Breast lump removal
Facility: Wesley Medical Center
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $3,142
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.79x 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 |
|---|---|---|
| Usa Managed Care | $815 | 20% |
| UnitedHealthcare | $1,235 | 31% |
| Medicaid / KanCare | $1,272 | 32% |
| Aetna | $1,284 - $3,283 | 32% |
| Amerigroup | $1,284 | 32% |
| Blue Cross Blue Shield | $3,000 | 75% |
| United | $4,423 | 111% |
| First Health | $5,183 | 130% |
| Multiplan | $5,401 | 135% |
| Wppa | $6,861 - $9,801 | 172% |
| Ambetter / Centene | $7,305 | 183% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, "Breast lump removal," at Wesley Medical Center in Wichita, KS, the facility's negotiated rates range from $815 to $5,401 depending on the insurance carrier. While the lowest negotiated rate of $815 from USA Managed Care is significantly lower than the facility's median negotiated rate of $3,142, patients should be aware that cash prices are often not listed in this report. If a patient has a high-deductible plan where their out-of-pocket costs exceed the cash price, paying out-of-pocket might result in a lower total cost than using insurance, which could lead to balance billing if the provider is out-of-network. However, the No Surprises Act generally protects patients from such surprise bills for emergency and non-emergency services at in-network facilities, so it is crucial to verify network status before scheduling.
To ensure the most accurate pricing, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% for upfront payment. Additionally, since over 80% of hospital bills contain errors, receiving an itemized, line-by-line statement is essential to identify unbundled codes or services not rendered. While the report does not provide specific county or state average comparisons for this procedure, the facility's Medicare benchmark of $4,000.24 serves as a reliable baseline for evaluating commercial rates, which typically average between 200% and 300% of the Medicare amount. Consumers are advised to dispute any summary bills that obscure individual charges and to request a formal written audit if they believe the invoice