CMS Price Transparency Data

Breast lump removal

Facility: Hamilton Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $572
Cash Discount Price: $1,151
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Hamilton Memorial Hospital is $572. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,151. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$1,151

Average discount available for prompt cash payment at this facility.

Insurance Median

$572

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: $1,151 (29%)

Insurance Median: $572 (14%)

Cash: $1,151 (29% of Medicare)

Ins. Median: $572 (14% 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
Aetna	$284 - $572	7%
Blue Cross Blue Shield	$284 - $572	7%
Medicaid / KanCare	$284 - $572	7%
Meridian Health	$284	7%
Health Alliance	$572	14%
Medicare (plans)	$572	14%
UnitedHealthcare	$572	14%
Wellcare	$572	14%
Alliance Coal	$600	15%
Hfn, Inc	$1,023 - $1,151	26%
Hope Trust	$1,143	29%
Multiplan	$1,143	29%
Three Rivers Provider	$1,151	29%
Stratose	$1,215	30%

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 $1,151.
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 Hamilton Memorial 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.