CMS Price Transparency Data

Breast lump removal

Facility: University of Wi Hospitals & Clinics Authority

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $4,720
  • Cash Discount Price: $4,543
  • vs. Medicare Baseline: 1.18x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at University of Wi Hospitals & Clinics Authority is $4,720. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,543. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 1.18x the Medicare baseline. Located in 600 Highland Avenue, Madison, WI.
Cash / Self-Pay
$4,543

Average discount available for prompt cash payment at this facility.

Insurance Median
$4,720

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: $4,543 (114%)
Insurance Median: $4,720 (118%)
Cash: $4,543 (114% of Medicare)
Ins. Median: $4,720 (118% 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.

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 $2,060 - $9,591 51%
Alliance_Premier_Network $2,411 - $4,823 60%
Mercycare $2,504 - $5,008 63%
Triology $2,574 - $6,159 64%
Security_Health_Plan $2,726 - $6,411 68%
Employer'S_Coalition_On_Health $2,776 - $7,774 69%
Alliance $2,839 - $5,678 71%
Hfn $2,877 - $7,774 72%
United_Healthcare $2,892 - $8,572 72%
Beloit_Health_System $2,928 - $5,856 73%
Aspirus_Health_Plan $2,948 - $5,896 74%
Cigna $3,029 - $6,058 76%
Health_Partners_Insurance $3,079 - $6,159 77%
Health_Payment_Systems $3,094 - $6,188 77%
UnitedHealthcare $3,160 - $6,320 79%
Dean_Health_Plan $3,231 - $6,461 81%
Medical_Associates $3,332 - $6,663 83%
Wps $3,498 - $7,703 87%
Employers_Healthcare_Coalition_Of_Wi $3,534 - $7,067 88%
Aetna $3,599 - $8,097 90%
Aspirus_Network_Inc $3,887 - $7,774 97%
Humana $4,000 - $6,000 100%
Medicare (plans) $4,000 - $6,120 100%
Chorus_Community $4,038 - $8,077 101%
Ghc_Eau_Claire_Health_Plan $4,038 - $8,077 101%
Multiplan $4,038 - $9,288 101%
Sheybogan_Employers_Health_Network $4,038 - $8,077 101%
Coventry $4,291 - $8,582 107%
Dean_Care $4,291 - $8,582 107%
Healthsmart $4,442 - $8,884 111%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 600 Highland Avenue, Madison, WI 53792
  • CMS Rating: ★★★★★
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Acute Care Hospitals