Breast lump removal
Facility: Lmh
Billing Code: 19120 (CPT)
- CPT Billing Code: 19120
- Insurance Median: $4,022
- Cash Discount Price: $2,404
- vs. Medicare Baseline: 1.01x 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 |
|---|---|---|
| Edw | $513 | 13% |
| UnitedHealthcare | $1,247 - $6,940 | 31% |
| Blue Cross Blue Shield | $1,247 - $6,881 | 31% |
| Medicare (plans) | $3,943 | 99% |
| Haskell Indian Health Services | $3,943 | 99% |
| Humana | $3,943 | 99% |
| Cigna | $3,943 - $6,423 | 99% |
| Allwell | $4,022 | 101% |
| Ambetter / Centene | $6,112 | 153% |
| Aetna | $6,125 - $7,980 | 153% |
| Non Contracted | $7,692 | 192% |
| First Health | $8,942 | 224% |
Consumer Guidance & Cost Commentary
For the CPT code 19120, representing a breast lump removal, the facility in Lawrence, KS, lists a gross charge of $9,615.00, which is significantly higher than the Medicare benchmark of $4,000.24. While the facility's cash median price is $2,404.00, commercial insurance negotiated rates vary widely, ranging from $513 for Edw to $8,942 for First Health. It is important to note that the median negotiated rate of $4,022.00 is approximately 100% higher than the cash price, meaning patients with high-deductible plans or those who have met their out-of-pocket maximum may find paying the cash rate directly more cost-effective than relying on insurance, which often includes administrative overhead and deductible requirements.
Patients should verify their specific plan details before scheduling, as the 12 payers listed for this procedure have different contract terms, with some like UnitedHealthcare and Blue Cross Blue Shield having negotiated ranges as high as $6,940. To potentially lower costs, individuals should contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, since the facility is an acute care hospital in a government-owned local facility, patients should request a detailed, itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes such as double-billing or unbundled codes that can be disputed to reduce the final amount owed.