CMS Price Transparency Data

Breast lump removal

Facility: Cherry County Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,331
Cash Discount Price: $2,091
vs. Medicare Baseline: 0.33x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cherry County Hospital is $1,331. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,091. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.33x the Medicare baseline. Located in 510 North Green St, Valentine, NE.

Cash / Self-Pay

$2,091

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,331

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: $2,091 (52%)

Insurance Median: $1,331 (33%)

Cash: $2,091 (52% of Medicare)

Ins. Median: $1,331 (33% 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
Molina Mcaid - All Other Plans	$378 - $1,748	9%
Molina Mcr Adv	$383 - $1,534	10%
Ambetter / Centene	$548	14%
Blue Cross Blue Shield	$605 - $2,697	15%
Midwest Ntwrk Profee Only - All Plans	$730	18%
Oscar Profee Only - All Plans	$730	18%
UnitedHealthcare	$779 - $2,711	19%
Midlands Choice-All Plans	$780 - $2,697	19%
First Choice-All Plans	$1,331 - $2,725	33%
Multiplan-All Plans	$1,331 - $2,725	33%
Phcs-All Plans	$1,331 - $2,725	33%
Tlc Advantage-All Plans	$1,331 - $2,725	33%
Avera Aca Ppo	$2,725	68%
Avera Aso Ppo	$2,725	68%
Avera Hmo	$2,725	68%
Avera Non-Aca Ppo - All Other Plans	$2,725	68%

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 $2,091.
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 Cherry County 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.