CMS Price Transparency Data

Breast lump removal

Facility: Hammond Henry Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $690
Cash Discount Price: $1,281
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Hammond Henry Hospital is $690. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,281. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.17x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$1,281

Average discount available for prompt cash payment at this facility.

Insurance Median

$690

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: $1,281 (32%)

Insurance Median: $690 (17%)

Cash: $1,281 (32% of Medicare)

Ins. Median: $690 (17% 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
Multiplan Phcs Adult	$90 - $1,971	2%
Multiplan Phcs Pediatric	$90 - $1,971	2%
Tricare	$200 - $379	5%
Aetna	$222 - $3,173	6%
Health Alliance Mcare Adv	$222 - $421	6%
UnitedHealthcare	$222 - $583	6%
Humana	$225 - $1,971	6%
Ambetter / Centene	$334 - $1,533	8%
Quad City Community Hc-All Plans	$384 - $1,095	10%
Wellmark Of Ia-All Plans	$384 - $1,095	10%
Blue Cross Blue Shield	$422 - $3,173	11%
Springfield Armory-All Plans	$499 - $1,424	12%
Health Alliance-All Other Plans	$547 - $1,642	14%
Multiplan Integrated Hp	$575 - $1,642	14%
Multiplan Pponext	$614 - $1,752	15%
Osf Direct Access Network-All Plans	$614 - $1,752	15%
Multiplan-All Other Plans	$652 - $1,862	16%
Corvel-All Plans	$690 - $1,971	17%
Healthsmart Adult-All Other Plans	$690 - $1,971	17%
Healthsmart Pediatric	$690 - $1,971	17%
Hfn-All Plans	$690 - $1,971	17%
Multiplan Beech Street	$690 - $1,971	17%
Usa Mco-All Plans	$690 - $1,971	17%
Meridian Health Plan-All Plans	$1,423 - $3,173	36%
Cigna	$1,988	50%

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 $1,281.
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 Hammond Henry Hospital 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.