payors_Organization_Plan	$826	21%
Uhc_Options_Ppo_Plan	$835	21%
Multiplan_Phcs_Plan	$852	21%
Mutual_Of_Omaha_Plan	$852	21%
Geha_Plan	$870	22%
Three_Rivers_Plan	$870	22%
Uhc_Onenet_Ppo_Plan	$870	22%
Upmc__Plan	$870	22%
The_Health_Plan_Peia_Plan	$3,132	78%
Zelis_Other_Plan	$3,219	80%
Blue Cross Blue Shield	$3,787 - $17,705	95%
Health_South_Mountain_View_Plan	$3,787	95%
Medicare (plans)	$3,787	95%
Paramount_Elite_Plan	$3,787	95%
Uhc_Va_Plan	$3,787	95%
Zelis_Group_Health_Plan	$3,787	95%
Seven_Corners_Plan	$7,575	189%

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 $449.
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 Mon Health Medical Center 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.