CMS Price Transparency Data
Breast lump removal
Facility: Mercy Hospital Carthage
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $607
- Cash Discount Price: $1,078
- vs. Medicare Baseline: 0.15x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Mercy Hospital Carthage is $607. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,078. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.15x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$1,078
Average discount available for prompt cash payment at this facility.
Insurance Median
$607
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: $1,078 (27%)
Insurance Median: $607 (15%)
Cash: $1,078 (27% of Medicare)
Ins. Median: $607 (15% 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.
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 |
|---|---|---|
| Medicaid / KanCare | $394 - $3,410 | 10% |
| Medicare (plans) | $399 - $486 | 10% |
| Aetna | $406 - $3,410 | 10% |
| Blue Cross Blue Shield | $406 - $552 | 10% |
| Centivo Contracted [320505] | $406 | 10% |
| Dept Of Veteran Affairs Contracted [320106] | $406 | 10% |
| UnitedHealthcare | $406 - $667 | 10% |
| Cherokee Nation Health Serv Contracted [320066] | $455 | 11% |
| Cigna | $455 - $607 | 11% |
| Cross Timbers Hospice [20098] | $455 | 11% |
| Elara Caring Aspire Hospice [20433] | $455 | 11% |
| Globalhealth Contracted [320145] | $455 | 11% |
| Halo Hcr Inc Hospice Contracted [320432] | $455 | 11% |
| Halo Hcr Inc Hospice [20432] | $455 | 11% |
| Humana | $455 - $3,410 | 11% |
| Indian Health Service Contracted [320198] | $455 | 11% |
| Kindful Hospice Contracted [320434] | $455 | 11% |
| Kindful Hospice [20434] | $455 | 11% |
| Medical Associates Health Contracted [320444] | $455 | 11% |
| Mercy Hospice Okc [20252] | $455 | 11% |
| Mercy Mgd Behavioral Health Contracted [320259] | $455 | 11% |
| Pace Of The Ozarks Contracted [320518] | $455 | 11% |
| Provider Partners Health Plans Contracted [320450] | $455 | 11% |
| Qual Choice Contracted [320325] | $455 | 11% |
| Tricare | $457 | 11% |
| Point C Contracted [320238] | $518 - $1,492 | 13% |
| United Medical Resources Contracted [320454] | $537 - $1,492 | 13% |
| Healthlink Contracted [320179] | $564 - $1,409 | 14% |
| Ambetter / Centene | $574 | 14% |
| Home State Health Plan Contracted [320187] | $574 | 14% |
| Novasys Contracted [320285] | $574 | 14% |
| First Health Contracted [320128] | $641 | 16% |
| Multiplan Contracted [320270] | $667 | 17% |
| Private Health Care Systems Contracted [320320] | $667 | 17% |
| Health Systems Inc Contracted [320174] | $713 | 18% |
| Insurance System Inc Contracted [320465] | $713 | 18% |
| Administrative Payor Contracted [320005] | $746 | 19% |
| Healthscope Contracted [320182] | $864 | 22% |
| Benefit Management Contracted [320052] | $995 - $1,442 | 25% |
| Auxiant Contracted [320462] | $1,078 - $1,409 | 27% |
| Preferred Health Plan Contracted [320522] | $1,078 | 27% |
| American Healthcare Alliance Contracted [320020] | $1,161 | 29% |
| Workers Comp [20426] | $1,326 - $1,658 | 33% |
| Aither Health Contracted [320449] | $1,409 | 35% |
| Ebms Contracted [320493] | $1,409 | 35% |
| Edison Health Solutions Contracted [320502] | $1,409 | 35% |
| Imagine 360 Contracted [320494] | $1,409 | 35% |
| Mercy Benefit Admin Contracted [320251] | $1,409 - $1,492 | 35% |
| Reflect Health Contracted [320492] | $1,409 | 35% |
| Show-Me Health Administrators Contracted [320483] | $1,409 | 35% |
| Yuzu Health Contracted [320521] | $1,409 | 35% |
| Evolutions Health Care Contracted [320124] | $1,442 | 36% |
| Ppo Plus Contracted [320310] | $1,492 | 37% |
| Usa Managed Care Org Contracted [320429] | $1,492 | 37% |
| Health Choice Contracted [320166] | $7,659 | 191% |