CMS Price Transparency Data

Breast lump removal

Facility: Tomah Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 19120
  • Insurance Median: $712
  • Cash Discount Price: $761
  • vs. Medicare Baseline: 0.18x Medicare
The contracted insurance negotiated median rate for a Breast lump removal at Tomah Memorial Hospital is $712. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $761. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.18x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.
Cash / Self-Pay
$761

Average discount available for prompt cash payment at this facility.

Insurance Median
$712

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: $761 (19%)
Insurance Median: $712 (18%)
Cash: $761 (19% of Medicare)
Ins. Median: $712 (18% 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.

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
Blue Cross Blue Shield $306 - $2,160 8%
Independent Care Mcaid $306 - $2,160 8%
Managed Hlth Mcaid - All Plans $306 - $2,160 8%
Quartz Mcaid $306 - $2,160 8%
Security Hp Mcaid $306 - $2,160 8%
UnitedHealthcare $312 - $1,033 8%
Group Hlth Mcr Adv - All Plans $367 - $373 9%
Independent Care Mcr - All Other Plans $367 - $373 9%
Quartz Mcr Adv $367 - $373 9%
Security Hp Mcr Adv $367 - $373 9%
Va Ccn - All Plans $367 - $373 9%
Humana $373 - $1,436 9%
Aetna $422 - $1,320 11%
Cigna $833 - $1,506 21%
Security Hp Comm - All Other Plans $931 - $1,320 23%
Quartz Comm - All Other Plans $986 - $1,397 25%
The Alliance - All Plans $1,019 - $1,561 25%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 501 Gopher Dr, Tomah, WI 54660
  • CMS Rating: ★★★★★
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Critical Access Hospitals