CMS Price Transparency Data

Breast lump removal

Facility: Lakewood Health System

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $447
Cash Discount Price: $673
vs. Medicare Baseline: 0.11x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Lakewood Health System is $447. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $673. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.11x the Medicare baseline. Located in 49725 County Road 83, Staples, MN.

Cash / Self-Pay

$673

Average discount available for prompt cash payment at this facility.

Insurance Median

$447

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: $673 (17%)

Insurance Median: $447 (11%)

Cash: $673 (17% of Medicare)

Ins. Median: $447 (11% 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
Ucare Msho/Special Needs	$258 - $447	6%
Blue Cross Blue Shield	$379 - $799	9%
Humana	$379 - $439	9%
Ucare Mcr Adv	$379 - $447	9%
UnitedHealthcare	$379 - $967	9%
Medica Msho/Mcr Adv	$395 - $434	10%
Ucare Individual/Family - All Other Plans	$500 - $606	12%
Medica Choice Care	$530 - $676	13%
Medica Choice/Focus/Ifb/Mhps - All Other Plans	$676 - $972	17%
Preferred One Hmo	$787 - $1,032	20%
Preferred One Ppo - All Other Plans	$834 - $1,032	21%
Health Partners - All Plans	$985 - $1,021	25%

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 $673.
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 Lakewood Health System 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.