CMS Price Transparency Data

Breast lump removal

Facility: Harrison County Community Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,668
Cash Discount Price: $2,990
vs. Medicare Baseline: 0.67x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Harrison County Community Hospital is $2,668. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,990. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.67x the Medicare baseline. Located in 2600 Miller Street, Bethany, MO.

Cash / Self-Pay

$2,990

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,668

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: $2,990 (75%)

Insurance Median: $2,668 (67%)

Cash: $2,990 (75% of Medicare)

Ins. Median: $2,668 (67% 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	$367 - $3,680	9%
Cigna	$387 - $3,680	10%
Provider Partners Health Plans	$387 - $2,881	10%
Care Improvement Plus	$399 - $2,668	10%
Blue Cross Blue Shield	$414 - $4,048	10%
Allwell	$445 - $2,668	11%
Ambetter / Centene	$445 - $2,668	11%
Blue Advantage Plus	$445 - $2,668	11%
Humana	$445 - $4,140	11%
UnitedHealthcare	$445 - $4,160	11%
Aetna	$542 - $4,048	14%
Wellmark	$544 - $3,680	14%
6 Degrees Health	$561 - $3,680	14%
Healthy Blue	$3,923 - $4,160	98%
Home State	$3,923 - $4,160	98%

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 $2,990.
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 Harrison County Community 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.