CMS Price Transparency Data

Breast lump removal

Facility: University of Iowa Health Care Medical Center Down

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $2,157
Cash Discount Price: $3,020
vs. Medicare Baseline: 0.54x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at University of Iowa Health Care Medical Center Down is $2,157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,020. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.54x the Medicare baseline. Located in 500 E Market Street, Iowa City, IA.

Cash / Self-Pay

$3,020

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,157

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: $3,020 (75%)

Insurance Median: $2,157 (54%)

Cash: $3,020 (75% of Medicare)

Ins. Median: $2,157 (54% 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
Aetna	$372 - $3,603	9%
Iowa Total Care	$372 - $3,747	9%
Medical Associates	$372 - $2,890	9%
Molina Healthcare	$372 - $1,726	9%
UnitedHealthcare	$372 - $7,682	9%
Blue Cross Blue Shield	$376 - $3,639	9%
Healthpartners	$379 - $3,675	9%
Wellpoint (Amerigroup)	$391 - $3,783	10%
Immergrun	$508 - $1,078	13%
Aplos Health Plan	$1,064 - $3,451	27%
Quad City Community Healthcare	$1,066 - $3,236	27%
Midlands Choice	$1,181 - $2,804	30%
Oscar Health	$1,281 - $2,718	32%
Great River Health Systems	$1,423 - $3,020	36%
Sedgwick	$1,626 - $3,451	41%
Global Excel	$1,728 - $3,667	43%
Sanford Health Plan	$1,728 - $3,667	43%
Employee Benefit Systems	$1,789 - $3,883	45%
Sisco	$1,789 - $3,796	45%
Healthsmart	$1,830 - $3,883	46%
Hfn	$1,870 - $3,969	47%
Multiplan	$1,870 - $3,969	47%

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 $3,020.
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 University of Iowa Health Care Medical Center Down 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.