CMS Price Transparency Data
Breast lump removal
Facility: Mercy Hospital Booneville
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $609
- Cash Discount Price: $922
- vs. Medicare Baseline: 0.15x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Mercy Hospital Booneville is $609. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $922. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.15x the Medicare baseline. Located in 880 West Main, Booneville, AR.
Cash / Self-Pay
$922
Average discount available for prompt cash payment at this facility.
Insurance Median
$609
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: $922 (23%)
Insurance Median: $609 (15%)
Cash: $922 (23% of Medicare)
Ins. Median: $609 (15% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $356 - $3,410 | 9% |
| American Health Advantage Of Mo Mcr [20264] | $356 | 9% |
| Blue Cross Blue Shield | $356 - $609 | 9% |
| Cherokee Nation Health Serv Contracted [320066] | $356 | 9% |
| Cross Timbers Hospice [20098] | $356 | 9% |
| Dept Of Veteran Affairs Contracted [320106] | $356 | 9% |
| Elara Caring Aspire Hospice Contracted [320433] | $356 | 9% |
| Elara Caring Aspire Hospice [20433] | $356 | 9% |
| Globalhealth Contracted [320145] | $356 | 9% |
| Halo Hcr Inc Hospice Contracted [320432] | $356 | 9% |
| Halo Hcr Inc Hospice [20432] | $356 | 9% |
| Humana | $356 - $3,410 | 9% |
| Independent Health [20197] | $356 | 9% |
| Indian Health Service Contracted [320198] | $356 | 9% |
| Indian Health Service [20198] | $356 | 9% |
| Jordan Valley Senior Care Pace [20515] | $356 | 9% |
| Kindful Hospice Contracted [320434] | $356 | 9% |
| Kindful Hospice [20434] | $356 | 9% |
| Medical Associates Health [20444] | $356 | 9% |
| Medicare (plans) | $356 - $438 | 9% |
| Mercy Hospice Okc [20252] | $356 | 9% |
| Pace Of The Ozarks [20518] | $356 | 9% |
| Provider Partners Health Plans Contracted [320450] | $356 | 9% |
| Qual Choice Contracted [320325] | $356 | 9% |
| Spina Bifida Hlthcare Benefit [20506] | $356 | 9% |
| UnitedHealthcare | $356 | 9% |
| Valir Pace [20503] | $356 | 9% |
| Wellfirst Health Mcr [20443] | $356 | 9% |
| Tricare | $419 | 10% |
| Cigna | $438 - $1,205 | 11% |
| Medicaid / KanCare | $453 - $3,410 | 11% |
| Usable Contracted [320409] | $609 | 15% |
| Ambetter / Centene | $651 | 16% |
| Home State Health Plan Contracted [320187] | $651 | 16% |
| Novasys Contracted [320285] | $651 | 16% |
| Mercy Interfacility [20513] | $692 | 17% |
| Qual Choice Contracted [320324] | $734 | 18% |
| Auxiant Contracted [320462] | $851 | 21% |
| Mercy Benefit Admin Contracted [320251] | $851 - $1,205 | 21% |
| Workers Comp [20426] | $922 | 23% |
| Multiplan Contracted [320270] | $1,134 | 28% |
| Private Health Care Systems Contracted [320320] | $1,134 | 28% |
| 90 Degree Benefits Contracted [320436] | $1,205 | 30% |
| Aither Health Contracted [320449] | $1,205 | 30% |
| Ebms Contracted [320493] | $1,205 | 30% |
| Edison Health Solutions Contracted [320502] | $1,205 | 30% |
| Healthlink Contracted [320179] | $1,205 | 30% |
| Imagine 360 Contracted [320494] | $1,205 | 30% |
| Ppo Plus Contracted [320310] | $1,205 | 30% |
| Reflect Health Contracted [320492] | $1,205 | 30% |
| Show-Me Health Administrators Contracted [320483] | $1,205 | 30% |
| Municipal Health Plan Contracted [320271] | $1,276 | 32% |