CMS Price Transparency Data

Breast lump removal

Facility: Methodist Jennie Edmundson

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $3,421
Cash Discount Price: $1,711
vs. Medicare Baseline: 0.86x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Methodist Jennie Edmundson is $3,421. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,711. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.86x the Medicare baseline. Located in 933 East Pierce Street, Council Bluffs, IA.

Cash / Self-Pay

$1,711

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,421

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: $1,711 (43%)

Insurance Median: $3,421 (86%)

Cash: $1,711 (43% of Medicare)

Ins. Median: $3,421 (86% 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
Medicare (plans)	$514 - $4,022	13%
Elite Choice - Mje	$983 - $8,174	25%
Ambetter / Centene	$1,071 - $8,294	27%
Blue Cross Blue Shield	$1,072 - $4,001	27%
Aetna	$1,080 - $5,702	27%
Midlands Choice	$1,175 - $3,991	29%
Wellmark	$2,342 - $2,577	59%
Medica	$2,423 - $4,401	61%
Ne Furniture Mart	$2,623 - $3,421	66%
Medica Choice	$2,851 - $5,178	71%
UnitedHealthcare	$3,421 - $4,352	86%
Humana	$3,943	99%

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 $1,711.
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 Methodist Jennie Edmundson 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.