Breast lump removal
Facility: Oakleaf Surgical Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,878
- Cash Discount Price: $8,334
- vs. Medicare Baseline: 0.97x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
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 | $3,878 - $9,999 | 97% |
| Dean Health Plan | $3,878 | 97% |
| Group Health Cooperative Of Eau Claire | $3,878 | 97% |
| Healthpartners | $3,878 | 97% |
| Humana | $3,878 | 97% |
| Medica | $3,878 | 97% |
| Quartz Health Solutions | $3,878 | 97% |
| Security Health Plan Of Wi | $3,878 - $6,283 | 97% |
| Ucare Wi | $3,878 | 97% |
| UnitedHealthcare | $3,878 | 97% |
Consumer Guidance & Cost Commentary
For a Breast lump removal at Oakleaf Surgical Hospital in Altoona, WI, the facility's cash median rate of $8,334 is significantly higher than the Medicare benchmark of $4,000.24, reflecting the typical markup found in commercial healthcare pricing. The hospital's gross charge for this CPT code 19120 is listed at $9,260, which serves as the baseline before any discounts are applied. While the facility is a physician-owned Acute Care Hospital, the data indicates that the negotiated rates paid by commercial payers average $3,878, which is lower than the cash price but still well above the Medicare amount.
Patients should be aware that while the cash price of $8,334 is the lowest possible out-of-pocket rate for those without insurance, it may not be the most economical option for those with high-deductible plans if their insurance negotiated rate exceeds the cash price. In this case, the median negotiated rate of $3,878 is lower than the cash price, suggesting that using in-network insurance coverage would likely result in lower total costs despite potential deductibles. It is crucial to request a full itemized billing audit before finalizing any payment to ensure no unbundled codes or services not rendered are included, and to inquire about prompt-pay discounts that could further reduce the balance if paying upfront.