CMS Price Transparency Data

Breast lump removal

Facility: HSHS St Clare Memorial Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$1,355

about 0.3× the $4,000 Medicare rate · typically $1,096–$5,587

modeled estimate · not a bill or quote

What this hospital charges insurers

$1,555

About the fair price

about $200 over the fair price · 0.4× Medicare

Medicare pays $4,000 Fair price $1,355 This hospital $1,555 Cash price $4,423 Hospital's list price $6,701

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

On the higher side — 6 of 8 other WI hospitals charge less.

Cheapest $479 Priciest $1,955

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 $1,355 (about 0.3× the $4,000 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $1,555, or about $4,423 in cash — about the fair price. Located in Oconto Falls, WI.

What each insurance company pays

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

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

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser 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	$422	11%
Blue Cross Blue Shieldmajor	$422 - $4,557	11%
Aetnamajor	$422 - $6,701	11%
Cignamajor	$4,188	105%
Humanamajor	$422 - $5,696	11%
Health Net	$4,021	101%
Meridian	$2,160	54%
Molina	$422 - $3,350	11%
Security Health Plan	$427 - $4,277	11%
+ 16 smaller / regional plans	$2,160 - $6,701

Government programs also on file: Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

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 4,423), 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 HSHS St Clare Memorial Hospital 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 HSHS St Clare Memorial Hospital

Compare: Breast lump removal at other WI hospitals

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