CMS Price Transparency Data

Breast lump removal

Facility: Rush Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $374
Cash Discount Price: $205
vs. Medicare Baseline: 0.09x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Rush Memorial Hospital is $374. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.09x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$374

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: $205 (5%)

Insurance Median: $374 (9%)

Cash: $205 (5% of Medicare)

Ins. Median: $374 (9% 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
Cigna	$64 - $224	2%
Health Net	$64 - $224	2%
Coventry/First Health-All Plans	$89 - $314	2%
UnitedHealthcare	$323 - $371	8%
Aetna	$342 - $374	9%
Consumers Life Ins-All Plans	$342	9%
Caresource Mcr Adv	$371	9%
Humana	$374 - $375	9%
Blue Cross Blue Shield	$382 - $586	10%
Today'S Option Mcr Adv-All Plans	$382	10%
Viant Beech St Mcr Adv	$382	10%
My True Advantage - All Plans	$389	10%
Phcs-All Plans	$478	12%
Caresource Marketplace-All Other Plans	$501	13%
Multiplan-All Plans	$790	20%
Encore Health Services-All Plans	$860	21%
Siho-All Plans	$860	21%

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 $205.
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 Rush 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.