CMS Price Transparency Data
Breast lump removal
Facility: Mercy Health Lakeshore Campus
Billing Code: 19120 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 19120
- Insurance Median: $3,504
- Cash Discount Price: $3,181
- vs. Medicare Baseline: 0.88x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Mercy Health Lakeshore Campus is $3,504. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,181. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.88x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$3,181
Average discount available for prompt cash payment at this facility.
Insurance Median
$3,504
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: $3,181 (80%)
Insurance Median: $3,504 (88%)
Cash: $3,181 (80% of Medicare)
Ins. Median: $3,504 (88% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Access Health | $685 - $1,028 | 17% |
| Blue Care Network Advantage | $959 - $1,439 | 24% |
| Blue Cross Blue Shield | $959 - $5,019 | 24% |
| Medicare (plans) | $959 - $1,439 | 24% |
| Aetna | $979 - $4,674 | 24% |
| Align Senior Care | $979 - $1,468 | 24% |
| Correctional Recovery | $979 - $1,468 | 24% |
| U Of M Health Plan | $1,028 - $5,255 | 26% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $1,103 - $1,655 | 28% |
| Oscar | $1,203 - $1,804 | 30% |
| Vitalcore | $1,304 - $1,957 | 33% |
| UnitedHealthcare | $1,371 - $5,285 | 34% |
| Molina Marketplace | $1,629 - $2,443 | 41% |
| Hospice Of Michigan | $2,153 - $3,230 | 54% |
| Nomi Health | $2,192 - $3,288 | 55% |
| Hap | $2,933 - $5,390 | 73% |
| Medicaid / KanCare | $2,950 - $3,008 | 74% |
| Wc Accident Fund | $3,088 - $4,631 | 77% |
| Wc Advantage | $3,088 - $4,631 | 77% |
| Wc Aig | $3,088 - $4,631 | 77% |
| Wc Allied | $3,088 - $4,631 | 77% |
| Wc Amerisure | $3,088 - $4,631 | 77% |
| Wc Amtrust | $3,088 - $4,631 | 77% |
| Wc Asu Risk Mgt | $3,088 - $4,631 | 77% |
| Wc Berkley Admin | $3,088 - $4,631 | 77% |
| Wc Broadspire | $3,088 - $4,631 | 77% |
| Wc Bunch & Associates | $3,088 - $4,631 | 77% |
| Wc Ccmsi | $3,088 - $4,631 | 77% |
| Wc Emc Insurance Company | $3,088 - $4,631 | 77% |
| Wc Esis | $3,088 - $4,631 | 77% |
| Wc Fcci | $3,088 - $4,631 | 77% |
| Wc Federated | $3,088 - $4,631 | 77% |
| Wc Gallagher Bassett | $3,088 - $4,631 | 77% |
| Wc Genex Care For Ohio | $3,088 - $4,631 | 77% |
| Wc Guard Insurance Company | $3,088 - $4,631 | 77% |
| Wc Hartford | $3,088 - $4,631 | 77% |
| Wc Liberty Mutual | $3,088 - $4,631 | 77% |
| Wc Meijers | $3,088 - $4,631 | 77% |
| Wc Michigan | $3,088 - $4,631 | 77% |
| Wc Mitchell Frankenmuth | $3,088 - $4,631 | 77% |
| Wc Pma | $3,088 - $4,631 | 77% |
| Wc Sedgwick | $3,088 - $4,631 | 77% |
| Wc Sentry | $3,088 - $4,631 | 77% |
| Wc Travelers | $3,088 - $4,631 | 77% |
| Wc Tristar | $3,088 - $4,631 | 77% |
| Wc Walmart | $3,088 - $4,631 | 77% |
| Wc Zurich | $3,088 - $4,631 | 77% |
| Geha | $3,116 - $5,285 | 78% |
| Meritain | $3,116 - $4,674 | 78% |
| Asr Health Benefits | $3,260 - $4,890 | 81% |
| Bcn Domestic | $3,346 - $5,019 | 84% |
| Blue Benefit Administrators Of Massachusetts | $3,346 - $5,019 | 84% |
| Blue Care Network | $3,346 - $5,019 | 84% |
| Blue Distinction Transplant | $3,346 - $5,019 | 84% |
| Blue Shield - Ca | $3,346 - $5,019 | 84% |
| Blue Shield - Id (Regence) | $3,346 - $5,019 | 84% |
| Blue Shield - Ny Highmark Northeastern | $3,346 - $5,019 | 84% |
| Blue Shield - Ny Highmark Western | $3,346 - $5,019 | 84% |
| Blue Shield - Pa (Highmark) | $3,346 - $5,019 | 84% |
| Blue Shield - Wa (Regence) | $3,346 - $5,019 | 84% |
| Health Choices | $3,346 - $5,255 | 84% |
| Kaiser Domestic | $3,346 - $5,019 | 84% |
| 1199 National Benefit Fund | $3,367 - $5,050 | 84% |
| Allied National Global Care | $3,367 - $5,050 | 84% |
| Asrm - Reliance Standard Life Insurance | $3,367 - $5,050 | 84% |
| Christian Care Ministry | $3,367 - $5,050 | 84% |
| Dean Health | $3,367 - $5,050 | 84% |
| Fallon Health | $3,367 - $5,050 | 84% |
| Family Life Insurance Company | $3,367 - $5,050 | 84% |
| Ghc Scw | $3,367 - $5,050 | 84% |
| Group Pension Administrators | $3,367 - $5,050 | 84% |
| International Benefit Administrators | $3,367 - $5,050 | 84% |
| Lifetime Benefit Solutions | $3,367 - $5,050 | 84% |
| Manhattan Life | $3,367 - $5,050 | 84% |
| Medi Share | $3,367 - $5,050 | 84% |
| Multiplan | $3,367 - $5,050 | 84% |
| Mvp | $3,367 - $5,050 | 84% |
| Pai | $3,367 - $5,050 | 84% |
| Pan-American Life | $3,367 - $5,050 | 84% |
| Paramount Hmo | $3,367 - $5,050 | 84% |
| Phcs | $3,367 - $5,050 | 84% |
| Trinity Health Share | $3,367 - $5,050 | 84% |
| Cigna | $3,398 - $5,096 | 85% |
| Caresource | $3,493 - $5,239 | 87% |
| Acclaim | $3,504 - $5,255 | 88% |
| Administrative Concepts | $3,504 - $5,255 | 88% |
| Allegeant | $3,504 - $5,255 | 88% |
| Allied Benefit Systems | $3,504 - $5,255 | 88% |
| Ameriben | $3,504 - $5,255 | 88% |
| American Family | $3,504 - $5,255 | 88% |
| American Healthcare Alliance | $3,504 - $5,255 | 88% |
| American Republic | $3,504 - $5,255 | 88% |
| Amerihealth | $3,504 - $5,255 | 88% |
| Aultcare | $3,504 - $5,255 | 88% |
| Automated Benefit Services | $3,504 - $5,255 | 88% |
| Auxiant | $3,504 - $5,255 | 88% |
| Benefit Administrative Systems,Llc | $3,504 - $5,255 | 88% |
| Boon Chapman | $3,504 - $5,255 | 88% |
| Cam Administrative Services | $3,504 - $5,255 | 88% |
| Christian Brother Services | $3,504 - $5,255 | 88% |
| Christian Brothers Holy Cross | $3,504 - $5,255 | 88% |
| Claimchoice Adminstrators | $3,504 - $5,255 | 88% |
| Comprehensive Benefits | $3,504 - $5,255 | 88% |
| Consociate | $3,504 - $5,255 | 88% |
| Continental Life Insurance | $3,504 - $5,255 | 88% |
| Custom Benefit Administrators | $3,504 - $5,255 | 88% |
| Cypress Benefit Administrators | $3,504 - $5,255 | 88% |
| Employee Benefit Concepts | $3,504 - $5,255 | 88% |
| Employee Benefit Management | $3,504 - $5,255 | 88% |
| Enterprise Group Planning | $3,504 - $5,255 | 88% |
| Forest County Potawatomi | $3,504 - $5,255 | 88% |
| Freedom Life Insurance Company | $3,504 - $5,255 | 88% |
| Group Administrators | $3,504 - $5,255 | 88% |
| Group Marketing Services | $3,504 - $5,255 | 88% |
| Guardian | $3,504 - $5,255 | 88% |
| Health America | $3,504 - $5,255 | 88% |
| Health Smart | $3,504 - $5,255 | 88% |
| Healthez | $3,504 - $5,255 | 88% |
| Healthgram | $3,504 - $5,255 | 88% |
| Healthscope | $3,504 - $5,255 | 88% |
| Humana | $3,504 - $5,255 | 88% |
| Insight | $3,504 - $5,255 | 88% |
| Intercare | $3,504 - $5,255 | 88% |
| Jfp Benefit Management | $3,504 - $5,255 | 88% |
| Jp Farley Corporation | $3,504 - $5,255 | 88% |
| Key Benefit Administrator | $3,504 - $5,255 | 88% |
| Liberty Union Life Assurance Co | $3,504 - $5,255 | 88% |
| Lucent Health | $3,504 - $5,255 | 88% |
| Luminare Health | $3,504 - $5,255 | 88% |
| Luminare Health (Detroit) | $3,504 - $5,255 | 88% |
| Medben | $3,504 - $5,255 | 88% |
| Medcost | $3,504 - $5,255 | 88% |
| Medical Mutual | $3,504 - $5,255 | 88% |
| Mutual Health Services | $3,504 - $5,255 | 88% |
| Mutual Of Omaha | $3,504 - $5,255 | 88% |
| Ncas | $3,504 - $5,255 | 88% |
| Nippon Life Ins | $3,504 - $5,255 | 88% |
| Nova | $3,504 - $5,255 | 88% |
| Painters Union Insurance Fund | $3,504 - $5,255 | 88% |
| Physicians Mutual | $3,504 - $5,255 | 88% |
| Plumbers Local 98 Insurance Fund | $3,504 - $5,255 | 88% |
| Prairie States | $3,504 - $5,255 | 88% |
| Primary Physician Care | $3,504 - $5,255 | 88% |
| Professional Benefit Administrators | $3,504 - $5,255 | 88% |
| Secureone Preferred United Plans | $3,504 - $5,255 | 88% |
| The Loomis Company | $3,504 - $5,255 | 88% |
| Trustmark Small Business Benefits | $3,504 - $5,255 | 88% |
| Unicare | $3,504 - $5,255 | 88% |
| Unified Group Services | $3,504 - $5,255 | 88% |
| Us Health And Life | $3,504 - $5,255 | 88% |
| Valenz | $3,504 - $5,255 | 88% |
| Varipro | $3,504 - $5,390 | 88% |
| Western & Southern Financial Group | $3,504 - $5,255 | 88% |
| Wps | $3,504 - $5,255 | 88% |
| Priority Health | $3,528 - $5,292 | 88% |
| First Health | $3,539 - $5,308 | 88% |
| Wellpath | $5,860 | 146% |