CMS Price Transparency Data

Breast lump removal

Facility: Gundersen Lutheran Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,860
Cash Discount Price: $2,046
vs. Medicare Baseline: 0.96x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Gundersen Lutheran Medical Center is $3,860. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,046. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.96x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$2,046

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,860

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: $2,046 (51%)

Insurance Median: $3,860 (96%)

Cash: $2,046 (51% of Medicare)

Ins. Median: $3,860 (96% 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
Amerigroup	$571 - $3,793	14%
Blue Cross Blue Shield	$571 - $11,270	14%
Group Health Eau Claire	$571 - $4,885	14%
Group Health Of South Central	$571 - $4,342	14%
Icare	$571 - $3,793	14%
Iowa Total Care	$571	14%
Managed Health Service	$571	14%
Molina Health	$571	14%
UnitedHealthcare	$571 - $4,424	14%
Medica	$1,813 - $4,158	45%
Dean Health Plan	$2,274	57%
Quartz	$2,296	57%
Health Partners	$2,714 - $4,793	68%
Ucare	$3,632 - $4,342	91%
Aetna	$3,793 - $5,157	95%
Medical Associates	$3,793 - $4,017	95%
Midland Choice	$4,071	102%
Alliance	$4,260 - $4,563	106%
Claim Doc Llc	$4,342	109%
Wps Narrow Network	$4,402	110%
Cigna	$4,451	111%
Wps - Arise	$4,462	112%
Aspirus Arise Health	$4,505	113%
Wps Statewide	$4,608	115%
Allied National General	$4,614	115%
Preferred One	$4,614	115%
Coventry Health Care	$5,157	129%
Humana	$5,157	129%
Multiplan/Healtheos	$5,211	130%

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 $2,046.
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 Gundersen Lutheran Medical Center 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.