CMS Price Transparency Data

Breast lump removal

Facility: Charlevoix Area Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,104
Cash Discount Price: $5,503
vs. Medicare Baseline: 0.78x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Charlevoix Area Hospital is $3,104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $5,503. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.78x the Medicare baseline. Located in 14700 Lakeshore Drive, Charlevoix, MI.

Cash / Self-Pay

$5,503

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,104

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: $5,503 (138%)

Insurance Median: $3,104 (78%)

Cash: $5,503 (138% of Medicare)

Ins. Median: $3,104 (78% 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 - $5,980	3%
Mclaren Health Plan	$272 - $6,027	7%
Meridian	$272 - $2,763	7%
Priority Health	$272 - $6,474	7%
UnitedHealthcare	$272 - $5,626	7%
Aetna	$400 - $5,846	10%
Blue Care Network	$400 - $3,043	10%
Hap (Health Alliance Plan)	$400 - $5,879	10%
Medicare (plans)	$400 - $3,043	10%
Michigan Amish Medical Board	$400 - $3,043	10%
Molina	$400 - $3,286	10%
Northern Michigan Mennonite Group	$400 - $3,043	10%
Cigna	$582 - $6,474	15%
Asr Physicians Care Network	$599 - $5,179	15%
Nomi Health	$639 - $6,021	16%
Employee Benefits Logistics	$679 - $5,173	17%
Hospice Of Michigan	$3,884	97%
Enterprise Group Planning Employee Benefit Plan	$5,179	129%
First Health/Coventry Health/Community Care Network	$5,179	129%
Medical Cost Savings Solution	$5,179	129%
Provider Network Of America/Hma Group Health	$5,487 - $5,503	137%
Three Rivers Provider Network	$5,503	138%
Iba Health And Life Assurance Company	$5,956	149%
Cofinity	$6,021	151%
Preferred Medical Claim Solutions	$6,150	154%

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 $5,503.
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 Charlevoix Area 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.