CMS Price Transparency Data

Breast lump removal

Facility: Southeast Iowa Regional Medical Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,068
Cash Discount Price: Unavailable
vs. Medicare Baseline: 0.27x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Southeast Iowa Regional Medical Center is $1,068. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.27x the Medicare baseline. Located in 1221 South Gear Avenue, West Burlington, IA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,068

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%)

Insurance Median: $1,068 (27%)

Ins. Median: $1,068 (27% 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
Medicaid / KanCare	$276 - $325	7%
American Healthplan Of Iowa - Midlevel	$390	10%
Humana	$477	12%
American Healthplan Of Iowa - Md	$567	14%
Aetna	$616 - $1,328	15%
Plain Church	$640 - $2,639	16%
Elap	$691 - $987	17%
Absolute Solutions	$886 - $1,328	22%
First Agency	$886 - $1,328	22%
Multiplan	$886 - $1,328	22%
Henderson County	$935 - $1,402	23%
Blue Cross Blue Shield	$936 - $2,500	23%
UnitedHealthcare	$955	24%
Midlands Choice	$1,148 - $3,654	29%
Wellpoint (Amerigroup)	$2,274	57%
Immergrun	$2,520	63%
Immugrun	$2,558	64%
Brighton Amish Church	$2,639	66%
6 Degree	$3,200 - $3,248	80%
Geha	$3,776	94%

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 $X.
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 Southeast Iowa Regional Medical Center 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.