CMS Price Transparency Data

Breast lump removal

Facility: St Mary's Hospital

Billing Code: 19120 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$633

about 0.2× the $4,000 Medicare rate · typically $384–$2,021

modeled estimate · not a bill or quote

What this hospital charges insurers

$517

Below the fair price — a good deal

about $116 under the fair price · 0.1× Medicare

Medicare pays $4,000 Fair price $633 This hospital $517 Cash price $638 Hospital's list price $850

How we calculate the fair BaseRate →

How this hospital compares to other ID hospitals

Lowest price of the 9 ID hospitals we have prices for — a strong deal.

Cheapest $517 Priciest $3,752

Black dot = this hospital, among the 9 ID hospitals with a price for this procedure. Full list below.

A fair price for a Breast lump removal is about $633 (about 0.2× the $4,000 Medicare rate). St Mary's Hospital charges insurers about $517, or about $638 in cash — below the fair price — a good deal. Located in Cottonwood, ID.

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	$369 - $693	9%
Blue Cross Blue Shieldmajor	$369 - $642	9%
Aetnamajor	$590	15%
GEHA	$824	21%
+ 4 smaller / regional plans	$369 - $833

Government programs also on file: Medicare, Military & VA.

Excludes 1 rental-network / third-party entry (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 638), 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 St Mary's 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 St Mary's Hospital

Compare: Breast lump removal at other ID hospitals

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