CMS Price Transparency Data

Breast lump removal

Facility: Mercy Hospital Carthage

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$579

about 0.1× the $4,000 Medicare rate · typically $579–$2,072

modeled estimate · not a bill or quote

What this hospital charges insurers

$537

About the fair price

about $42 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $579 This hospital $537 Cash price $1,078 Hospital's list price $1,658

How we calculate the fair BaseRate →

How this hospital compares to other MO hospitals

Highest price of the 9 MO hospitals we have prices for — worth calling around.

Cheapest $445 Priciest $537

Black dot = this hospital, among the 9 MO hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $579 (about 0.1× the $4,000 Medicare rate). Mercy Hospital Carthage charges insurers about $537, or about $1,078 in cash — about the fair price. Located in Carthage, MO.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$406 - $1,492	10%
Blue Cross Blue Shieldmajor	$406 - $552	10%
Aetnamajor	$406 - $3,410	10%
Cignamajor	$455 - $607	11%
Humanamajor	$455 - $3,410	11%
Ambetter (Centene)	$574	14%
HealthLink	$564 - $1,409	14%
+ 36 smaller / regional plans	$406 - $7,659

Government programs also on file: Medicare, Medicaid, Military & VA.

Excludes 8 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 1,078), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Mercy Hospital Carthage is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Mercy Hospital Carthage

Compare: Breast lump removal at other MO hospitals

Insurance negotiated median for the same procedure, sorted lowest first.