CMS Price Transparency Data

Breast lump removal

Facility: Thedacare Regional Medical Center - Appleton Inc

Billing Code: 19120 (CPT)

The BaseRate · fair price low confidence

A fair price for this

$2,711

about 0.7× the $4,000 Medicare rate · typically $596–$6,692

modeled estimate · not a bill or quote

What this hospital charges insurers

$5,186

Well above the fair price

about $2,475 over the fair price · 1.3× Medicare

Medicare pays $4,000 Fair price $2,711 This hospital $5,186 Cash price $5,010 Hospital's list price $8,946

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $479 Priciest $5,186

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $2,711 (about 0.7× the $4,000 Medicare rate). Thedacare Regional Medical Center - Appleton Inc charges insurers about $5,186, or about $5,010 in cash — well above the fair price. Located in Appleton, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $2,711. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

4 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Cigna✓ Humana AetnaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$574 - $8,814	14%
Blue Cross Blue Shieldmajor	$4,504 - $5,459	113%
Cignamajor	$6,487	162%
Humanamajor	$3,427	86%
HealthPartners	$8,712	218%
+ 1 smaller / regional plan	$5,654

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 5,010), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Thedacare Regional Medical Center - Appleton Inc is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Thedacare Regional Medical Center - Appleton Inc

Compare: Breast lump removal at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.