CMS Price Transparency Data

Breast lump removal

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $813
Cash Discount Price: $868
vs. Medicare Baseline: 0.20x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $813. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $868. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.20x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

$868

Average discount available for prompt cash payment at this facility.

Insurance Median

$813

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: $868 (22%)

Insurance Median: $813 (20%)

Cash: $868 (22% of Medicare)

Ins. Median: $813 (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
The Alliance	$464	12%
Security Health Plan (Shp)	$475 - $3,650	12%
Amish/Mennonite	$503	13%
Quartz	$521 - $3,650	13%
Wps Health Insurance	$615	15%
Cigna	$622	16%
Health Payment Systems	$636	16%
UnitedHealthcare	$685 - $3,650	17%
Humana	$722 - $3,650	18%
Group Health Cooperative Of Eau Claire	$749 - $3,869	19%
Network Health Plan	$763 - $3,650	19%
First Health	$777	19%
Molina Healthcare Of Wi	$777 - $3,650	19%
Trilogy	$823	21%
Healtheos By Multiplan Inc.	$850 - $868	21%
Health Partners	$868	22%
Coventry	$877	22%
Managed Health Services	$3,650	91%
Veteran'S Administration (Va Ccn)	$3,650	91%
Blue Cross Blue Shield	$3,760	94%
Icare	$3,906	98%

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 $868.
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 Marshfield Medical Center - Beaver Dam (Mmc-Bd) 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.