Breast lump removal
Facility: Labette Health
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $922
- Cash Discount Price: $738
- vs. Medicare Baseline: 0.23x 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 |
|---|---|---|
| Aetna | $356 | 9% |
| Kansas Superior Select | $386 - $3,648 | 10% |
| Montgomery County | $398 - $6,481 | 10% |
| Uhccp | $468 | 12% |
| Medicaid / KanCare | $474 - $3,541 | 12% |
| Multiplan | $896 | 22% |
| Health Partners Of Kansas, Inc | $949 | 24% |
| Choicecare (First Health Network) | $949 | 24% |
| Ambetter / Centene | $1,054 | 26% |
| Wellcare | $3,541 | 89% |
| UnitedHealthcare | $3,541 | 89% |
| Blue Cross Blue Shield | $3,541 - $4,143 | 89% |
| Humana | $3,541 | 89% |
Consumer Guidance & Cost Commentary
For the CPT code 19120 (Breast lump removal) at Labette Health in Parsons, KS, the cash median price is $738.00, which is significantly lower than the facility's gross charge of $1,054.00. While the facility is a government-owned acute care hospital, patients should be aware that many commercial insurance payers, such as Kansas Superior Select and Montgomery County, have negotiated rates ranging from $386 to over $6,400, which often exceed the cash price. This pricing structure highlights the potential benefit of paying cash or utilizing a prompt-pay discount, as these upfront options can bypass the administrative overhead and multi-layered contract structures that inflate commercial negotiated rates. Consumers with high-deductible plans may find that paying the cash median of $738.00 is more cost-effective than relying on insurance, especially if the insurer's allowed amount is higher than the cash rate.
To ensure you are receiving the most accurate and fair pricing, 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. By demanding a line-by-line statement showing specific CPT codes, you can identify any discrepancies before finalizing payment. Additionally, when comparing this facility's rates to broader benchmarks, note that the Medicare amount for this service is $4,000.24, which serves as a scientifically validated baseline for evaluating markup. While commercial negotiated rates often average 200% to 300% of Medicare, fair pricing is typically defined as 120% to 1