Breast lump removal
Facility: Pratt Regional Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $1,739
- Cash Discount Price: $998
- vs. Medicare Baseline: 0.43x 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 |
|---|---|---|
| Christian Health Aid | $572 - $1,568 | 14% |
| UnitedHealthcare | $634 - $3,886 | 16% |
| Health Partners Of Kansas | $648 - $1,777 | 16% |
| Aetna | $686 - $1,881 | 17% |
| Choicecare | $762 - $2,090 | 19% |
| Celtic Insurance Company | $3,533 | 88% |
| Healthy Blue | $3,639 | 91% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at Pratt Regional Medical Center in Pratt, KS, the facility's cash price of $998 is notably lower than the gross charge of $1,426. While the Medicare benchmark for this service is $4,000.24, which serves as the objective baseline for evaluating pricing markups, the negotiated rates paid by commercial payers range from $572 to $3,886 depending on the insurance plan. It is important to note that for patients with high-deductible plans, paying the cash price of $998 upfront may result in lower out-of-pocket costs compared to using insurance, particularly if the insurer's negotiated rate exceeds the cash price or if the patient has not yet met their deductible. Patients should verify their specific plan's allowed amount and consider asking the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
The facility's ownership is proprietary, and the data reflects a vintage of June 2026. While the provided dataset does not include explicit state or county average figures for comparison, the wide variance in negotiated rates across the seven payers—ranging from Celtic Insurance Company's fixed rate of $3,533 to Christian Health Aid's low of $572—highlights the importance of checking individual plan details before scheduling. To ensure you are receiving fair pricing, we recommend requesting an itemized billing audit to review every line item and confirm that no services were unbundled or billed twice. Always confirm with the billing department whether your specific insurance plan is in-network and whether any balance billing protections apply to your