CMS Price Transparency Data

Breast lump removal

Facility: Astera Health

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $804
Cash Discount Price: $1,124
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Astera Health is $804. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,124. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.20x the Medicare baseline. Located in 421 11Th Street Nw, Wadena, MN.

Cash / Self-Pay

$1,124

Average discount available for prompt cash payment at this facility.

Insurance Median

$804

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: $1,124 (28%)

Insurance Median: $804 (20%)

Cash: $1,124 (28% of Medicare)

Ins. Median: $804 (20% 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 Pmap [30006]	$287 - $4,920	7%
Blue Plus Pmap [40002]	$296 - $484	7%
Health Partners Pmap [10046]	$296 - $6,799	7%
Medica Pmap [10057]	$296 - $5,407	7%
Primewest Pmap [30003]	$296 - $5,407	7%
Sanford Health Plan [10120]	$296 - $11,489	7%
Blue Cross Blue Shield	$484 - $10,279	12%
Health Partners [10045]	$484 - $9,664	12%
Medica Nonpmap [10056]	$484 - $121,223	12%
Primewest Non Pmap [30004]	$484	12%
Ucare Non Pmap [30007]	$484 - $5,677	12%
UnitedHealthcare	$515 - $10,448	13%
Ucare Commercial [10705]	$1,157 - $10,048	29%
Multiplan	$1,245 - $10,813	31%
Aetna	$1,401 - $12,165	35%

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 $1,124.
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 Astera Health 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.