CMS Price Transparency Data

Breast lump removal

Facility: Madison County Health Care System

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$582

about 0.1× the $4,000 Medicare rate · typically $397–$1,845

modeled estimate · not a bill or quote

What this hospital charges insurers

$575

About the fair price

about $7 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $582 This hospital $575 Cash price $2,159 Hospital's list price $2,699

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

A typical price — 4 charge more and 4 charge less, among the 9 IA hospitals compared.

Cheapest $465 Priciest $757

Black dot = this hospital, among the 9 IA hospitals with a price for this procedure. Full list below.

⚠ The cash price looks unusually high next to the insurance price — it may be the full list price, not a real cash discount. Call to confirm the self-pay rate.

A fair price for a Breast lump removal is about $582 (about 0.1× the $4,000 Medicare rate). Madison County Health Care System charges insurers about $575, or about $2,159 in cash — about the fair price. Located in Winterset, IA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

3 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna CignaHumanaKaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$364 - $3,544	9%
Blue Cross Blue Shieldmajor	$748 - $2,638	19%
Aetnamajor	$364 - $2,560	9%
Amerigroup	$1,547 - $1,962	39%
Molina	$1,495 - $1,916	37%
Oscar Health	$630 - $2,540	16%
+ 14 smaller / regional plans	$364 - $3,938

Government programs also on file: Military & VA.

Excludes 4 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 2,159), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 19120.

Insurance Before you use insurance

Call your insurance company to confirm Madison County Health Care System is in-network.
Ask your insurer whether prior approval is required for CPT code 19120.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Madison County Health Care System

Compare: Breast lump removal at other IA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.