CMS Price Transparency Data

Breast lump removal

Facility: Cass County Memorial Hospital

Billing Code: 19120 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 19120
Insurance Median: $401
Cash Discount Price: $840
vs. Medicare Baseline: 0.10x Medicare

The contracted insurance negotiated median rate for a Breast lump removal at Cass County Memorial Hospital is $401. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $840. Compared to the federal Medicare reimbursement reference rate of $4,000.24, this hospital’s rate is 0.10x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$840

Average discount available for prompt cash payment at this facility.

Insurance Median

$401

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: $840 (21%)

Insurance Median: $401 (10%)

Cash: $840 (21% of Medicare)

Ins. Median: $401 (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
Midlands Choice Medica Mcr	$240	6%
Triwest - All Plans	$354	9%
Aetna	$364 - $1,080	9%
Amerigroup Mcr Adv - All Other Plans	$364	9%
Medica Mcr Adv	$364	9%
Tricare	$364	9%
UnitedHealthcare	$364 - $622	9%
Va Ccn - All Plans	$364	9%
Wellmark Mcr Adv	$368	9%
Iowa Total Care Mcr	$372	9%
American Hlth Mcr Adv - All Plans	$375	9%
Iowa Total Care Comm - All Other Plans	$401	10%
Wellmark Hmo	$756	19%
Wellmark Ppo - All Other Plans	$890	22%
Midlands Choice New Bus	$925	23%
Midlands Choice Pho (Ppo) - All Other Plans	$925	23%
Medica Comm - All Other Plans	$1,056	26%
Multiplan - All Plans	$1,140	28%
Medicaid / KanCare	$1,200	30%
Iowa Total Care Mcaid	$1,224	31%
Molina Mcaid - All Plans	$1,224	31%

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 $840.
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 Cass County Memorial 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.