CMS Price Transparency Data

Breast lump removal

Facility: Anderson Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,129
  • Cash Discount Price: Unavailable
  • vs. Medicare Baseline: 1.03x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Anderson Hospital is $4,129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.03x the Medicare baseline. Located in 6800 State Route 162, Maryville, IL.
Cash / Self-Pay
Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,129

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%)
Insurance Median: $4,129 (103%)
Ins. Median: $4,129 (103% 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
Tricare $520 - $6,183 13%
Humana $586 - $4,129 15%
Medicare (plans) $586 - $4,129 15%
UnitedHealthcare $586 - $4,129 15%
Work Comp $723 - $4,526 18%
Medicaid / KanCare $752 - $1,670 19%
Aetna $4,129 103%
Essence $4,196 - $4,322 105%
Devoted Health Ppo $4,211 105%
Clear Springs Health $4,253 106%
Ambetter / Centene $6,084 152%
Blue Choice $6,084 152%
Blue Cross Blue Shield $7,036 176%
Hopetrust $10,490 262%
Self Pay $25,000 625%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 6800 State Route 162, Maryville, IL 62062
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals