Breast lump removal
Facility: Susan B Allen Memorial Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $554
- Cash Discount Price: $3,409
- vs. Medicare Baseline: 0.14x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| UnitedHealthcare | $350 | 9% |
| Providrs Care | $757 | 19% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," Susan B Allen Memorial Hospital in El Dorado, KS, lists a cash median price of $3,409.00, which is lower than the facility's gross charge of $5,245.00. While the hospital's negotiated rates with UnitedHealthcare ($350) and Providrs Care ($757) are significantly lower than the cash price, patients with high-deductible plans may find the cash rate more affordable if their insurance allowed amount exceeds $3,409.00. It is important to note that these negotiated rates are often inflated by administrative costs and contract structures, meaning the cash price can sometimes represent a more direct cost for self-pay patients.
To ensure you are not overcharged, always request a full itemized bill before paying, as summary invoices can hide unbundled codes or services not rendered. Additionally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the final balance by 20% to 50% if paid upfront. If you receive a balance bill from an out-of-network provider, remember that the No Surprises Act generally protects you from paying the difference between the provider's full charge and your insurance allowed amount for emergency or non-emergency services at in-network facilities.