CMS Price Transparency Data

Breast lump removal

Facility: Fort Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,690
Cash Discount Price: $1,888
vs. Medicare Baseline: 0.92x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Fort Memorial Hospital is $3,690. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,888. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.92x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$1,888

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,690

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: $1,888 (47%)

Insurance Median: $3,690 (92%)

Cash: $1,888 (47% of Medicare)

Ins. Median: $3,690 (92% 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
Molina	$401 - $3,690	10%
UnitedHealthcare	$483 - $3,690	12%
Blue Cross Blue Shield	$549 - $4,186	14%
Dean Health Plan	$549 - $7,419	14%
Medicaid / KanCare	$549	14%
Quartz	$549 - $3,983	14%
Managed Health Services	$598	15%
Group Health Cooperative	$801 - $3,776	20%
Fort Care	$1,260	31%
Aetna	$2,354 - $4,378	59%
Humana	$3,690 - $8,014	92%
Medicare (plans)	$3,690	92%
Alliance	$4,189	105%
Mercycare	$4,346	109%
Veteran Evaluation Services	$4,411	110%
Trilogy	$5,133	128%
Cigna	$5,546	139%
Centivo	$8,469 - $8,822	212%

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 $1,888.
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 Fort 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.