CMS Price Transparency Data

Breast lump removal

Facility: Waverly Health Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $386
Cash Discount Price: $623
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Waverly Health Center is $386. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $623. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.10x the Medicare baseline. Located in 312 9Th Street Sw, Waverly, IA.

Cash / Self-Pay

$623

Average discount available for prompt cash payment at this facility.

Insurance Median

$386

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: $623 (16%)

Insurance Median: $386 (10%)

Cash: $623 (16% of Medicare)

Ins. Median: $386 (10% 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
Hlth Partners Bridges Ntwrk	$83 - $1,235	2%
Hlth Partners Open Ntwrk - All Other Plans	$83 - $1,235	2%
UnitedHealthcare	$83 - $1,246	2%
Aetna	$101 - $1,510	3%
Health Alliance-All Plans	$107 - $364	3%
Midlands Choice-All Other Plans	$107 - $858	3%
Choicecare Network - All Plans	$364	9%
Midlands Choice Mcare	$364	9%
Medicare (plans)	$408	10%
Wellmark Hmo	$769 - $2,822	19%
Wellmark Ppo - All Other Plans	$905 - $3,102	23%

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 $623.
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 Waverly Health 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.