CMS Price Transparency Data

Breast lump removal

Facility: Stoughton Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $743
Cash Discount Price: $1,089
vs. Medicare Baseline: 0.19x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Stoughton Hospital is $743. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,089. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.19x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$1,089

Average discount available for prompt cash payment at this facility.

Insurance Median

$743

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: $1,089 (27%)

Insurance Median: $743 (19%)

Cash: $1,089 (27% of Medicare)

Ins. Median: $743 (19% 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
Healthnet Mcr Adv - All Plans	$312	8%
Tricare	$312	8%
Aetna	$367 - $1,545	9%
Dean Health Insurance Med Adv	$367	9%
Quartz Mcr Adv	$367	9%
Security Health/First Health - All Plans	$367	9%
UnitedHealthcare	$367 - $1,584	9%
Humana	$449 - $1,782	11%
Medicaid / KanCare	$743	19%
Blue Cross Blue Shield	$779	19%
Quartz Health Solutions - All Other Lans	$840	21%
Alliance - All Plans	$1,359	34%
Wps - All Plans	$1,390	35%
Geha - All Plans	$1,485	37%
Cigna	$1,584	40%
Wisconsin Ppo Ppa Direct - All Plans	$1,584	40%

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 $1,089.
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 Stoughton Hospital 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.