Breast lump removal
Facility: University Of Kansas Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,506
- Cash Discount Price: $1,971
- vs. Medicare Baseline: 1.13x 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 | $1,235 - $5,849 | 31% |
| Medicaid / KanCare | $1,235 | 31% |
| Blue Cross Blue Shield | $1,235 - $7,841 | 31% |
| Larned State Hospital [503200090] | $1,752 | 44% |
| Alt Theramatrix [5032000967] | $2,447 | 61% |
| Health Plan Inc [503999941] | $2,791 | 70% |
| Alt Carelon Behavioral Health [503200905] | $2,970 | 74% |
| Accarent Health [503999034] | $2,970 | 74% |
| Coventry [503200022] | $3,065 - $4,018 | 77% |
| Aetna | $3,065 - $5,118 | 77% |
| Meritain Health [503200039] | $3,065 - $4,989 | 77% |
| Coresource [503200089] | $3,065 | 77% |
| Workers Comp [503999901] | $3,106 - $5,642 | 78% |
| Medica [503200074] | $3,106 | 78% |
| Geha [503200036] | $3,106 - $3,598 | 78% |
| National Assn Letter Carriers [503200019] | $3,278 | 82% |
| Php [503200005] | $3,563 - $4,389 | 89% |
| Allied National [503999937] | $3,563 | 89% |
| Med-Pay [503200040] | $3,598 | 90% |
| Alt Wppa [5032000964] | $3,598 - $7,311 | 90% |
| Inter-Americas Insurance [503999032] | $3,598 | 90% |
| Healthlink [503200007] | $3,598 - $4,389 | 90% |
| Cerner [503200038] | $3,598 | 90% |
| Triwest [503201703] | $3,656 | 91% |
| Ku Athletics [503200094] | $3,656 | 91% |
| Tricare | $3,656 | 91% |
| Humana | $3,656 - $3,729 | 91% |
| Lasso Healthcare [503999926] | $3,656 | 91% |
| Medicare (plans) | $3,656 - $3,729 | 91% |
| Devoted [503200068] | $3,656 | 91% |
| Allwell [503200078] | $3,765 | 94% |
| American Health Plans [503200968] | $3,838 | 96% |
| First Health [5032000110] | $3,914 | 98% |
| Aha-Healthcare Preferred [503200050] | $3,914 | 98% |
| Alt Meritain Health [503999911] | $4,018 | 100% |
| Correct Care Solutions [50311253] | $4,157 | 104% |
| Coeur Plan Services [503301517] | $4,157 | 104% |
| Consolidated Billing [50311256] | $4,157 | 104% |
| Ascension Living Hope [503201517] | $4,157 | 104% |
| Orscheln Industries [503201608] | $4,454 | 111% |
| Empire Plan/Nyship [503200705] | $4,558 | 114% |
| Alt Lineco [5032000976] | $4,558 | 114% |
| Alt Lucent Health Solutions [503202603] | $4,558 | 114% |
| Cigna | $4,751 | 119% |
| Quiktrip [5032000412] | $4,751 | 119% |
| Century Health Solutions [503200054] | $4,751 | 119% |
| Point Comfort Underwriters [503200018] | $4,751 | 119% |
| Centurion [5032000966] | $4,752 | 119% |
| Wppa [503200056] | $4,989 | 125% |
| Employers Health Network [503999025] | $5,345 | 134% |
| Plan Care America [503999026] | $5,345 | 134% |
| Sanford Health Plan [503999027] | $5,345 | 134% |
| Three Rivers Provider Network [503999029] | $5,345 | 134% |
| Usa Managed Care [503999030] | $5,345 | 134% |
| Alt Bnsf Railway Co [503301503] | $5,456 | 136% |
| Gallagher Bassett [5032000103] | $5,456 | 136% |
| Sedgwick Claims Management Services [53201618] | $5,456 | 136% |
| Prime Health Services [503999912] | $5,456 | 136% |
| Ambetter / Centene | $6,214 | 155% |
| Oscar [503201609] | $6,946 | 174% |
| Centivo [5032000982] | $6,946 | 174% |
| Wellfit [503301514] | $6,946 | 174% |
| 6 Degrees Health [503999050] | $7,128 - $9,139 | 178% |
| Occunet [503999930] | $7,677 | 192% |
| Fort Hays State Student Athletes [5032000960] | $7,677 | 192% |
| Claimdoc [503301509] | $9,870 | 247% |
| Multiplan [503200057] | $9,870 | 247% |
| Advanced Medical Pricing Solutions [503301513] | $10,967 | 274% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal procedure at University Of Kansas Hospital, the facility's cash price is $1,971, which is significantly lower than the median negotiated rate of $5,090 paid by insurers. While the hospital's gross charge is $9,854, patients with high-deductible plans may find the cash price more cost-effective if their insurance allows a negotiated rate that exceeds this amount. It is important to note that the facility's cash rate is well below the state average for this procedure, offering a clear opportunity for savings for those paying out-of-pocket. Additionally, patients should inquire about "self-pay" or "prompt-pay" discounts, as hospitals often offer further reductions for upfront payments, bypassing the administrative costs associated with insurance billing cycles.
The data indicates that while many payers have negotiated rates starting as low as $1,235, others, such as 6 Degrees Health, have rates reaching up to $9,139, highlighting significant variation in commercial pricing. The facility's Medicare benchmark rate of $4,000.24 serves as a reliable baseline for evaluating commercial pricing, as commercial negotiated rates often range from 200% to 300% of this figure, whereas fair pricing is typically defined between 120% and 150%. Given that over 80% of hospital bills contain errors, consumers should request a detailed, itemized bill to identify any unbundled codes or services not rendered before accepting a summary invoice. If a balance bill arises from an out-of-network service, patients should verify its legality under the No Surprises Act and