Breast lump removal
Facility: Mcpherson Hospital
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $1,153
- Cash Discount Price: $853
- vs. Medicare Baseline: 0.29x 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 |
|---|---|---|
| Wppa - All Plans | $807 | 20% |
| Central Plains - All Plans | $865 | 22% |
| Medical Associates - All Plans | $865 | 22% |
| UnitedHealthcare | $899 - $3,601 | 22% |
| Christian Health Aid - All Plans | $922 | 23% |
| Aetna | $951 - $1,153 | 24% |
| Multiplan - All Plans | $1,038 | 26% |
| Cigna | $1,095 | 27% |
| First Health - All Plans | $1,095 | 27% |
| Health Partners - All Plans | $1,095 | 27% |
| Medicaid / KanCare | $1,153 | 29% |
| Health Blue Mcaid - All Other Plans | $1,176 | 29% |
| Tricare | $3,169 | 79% |
| Healthy Blue Mcr Adv | $3,601 | 90% |
| Va Ccn - All Plans | $3,601 | 90% |
| Blue Cross Blue Shield | $3,601 | 90% |
| Humana | $3,601 | 90% |
| Wellcare Mcr Adv - All Plans | $3,601 | 90% |
| Ambetter / Centene | $4,141 | 104% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal at McPherson Hospital in McPherson, Kansas, the facility's cash median rate is $853.00, while the median negotiated rate across payers is $1,153.00. This data indicates that paying cash directly can result in significant savings compared to standard insurance billing, as the cash price is approximately 74% lower than the average negotiated amount. Given that commercial rates often include administrative overhead and contract markups, patients with high-deductible plans or those without insurance may find the cash price more favorable. It is important to note that while the facility is a voluntary non-profit acute care hospital, the specific negotiated rates vary widely by payer, ranging from $807 for some plans to $4,141 for others, highlighting the necessity of verifying individual plan allowances before scheduling.
When evaluating costs against federal benchmarks, the Medicare amount for this procedure is $4,000.24, which serves as a baseline for understanding the facility's pricing structure. Although the cash rate of $853.00 is significantly lower than the Medicare amount, it is crucial to understand that commercial negotiated rates are often inflated by administrative costs and contract dynamics rather than reflecting the true cost of care. Patients should be aware that balance billing is generally prohibited for emergency services under the No Surprises Act, but out-of-network ancillary services or non-emergency care from out-of-network providers could still result in unexpected bills if not carefully managed. To minimize financial risk, consumers are advised to request a full itemized billing audit before paying any invoice, as over 80% of hospital bills