Breast lump removal
Facility: St. Catherine Hospital - Garden City
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $407
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.10x 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 |
|---|---|---|
| Kaiser | $367 - $407 | 9% |
| Kansas Health | $367 | 9% |
| Humana | $367 - $407 | 9% |
| Medicare (plans) | $367 - $407 | 9% |
| UnitedHealthcare | $367 - $407 | 9% |
| Blue Cross Blue Shield | $367 - $4,910 | 9% |
| Cigna | $367 - $407 | 9% |
| Aetna | $367 - $407 | 9% |
| Devoted Health | $407 | 10% |
| Innovage | $407 | 10% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing breast lump removal at St. Catherine Hospital in Garden City, KS, the facility's negotiated rates for commercial payers range from $367 to $4910, with a median negotiated amount of $407. This commercial rate aligns closely with the state average for this procedure, which is also $407. While the facility is a voluntary non-profit church-owned acute care hospital, the pricing structure reflects standard market dynamics where commercial contracts often exceed the federal Medicare benchmark of $4000.24. It is important to note that while commercial rates appear higher than the Medicare baseline, the actual out-of-pocket cost for a patient depends heavily on their specific insurance deductible and copayment structure, meaning the negotiated rate does not necessarily represent the final amount the patient pays.
Patients should be aware that cash-pay options or "prompt-pay" discounts may offer a lower total cost than the insurance negotiated rate, particularly for those with high-deductible plans who might not yet have met their coverage thresholds. Although the data does not list a specific cash median, facilities frequently offer self-pay discounts ranging from 20% to 50% for upfront payment, which bypasses the administrative overhead and claims processing costs embedded in insurance billing. To maximize savings, it is recommended to explicitly request a self-pay classification and a prompt-pay discount before scheduling the service, and to obtain a full itemized bill to verify that no unbundled codes or services not rendered are included in the final charge.