CMS Price Transparency Data

Breast lump removal

Facility: Decatur County Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $680
Cash Discount Price: $680
vs. Medicare Baseline: 0.17x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Decatur County Hospital is $680. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $680. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.17x the Medicare baseline. Located in 1405 Nw Church Street, Leon, IA.

Cash / Self-Pay

$680

Average discount available for prompt cash payment at this facility.

Insurance Median

$680

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: $680 (17%)

Insurance Median: $680 (17%)

Cash: $680 (17% of Medicare)

Ins. Median: $680 (17% 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
Aetna	$364	9%
Tricare	$364	9%
UnitedHealthcare	$364 - $722	9%
Amerigroup Mcaid-All Plans	$383	10%
Everystep Hospice-All Plans	$442	11%
Misc Commercial-All Plans	$620	15%
Rural Carrier Benefit Plan-All Plans	$654	16%
Christian Healthcare -All Plans	$680	17%
Ntca The Rural Broadband-All Plans	$722	18%
Farm Bureau Financial-All Other Plans	$765	19%
Farm Bureau Property And Ca	$765	19%
Wellmark Hmo	$775	19%
Wellmark Ppo - All Other Plans	$775	19%
Priority Health-All Plans	$850	21%
Midlands Choice-All Plans	$853	21%
Iowa Total Care Mcaid-All Plans	$867	22%

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 $680.
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 Decatur County Hospital 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.