Breast lump removal
Facility: Nmc Health
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $5,351
- Cash Discount Price: $5,482
- vs. Medicare Baseline: 1.34x 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 |
|---|---|---|
| Bluestem Pace | $3,507 | 88% |
| Blue Cross Blue Shield | $4,143 | 104% |
| Wppa | $4,308 | 108% |
| Occunet | $4,699 | 117% |
| Samaritan Ministries International | $5,091 | 127% |
| Medincrease Health Plan | $5,091 | 127% |
| Leading Age | $5,611 | 140% |
| Medicaid / KanCare | $5,611 | 140% |
| Prime Health Services | $5,874 | 147% |
| UnitedHealthcare | $7,049 | 176% |
| Cigna | $7,440 | 186% |
| Aetna | $7,656 | 191% |
Consumer Guidance & Cost Commentary
For the CPT code 19120 (Breast lump removal) at Nmc Health in Newton, Kansas, the facility's cash median price is $5,482.00, which is lower than the gross charge of $7,832.00. This cash rate is notably lower than the Medicare benchmark of $4,000.24, with the cash price representing a 1.3x markup over the federal baseline. While the facility offers a negotiated rate of $5,351.00, this amount is still higher than the cash option. Patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rates for various payers range from $3,507 to $7,656, often exceeding the cash median. To secure the lowest possible cost, patients should explicitly request "self-pay" or "prompt-pay" discounts from the hospital before scheduling, as these upfront payment incentives can further reduce the final bill.
When reviewing your statement, it is critical to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a summary bill showing broad categories like "Laboratory" or "Pharmacy," demand a full line-by-line CPT-coded statement to identify any double-billing or charges for cancelled items. Additionally, be aware that while the No Surprises Act protects you from balance billing for out-of-network services at in-network facilities, you must verify your plan's specific coverage and deductible status before proceeding. Always compare the facility's rates against the