CMS Price Transparency Data

Breast lump removal

Facility: Clay County Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $426
Cash Discount Price: $1,747
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Clay County Hospital is $426. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,747. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.11x the Medicare baseline. Located in 911 Stacy Burk Dr, Flora, IL.

Cash / Self-Pay

$1,747

Average discount available for prompt cash payment at this facility.

Insurance Median

$426

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: $1,747 (44%)

Insurance Median: $426 (11%)

Cash: $1,747 (44% of Medicare)

Ins. Median: $426 (11% 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	$292 - $432	7%
Blue Cross Blue Shield	$292 - $904	7%
Meridian	$292 - $421	7%
Molina	$292	7%
Ambetter / Centene	$421	11%
Medica(Wellfirst)	$421 - $526	11%
UnitedHealthcare	$421 - $447	11%
Wellcare	$421	11%
Healthlink	$1,136 - $1,398	28%
Cigna	$1,398	35%
Usa Mco	$1,660	41%

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 $1,747.
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 Clay County 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.