CMS Price Transparency Data

Breast lump removal

Facility: St Luke's Wood River Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $9,145
Cash Discount Price: $10,392
vs. Medicare Baseline: 2.29x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at St Luke's Wood River Medical Center is $9,145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $10,392. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.29x the Medicare baseline. Located in 100 Hospital Drive, Ketchum, ID.

Cash / Self-Pay

$10,392

Average discount available for prompt cash payment at this facility.

Insurance Median

$9,145

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: $10,392 (260%)

Insurance Median: $9,145 (229%)

Cash: $10,392 (260% of Medicare)

Ins. Median: $9,145 (229% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 229% of the Medicare baseline (a markup of 129%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Commercial [1028]	$5,923 - $10,080	148%
Medicare (plans)	$5,923 - $6,042	148%
Veterans Affairs [1056]	$5,923	148%
Blue Cross Blue Shield	$5,983	150%
UnitedHealthcare	$6,220 - $9,405	155%
Aetna	$6,516 - $9,872	163%
Moda [1055]	$9,145	229%
Geha [1065]	$9,405	235%
United Medical Resources [1051]	$9,405	235%
Pacificsource [1020]	$9,768	244%
First Health [1064]	$9,872 - $10,080	247%
Webtpa [1071]	$9,872	247%

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 $10,392.
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 St Luke's Wood River 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.