CMS Price Transparency Data

Breast lump removal

Facility: Gundersen Palmer Lutheran Hospital and Clinics

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,592
Cash Discount Price: $1,636
vs. Medicare Baseline: 0.40x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Gundersen Palmer Lutheran Hospital and Clinics is $1,592. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,636. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.40x the Medicare baseline. Located in 112 Jefferson Street, West Union, IA.

Cash / Self-Pay

$1,636

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,592

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: $1,636 (41%)

Insurance Median: $1,592 (40%)

Cash: $1,636 (41% of Medicare)

Ins. Median: $1,592 (40% 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
Amerigroup	$571 - $1,505	14%
Molina Health	$571	14%
UnitedHealthcare	$1,436 - $1,505	36%
Health Partners	$1,448 - $2,556	36%
Wellmark	$1,476 - $3,352	37%
Humana	$1,505	38%
Iowa Total Care	$1,505	38%
Managed Health Service	$1,505	38%
Ucare	$1,505 - $2,316	38%
Quartz	$1,578	39%
Alliance	$2,292 - $2,435	57%
Medical Associates	$2,316	58%
Aspirus Arise Health	$2,403	60%
Multiplan/Healtheos	$2,548 - $2,692	64%
Coventry Health Care	$2,750	69%
Midland Choice	$2,808	70%

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 $1,636.
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 Gundersen Palmer Lutheran Hospital and Clinics 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.