CMS Price Transparency Data

Breast lump removal

Facility: McLaren Flint

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,387
Cash Discount Price: $3,175
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at McLaren Flint is $1,387. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,175. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.35x the Medicare baseline. Located in 401 S Ballenger Highway, Flint, MI.

Cash / Self-Pay

$3,175

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,387

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: $3,175 (79%)

Insurance Median: $1,387 (35%)

Cash: $3,175 (79% of Medicare)

Ins. Median: $1,387 (35% 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	$272 - $2,157	7%
Humana	$400 - $3,735	10%
Medicare (plans)	$400 - $5,975	10%
Hap - Hmo	$414	10%
Mclaren Commercial Ins	$418	10%
Bcccnp	$423	11%
U Of M Health Plan	$460	11%
Aetna	$496	12%
UnitedHealthcare	$521	13%
Priority Health	$549	14%
Blue Cross Blue Shield	$680 - $3,436	17%
Tricare	$3,651	91%
Mi Amish Medical Board	$3,735	93%

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 $3,175.
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 McLaren Flint 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.