CMS Price Transparency Data

Breast lump removal

Facility: Prisma Health Laurens County Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $7,001
Cash Discount Price: $7,110
vs. Medicare Baseline: 1.75x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Prisma Health Laurens County Hospital is $7,001. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $7,110. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.75x the Medicare baseline. Located in 22725 Highway 76 East, Clinton, SC.

Cash / Self-Pay

$7,110

Average discount available for prompt cash payment at this facility.

Insurance Median

$7,001

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: $7,110 (178%)

Insurance Median: $7,001 (175%)

Cash: $7,110 (178% of Medicare)

Ins. Median: $7,001 (175% 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
Medicaid / KanCare	$1,685 - $1,917	42%
UnitedHealthcare	$1,685 - $12,943	42%
First Choice Benefits Mgmt [3074]	$1,825	46%
Medicare (plans)	$1,825	46%
Humana	$1,953	49%
Blue Cross Blue Shield	$2,089 - $10,885	52%
Bluechoice [810]	$2,494 - $11,468	62%
Prisma Health Seniorcare Pace - Midlands [5400]	$2,538	63%
Prisma Health Seniorcare Pace-Upstate [5200]	$2,538	63%
Promise Health Plan Contracted [2401]	$3,829 - $6,563	96%
Orangeburg Senior Helping Center Pace [5401]	$4,376	109%
Sc Dept Of Corrections [2998]	$4,573	114%
Scdc-Sc Dept Of Corrections [7232]	$4,573	114%
Bob Jones Univ-Pai [821]	$6,563	164%
Aetna	$7,001 - $8,642	175%
Meritain Health Contracted [2200]	$7,001 - $8,642	175%
Cigna	$7,592	190%
Evernorth Behavioral Contracted [2982]	$7,592	190%
Mvp Health Care [3037]	$7,592	190%
Preferred Administrators Contracted [2839]	$7,657	191%
Medcost [2940]	$8,095 - $9,079	202%
Atlantic Packaging Contracted [4833]	$8,204	205%
Aps Healthcare System [2981]	$8,751	219%
Multiplan/Phcs Contracted [2950]	$9,736	243%
Vsp Vision Care [2986]	$9,845	246%
First Health Contracted [2952]	$10,173	254%
Furman Int/Allen University Student [2951]	$10,173	254%
Quiktrip-First Health [3067]	$10,173	254%
Planned Administrators [820]	$10,885	272%
Golden Rule Insurance Company [2991]	$12,943	324%
Oxford Health Plans [2992]	$12,943	324%
Zzumr-Salt Lake City Ut [3169]	$12,943	324%

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 $7,110.
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 Prisma Health Laurens 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.