CMS Price Transparency Data

Breast lump removal

Facility: Pawnee County Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,016
Cash Discount Price: $874
vs. Medicare Baseline: 0.25x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Pawnee County Memorial Hospital is $1,016. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $874. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.25x the Medicare baseline. Located in 600 I Street, Pawnee City, NE.

Cash / Self-Pay

$874

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,016

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: $874 (22%)

Insurance Median: $1,016 (25%)

Cash: $874 (22% of Medicare)

Ins. Median: $1,016 (25% 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
Aetna	$754 - $1,027	19%
Blue Cross Blue Shield	$754 - $1,038	19%
Medica Choice	$754 - $995	19%
UnitedHealthcare	$754 - $1,038	19%
Ambetter / Centene	$1,016	25%
Medica Ifb	$1,049	26%
Midlands Choice	$1,049	26%

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 $874.
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 Pawnee County 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.