CMS Price Transparency Data

Breast lump removal

Facility: Beloit Health System

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,102
Cash Discount Price: $758
vs. Medicare Baseline: 0.53x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Beloit Health System is $2,102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $758. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.53x the Medicare baseline. Located in 1969 W Hart Rd, Beloit, WI.

Cash / Self-Pay

$758

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,102

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: $758 (19%)

Insurance Median: $2,102 (53%)

Cash: $758 (19% of Medicare)

Ins. Median: $2,102 (53% 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
Cook Children'S Health Plan (Cchp)	$318 - $4,121	8%
UnitedHealthcare	$318 - $4,267	8%
Aetna	$382 - $4,121	10%
Blue Cross Blue Shield	$382 - $10,303	10%
Dean Health	$382 - $6,808	10%
Independent Care Health Plan	$382 - $4,121	10%
Quartz	$382 - $4,121	10%
Naphcare	$573 - $6,181	14%
Wea Trust	$963 - $1,927	24%
Multiplan	$1,401 - $2,803	35%
Humana	$1,412 - $15,328	35%
Health Eos	$1,594 - $3,188	40%
The Alliance	$1,624 - $16,482	41%
Cigna	$1,664 - $3,329	42%
Hfn	$1,664 - $3,329	42%
Preferred Network Access	$1,664 - $3,329	42%
Wps	$1,719 - $2,595	43%
Managed Health Services	$4,121	103%
Molina Healthcare	$4,121	103%
Wellcare	$4,121	103%

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 $758.
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 Beloit Health System 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.