CMS Price Transparency Data

Breast lump removal

Facility: Perham Health

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $538
Cash Discount Price: $617
vs. Medicare Baseline: 0.13x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Perham Health is $538. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $617. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.13x the Medicare baseline. Located in 1000 Coney Street West, Perham, MN.

Cash / Self-Pay

$617

Average discount available for prompt cash payment at this facility.

Insurance Median

$538

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: $617 (15%)

Insurance Median: $538 (13%)

Cash: $617 (15% of Medicare)

Ins. Median: $538 (13% 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
Medica Mcaid Mn Care	$232 - $579	6%
Ucare Mn Special Needs Basic Care Dual	$257 - $565	6%
Medica Mn (Msho)	$261 - $652	7%
Ucare Mn Medical Assistance	$282 - $570	7%
Ucare Mn Minnesota Care	$282 - $570	7%
Ucare Mn Senior Care Plus	$282 - $570	7%
Ucare Mn Special Needs Basic Care	$282 - $570	7%
Health Partners Minnesota Care	$316 - $791	8%
Ucare Mn Senior Health Options	$316 - $538	8%
Medica Mn Senior Hp/Outside Mn	$323 - $484	8%
Preferred One (Pchp, Pic, Pas)-All Other Plans	$348 - $1,186	9%
Blue Cross Blue Shield	$379 - $1,070	9%
Health Partners Mcr Adv	$379 - $538	9%
Humana	$379 - $538	9%
Medicare (plans)	$379 - $633	9%
Ucare Individual And Family Plan-All Other Plans	$410 - $791	10%
Medica Mcr Adv	$435 - $538	11%
Medica Commercial-All Other Plans	$463 - $1,158	12%
UnitedHealthcare	$481 - $1,234	12%
Health Partners-All Plans	$519 - $1,297	13%
Preferred One (Ppo)	$538 - $1,345	13%
Medicaid / KanCare	$570 - $977	14%
Sanford Health Plan-All Plans	$912 - $1,345	23%

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 $617.
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 Perham 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.