CMS Price Transparency Data

Breast lump removal

Facility: Caribou Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $802
Cash Discount Price: $1,203
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Caribou Medical Center is $802. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,203. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.20x the Medicare baseline. Located in 300 South 3Rd West, Soda Springs, ID.

Cash / Self-Pay

$1,203

Average discount available for prompt cash payment at this facility.

Insurance Median

$802

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: $1,203 (30%)

Insurance Median: $802 (20%)

Cash: $1,203 (30% of Medicare)

Ins. Median: $802 (20% 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	$158 - $1,756	4%
Humana	$252 - $369	6%
Pacific Source Mcr Adv	$252 - $369	6%
Regence Blue Shield Mcr	$252 - $369	6%
Select Health Mcr Adv	$252 - $369	6%
Select Health/Bright Path Mcr Adv	$252 - $838	6%
Blue Cross Blue Shield	$255 - $1,756	6%
Cigna	$627	16%
Select Health-All Other Plans	$742 - $1,756	19%
Montana Health Co-Op-All Plans	$780 - $1,756	19%
Bc Qualified Hp (Qhp)	$802 - $1,667	20%
Regence Blue Shield-All Other Plans	$909 - $1,756	23%
First Choice Health-All Plans	$1,480 - $1,613	37%
Pacific Source-All Other Plans	$1,595 - $1,738	40%
UnitedHealthcare	$1,611	40%
Deseret Healthcare-All Plans	$1,703	43%

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 $1,203.
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 Caribou Medical Center 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.