CMS Price Transparency Data

Breast lump removal

Facility: Boone Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $540
Cash Discount Price: $2,565
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Boone Memorial Hospital is $540. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,565. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.13x the Medicare baseline. Located in 701 Madison Avenue, Madison, WV.

Cash / Self-Pay

$2,565

Average discount available for prompt cash payment at this facility.

Insurance Median

$540

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: $2,565 (64%)

Insurance Median: $540 (13%)

Cash: $2,565 (64% of Medicare)

Ins. Median: $540 (13% 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	$106 - $2,972	3%
Cigna	$263 - $7,391	7%
Aetna	$334 - $9,412	8%
Medicare (plans)	$345 - $2,718	9%
Humana	$352 - $2,718	9%
Blue Cross Blue Shield	$468 - $2,774	12%

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 $2,565.
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 Boone 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.