CMS Price Transparency Data

Breast lump removal

Facility: Marshfield Medical Center - Weston

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $868
Cash Discount Price: $868
vs. Medicare Baseline: 0.22x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Marshfield Medical Center - Weston is $868. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $868. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.22x the Medicare baseline. Located in 3400 Ministry Parkway, Weston, WI.

Cash / Self-Pay

$868

Average discount available for prompt cash payment at this facility.

Insurance Median

$868

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: $868 (22%)

Insurance Median: $868 (22%)

Cash: $868 (22% of Medicare)

Ins. Median: $868 (22% 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
Family Health Center (Fhc)	$457	11%
Amish/Mennonite	$503	13%
Sanford Health Plan	$503	13%
The Alliance	$704 - $7,803	18%
Group Health Cooperative Of Eau Claire	$749 - $3,854	19%
UnitedHealthcare	$755 - $3,636	19%
Besse Forest Products	$777	19%
Molina Healthcare Of Wi	$777	19%
Rice Lake School District	$777	19%
Wps Health Insurance	$809 - $882	20%
Medica Of Wi	$852 - $870	21%
Cigna	$859	21%
Healtheos By Multiplan Inc.	$859 - $868	21%
Corvel	$868	22%
First Health	$868	22%
Health Partners	$868	22%
Three Rivers Provider Network (Trpn)	$868	22%
Trilogy	$873 - $877	22%
Coventry	$877	22%
Health Smart	$877	22%
Rising Medical Work Comp	$887	22%
Security Health Plan (Shp)	$3,636 - $7,305	91%
Veteran'S Administration (Va Ccn)	$3,636	91%
Blue Cross Blue Shield	$3,745 - $7,621	94%

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 $868.
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 Marshfield Medical Center - Weston 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.