CMS Price Transparency Data

Breast lump removal

Facility: Munson Healthcare Otsego Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,040
Cash Discount Price: $5,504
vs. Medicare Baseline: 0.51x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Munson Healthcare Otsego Memorial Hospital is $2,040. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,504. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.51x the Medicare baseline. Located in 825 N Center Ave, Gaylord, MI.

Cash / Self-Pay

$5,504

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,040

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: $5,504 (138%)

Insurance Median: $2,040 (51%)

Cash: $5,504 (138% of Medicare)

Ins. Median: $2,040 (51% 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
Blue Cross Blue Shield	$124 - $4,044	3%
Mclaren Health Plan	$272 - $5,429	7%
Meridian	$272 - $2,040	7%
Molina	$272 - $4,213	7%
Priority Health	$272 - $3,901	7%
UnitedHealthcare	$272 - $5,186	7%
Blue Care Network	$400 - $3,901	10%
Hap (Health Alliance Plan)	$400 - $5,180	10%
Humana	$400 - $3,901	10%
Medicare (plans)	$400 - $3,901	10%
Michigan Amish Medical Board	$400 - $3,901	10%
Northern Michigan Mennonite Group	$400 - $3,901	10%
Aetna	$404 - $5,245	10%
Cigna	$582 - $1,632	15%
Asr Physicians Care Network	$599 - $5,180	15%
Nomi Health	$639 - $5,180	16%
Employee Benefit Logistics	$679 - $6,632	17%
Munson Hospice	$852 - $4,532	21%
Hospice Of Michigan	$3,885	97%
Enterprise Group Planning/Employee Benefit Plan	$5,180	129%
Cofinity	$5,504	138%
Provider Network Of America/Hawaii Mainland Administrative Group Health	$5,504	138%
Three Rivers Provider Network	$5,504	138%

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 $5,504.
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 Munson Healthcare Otsego 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.