CMS Price Transparency Data

Breast lump removal

Facility: Pulaski Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $568
Cash Discount Price: $866
vs. Medicare Baseline: 0.14x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Pulaski Memorial Hospital is $568. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $866. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.14x the Medicare baseline. Located in 616 E 13Th St, Winamac, IN.

Cash / Self-Pay

$866

Average discount available for prompt cash payment at this facility.

Insurance Median

$568

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: $866 (22%)

Insurance Median: $568 (14%)

Cash: $866 (22% of Medicare)

Ins. Median: $568 (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
Humana	$328 - $1,472	8%
UnitedHealthcare	$332 - $1,831	8%
Blue Cross Blue Shield	$354 - $1,831	9%
Cigna	$354 - $1,739	9%
Sagamore - All Other Plans	$354 - $1,384	9%
Sagamore Rose Acre	$354 - $1,364	9%
Ambetter / Centene	$371 - $568	9%
Caresource Mcaid Hip	$371 - $568	9%
Caresource Mcare Hmo	$371 - $568	9%
Cenpatico Mcaid Hip	$371 - $568	9%
Mhs Mcaid Hip	$371 - $568	9%
Mhs Mcare Allwell	$371 - $573	9%
Multiplan - All Plans	$371 - $1,648	9%
Caresource Mcaid Hhw	$375 - $1,831	9%
Cenpatico Mcaid Hhw - All Other Plans	$375 - $1,831	9%
Mhs Mcaid Hhw/Hcc	$375 - $1,831	9%
Mdwise Mcaid Hcc	$376 - $1,831	9%
Mdwise Mcaid Hhw	$376 - $1,831	9%
Mdwise Mcaid Hip - All Other Plans	$376 - $568	9%
Caresource Exch Hmo Hix - All Other Plans	$463 - $709	12%
Encore Ppo - All Other Plans	$501 - $1,556	13%
Encore Workers Comp	$580 - $1,648	14%
Aetna	$659	16%
Community Health Alliance - All Plans	$886 - $1,629	22%

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 $866.
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 Pulaski 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.