CMS Price Transparency Data

Breast lump removal

Facility: Decatur County Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$802

about 0.2× the $4,000 Medicare rate · typically $463–$1,862

modeled estimate · not a bill or quote

What this hospital charges insurers

$679

Below the fair price — a good deal

about $123 under the fair price · 0.2× Medicare

Medicare pays $4,000 Fair price $802 This hospital $679 Cash price $680 Hospital's list price $850

How we calculate the fair BaseRate →

How this hospital compares to other IA hospitals

A typical price — 3 charge more and 5 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.

A fair price for a Breast lump removal is about $802 (about 0.2× the $4,000 Medicare rate). Decatur County Hospital charges insurers about $679, or about $680 in cash — below the fair price — a good deal. Located in Leon, 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 - $722	9%
Blue Cross Blue Shieldmajor	$775	19%
Aetnamajor	$364	9%
Amerigroup	$383	10%
Priority Health	$850	21%
+ 8 smaller / regional plans	$442 - $867

Government programs also on file: Military & VA.

Excludes 2 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 680), 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 Decatur County Hospital 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 Decatur County Hospital

Compare: Breast lump removal at other IA hospitals

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