CMS Price Transparency Data

Breast lump removal

Facility: Kossuth Regional Health Center

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $1,407
Cash Discount Price: $2,063
vs. Medicare Baseline: 0.35x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Kossuth Regional Health Center is $1,407. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,063. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.35x the Medicare baseline. Located in 1515 South Phillips Street, Algona, IA.

Cash / Self-Pay

$2,063

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,407

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: $2,063 (52%)

Insurance Median: $1,407 (35%)

Cash: $2,063 (52% of Medicare)

Ins. Median: $1,407 (35% 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
Humana	$364 - $1,421	9%
Va Ccn - All Plans	$364 - $1,407	9%
Amerigroup Mcr Adv - All Other Plans	$372 - $1,435	9%
UnitedHealthcare	$375 - $2,810	9%
Mercy One - All Plans	$383 - $1,407	10%
Sanford Pho Isno Mcr Adv Profee Only - All Plans	$383	10%
Medical Associates - All Plans	$601 - $3,147	15%
Preferred Health - All Plans	$601 - $3,147	15%
Blue Cross Blue Shield	$756 - $1,829	19%
Aetna	$892 - $3,591	22%
Health Partners New Bus - All Other Plans	$918 - $2,591	23%
Midlands Choice - All Plans	$991 - $2,591	25%
Health Partners Exisiting Bus	$1,010 - $3,591	25%
Multiplan - All Plans	$1,382 - $3,517	35%
Molina Mcaid/Chip - All Plans	$1,491 - $3,813	37%
Amerigroup Mcaid	$1,499 - $3,850	37%

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 $2,063.
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 Kossuth Regional 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.