CMS Price Transparency Data

Breast lump removal

Facility: St Josephs Community Hospital West Bend

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$4,829

about 1.2× the $4,000 Medicare rate · typically $2,485–$9,613

modeled estimate · not a bill or quote

What this hospital charges insurers

$3,718

Below the fair price — a good deal

about $1,111 under the fair price · 0.9× Medicare

Medicare pays $4,000 Fair price $4,829 This hospital $3,718 Cash price $5,905 Hospital's list price $10,737

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $479 Priciest $3,718

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $4,829 (about 1.2× the $4,000 Medicare rate). St Josephs Community Hospital West Bend charges insurers about $3,718, or about $5,905 in cash — below the fair price — a good deal. Located in West Bend, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$3,543 - $8,783	89%
Blue Cross Blue Shieldmajor	$3,718 - $9,126	93%
Aetnamajor	$3,793 - $7,516	95%
Cignamajor	$10,200	255%
Humanamajor	$3,718	93%
Health Net	$8,135	203%
HealthPartners	$3,718 - $6,979	93%
Molina	$3,718	93%
Security Health Plan	$3,718	93%
+ 15 smaller / regional plans	$3,221 - $9,663

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 5,905), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm St Josephs Community Hospital West Bend is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Josephs Community Hospital West Bend

Compare: Breast lump removal at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.