CMS Price Transparency Data

Breast lump removal

Facility: Bellin Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $8,858
Cash Discount Price: $8,681
vs. Medicare Baseline: 2.21x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Bellin Memorial Hospital is $8,858. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $8,681. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 2.21x the Medicare baseline. Located in 744 S Webster Ave, Green Bay, WI.

Cash / Self-Pay

$8,681

Average discount available for prompt cash payment at this facility.

Insurance Median

$8,858

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: $8,681 (217%)

Insurance Median: $8,858 (221%)

Cash: $8,681 (217% of Medicare)

Ins. Median: $8,858 (221% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 221% of the Medicare baseline (a markup of 121%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$1,384 - $10,048	35%
Aetna	$3,446 - $3,484	86%
Community Care	$3,446 - $7,506	86%
Humana	$3,446 - $7,506	86%
My Choice	$3,446 - $3,484	86%
Network Health	$3,446 - $10,017	86%
UnitedHealthcare	$3,632 - $9,336	91%
Common Ground	$8,014	200%
Chorus Community Health Plan	$8,588	215%
Aspirus Arise	$9,217 - $9,630	230%
Cigna	$9,416 - $9,523	235%
Wps Insurance	$9,745 - $11,353	244%
Hps/Paymedix	$9,883 - $10,685	247%
Trilogy	$10,151	254%
Healthsmart	$10,685	267%
Ihs(Claimsbridge)	$10,685	267%
Medical College Of Wi	$10,685	267%
Multiplan	$10,685	267%
Allied National	$11,353	284%
First Health	$11,353	284%
Galaxy Health	$11,353	284%
Three Rivers Provider Network	$12,020	300%

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 $8,681.
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 Bellin Memorial 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.